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Mosby items and derived items 2005, 2001 by Mosby, Inc.

The Child withCardiovascular

Dysfunction

Chapter 25


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Fetal Circulation Structures Umbilical vein; umbilical arteries

Foramen ovale

Ductus arteriosus

Ductus venosus


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Changes at Birth (Note to instructor: Image available in

Electronic Image Collection)


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Pediatric Indicators

of Cardiac Dysfunction Poor feeding

Tachypnea/ tachycardia

Failure to thrive/poor weight gain/activityintolerance

Developmental delays

+ Prenatal history

+ Family history of cardiac disease


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Innocent Murmurs


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Thrills


7/48Mosby items and derived items 2005, 2001 by Mosby, Inc.

Two Types of Cardiac Defects

Congenital

Anatomic>abnormal function

Acquired

Disease process

Infection

Autoimmune response

Environmental factors

Familial tendencies



Causes of CHD

Chromosomal/genetic = 10%-12%

Maternal or environmental = 1%-2%

Maternal drug use

Fetal alcohol syndrome50% have CHD Maternal illness

Rubella in 1st 7 wks of pregnancy50% risk ofdefects including PDA and pulmonary branchstenosis

CMV, toxoplasmosis, other viral illnesses>>cardiac defects

IDMs = 10% risk of CHD (VSD, cardiomyopathy,TGA most common)

Multifactorial = 85%



CHD

Incidence: 5-8 per 1000 live births

About 2-3 of these are symptomatic in

first year of life Major cause of death in first year of

life (after prematurity)

Most common anomaly is VSD

28% of kids with CHD have anotherrecognized anomaly (trisomy 21, 13,18, +++ )



Older Classifications of CHD

Acyanotic

May become cyanotic

Cyanotic

May be pink

May develop CHF



Newer Classification of CHD

Hemodynamic characteristics

Increased pulmonary blood flow

Decreased pulmonary blood flow

Obstruction of blood flow out of theheart

Mixed blood flow



Increased PulmonaryBlood Flow Defects

Abnormal connection between two sidesof heart

Either the septum or the great vessels

Increased blood volume on right side ofheart

Increased pulmonary blood flow Decreased systemic blood flow


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Increased PulmonaryBlood Flow Defects

Atrial septal defect

Ventricular septal defect

Patent ductus arteriosus


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ASD

(Note to instructor: Image available inElectronic Image Collection)


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VSD



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PDA



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Obstructive Defects

Coarctation of the aorta

Aortic stenosis

Pulmonic stenosis


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COA



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Aortic Stenosis



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Pulmonic Stenosis andCatheter Placement



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Decreased PulmonaryBlood Flow Defects

Tetralogy of Fallot

Tricuspid atresia


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Tetralogy of Fallot



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Tricuspid Atresia



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Mixed Defects

Transposition of great vessels

Total anomalous pulmonary venous

connection Hypoplastic heart syndrome

Right

Left


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Transposition of Great Vessels



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Normal Heart



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Totally Anomalous PulmonaryVenous Connection



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Hypoplastic Left Heart



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CHF in Children

Impaired myocardial function

Tachycardia, fatigue, weakness, restless,pale, cool extremities, decreased BP,decreased urine output

Pulmonary congestion

Tachypnea, dyspnea, respiratory distress,exercise intolerance, cyanosis

Systemic venous congestion

Peripheral and periorbital edema, weightgain, ascites, hepatomegaly, neck veindistention


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Interventional Cardiac CatheterProcedures in Children

Transposition of great vessels

Some complex single-ventricle defects

ASD

Pulmonary artery stenosis


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INTERVENTION

Balloon dilation

Balloon dilation

Balloon dilation

DIAGNOSIS

Valvular pulmonicstenosis

Recurrent coarctationof aorta

Congenital mitralstenosis

Interventional Cardiac CatheterProcedures in Children (contd)


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Surgical Interventions

Open heart

Closed heart procedures

Staged procedures

Prepare child and family for procedures


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Postpericardiotomy Syndrome

Symptoms: fever, pericardial friction rub,pericardial and pleural effusion

Occurs in immediate postoperative period

Also can occur later (postoperative day 7-21)

Etiology unknown

Theories of etiology

Viral infection; auto immune response;reaction to blood in pericardium

May require pericardiocentesis orpleurocentesis


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Acquired Cardiovascular

Disorders

Infectious and InflammatoryCardiac Disorders


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Endocarditis

BE, IE, or SBE

Strep

Staph

Fungal infections

PROPHYLAXIS: 1 hr before procedures

(IV) or may use PO in some cases


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Rheumatic FeverRheumatic Heart Disease

RF

Inflammatory disease occurs after Group A

-hemolytic streptococcal pharyngitis

Infrequently seen in U.S.; big problem in Third World

Self-limiting

Affects joints, skin, brain, serous surfaces, andheart

Rheumatic heart disease Most common complication of RF

Damage to valves as result of RF


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Clinical Manifestations of RF

Carditis

Polyarthritis

Erythema marginatum

Subcutaneous nodules


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St. Vitus Dance5th Manifestation


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Prevention of RHD

Treatment of streptococcal tonsillitis/pharyngitis

Penicillin GIM X 1

Penicillin VOral X 10 days SulfaOral X 10 days

Erythromycin (if allergic to above)Oral X10 days

Treatment of recurrent RF

Same as above


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Kawasaki Disease


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Kawasaki Disease Treatment

Then 3-5 mg/kg/dayantiplatelet

IVIG

ASA 80-100 mg/kg /dayfever


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Systemic Hypertension

Primary: No known cause

Secondary: Identifiable cause

Pediatrics: HTN generally secondary tostructural abnormality or underlyingpathology

Renal disease

CV disease

Endocrine or neurologic disorders


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BP Screenings for Children


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Hyperlipidemia

Identify kids at risk and treat early

Treatment: dietary

Restrict intake of cholesterol and fats

If no response to dietRx

colestipol (Colestid)

cholestyramine (Questran)


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Pharmacology

Iv IgG

Digoxin/lanoxin

ACE inhibitors

ASA, NSAIDs

Lasix

Spironolactone (Aldactone)


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Heart Transplantation

Orthotopic transplant

Heterotopic transplant (piggyback)

Organ donation issues

Nursing considerations


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Anaphylaxis

Definition

Clinical manifestations

Therapeutic management



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Toxic Shock Syndrome (TSS)

Diagnostic evaluation

Therapeutic management


Criteria for definition of TSS

the child with cardiovascular dysfunction.ppt

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