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Cardiovascular

Cardiovascular. Common Cardiovascular Disorders in Children. Congenital Heart Defects Congestive Heart Failure Acquired Heart Disease. Review of Normal Circulation. How to Understand Congenital Defects. Think of blood as: Red highly O2 saturated Blue unsaturated

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Cardiovascular

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  1. Cardiovascular

  2. Common Cardiovascular Disorders in Children • Congenital Heart Defects • Congestive Heart Failure • Acquired Heart Disease

  3. Review of Normal Circulation

  4. How to Understand Congenital Defects • Think of blood as: • Redhighly O2 saturated • Blueunsaturated • Purple medium O2 saturated (mixed) • Lavender- reduced volume of medium O2 saturated (mixed) • Pinkreduced volume of O2 saturated • Light Blue Reduced volume of unsaturated

  5. Fetal Circulation

  6. Fetal Circulation

  7. Fetal Shunts • foramen ovaleshunts mixed blood from right atrium to left atrium (hole in the atrial septum) • ductusarteriosusaccessory (extra) artery, shunts mixed blood away from lungs to descending aorta • ductusvenosusaccessory (extra) vein, carries oxygenated blood from umbilical vein into lower venous system

  8. How does the fetus receive sufficient oxygen from the maternal blood supply? • Fetal hemoglobin carries 20-30% more oxygen than maternal hemoglobin • Fetal hemoglobin concentration is 50% greater than mother’s • Fetal heart rate 120-160bpm (increases cardiac output)

  9. Newborn

  10. What happens to the shunts after birth?

  11. Transition from intrauterine to extra- uterine life • Cord is clamped • Neonate initiates respirations • O2 levels rise • Greater pressure in the left atrium • Decreased pressure in the right atrium • Immediate closure of foramen ovale

  12. Transition from intrauterine to extrauterine life • After O2 circulates systemically, over 24 hours, the pressure in the left ventricle will become greater than the pulmonary artery and closes the ductus arterosis • The absent flow of blood through the umbilicus gradually closes the ductus venosus over 12 hr to 2 weeks

  13. Cardiac Defects Either • Ductal closure failure (no structural abnormality) • Structural abnormality

  14. Cardiac Catheterization • Primary method to measure extent of cardiac disease in children • Shows type and severity of the CHD • Insert tiny catheter through an artery in arm, leg or neck into the heart • Take blood samples and measure pressure, measure o2 saturation, and as an intervention

  15. Cardiac Catheterization-Post Op • Monitor closely (cardiac monitor, continuous pulse ox) VS q 15 • Assess dressing at insertion site for infection, hematoma • Dressing must remain dry for 1st 48-72 hrs • Palpate a pulse distal to the dressing to assure blood flow • Keep extremity straight for 48 hrs after procedure

  16. If Congenital Defect is suspected or confirmed, • Intervention is Important to Prevent CHF

  17. Congestive Heart Failure

  18. Congestive Heart Failure • Heart doesn’t pump blood well enough • Can not provide adequate cardiac output due to impaired myocardial contractility • Causes in children: • Defects • Acquired heart disease • Infections

  19. Congestive Heart Failure • Most common cause in children is congenital heart defects • Increased volume load or increased pressure in heart • Excess volume and pressure builds up in lungs leading to labored breathing • Builds up in rest of body leading to edema

  20. Congestive Heart Failure Symptoms • 1st sign is tachycardia • tire easily • rapid, labored breathing • decreased urine output • increased sweating, pallor • peripheral edema

  21. CHF Diagnosis and Treatment • CXR- shows enlargement • Echocardiogram- dilated heart vessels, hypertrophy, increase in heart size • Treatment is aimed at reducing volume overload, improve contractility • May require surgery

  22. Congestive Heart Failure Medical Management • Digoxin • Lasix • Potassium

  23. Digoxin • Strengthen the heart muscle, enables it to pump more efficiently • Digoxin toxicity: vomiting, bradycardia • Need HR, EKG, drug levels • Check apical pulse first, don’t give if HR < 100 bmp in infants and < 70 bpm in children • Parents need teaching to assess apical pulse

  24. Lasix • Helps the kidneys remove excess fluid from the body • Potassium wasting • Must administer potassium supplements

  25. Congenital Heart Defects

  26. Congenital Heart Disease • 35 different types • Common to have multiple defects • Range from mild to life threatening and fatal • Genetic and environmental causes

  27. Blood Flows From High to Low Pressure Higher pressure Lower Pressure

  28. Types of Congenital Heart Defects Acyanotic Defects Cyanotic Defects • Purple blood (mixed and too much blood sent to lungs but not enough to cause cyanosis) • Septal defects • Ventra Septal Defect (VSD) • Atrial Septal Defect (ASD) • Patent DuctusArteriosis(PDA) • Light blue blood (too little sent to lungs) • Pulmonic Stenosis • Pink blood (too little O2 sent to body) • Coarctation of the aorta • Light blue & purple blood (poor perfusion to lungs and body) • Tetrology of Fallot

  29. Acyanotic Defects

  30. Septal Defects- increased pulmonary blood flow • Left to right shunting (acyanotic defect) • Sends already sat blood back to lungs • Increased cardiac workload • Excessive pulmonary blood flow • Right ventricular strain, dilation, hypertrophy

  31. Ventricular Septal Defect (VSD) • Most common CHD • Hole in ventral septum • High Pressure in LV forces blood back to RV • Results in increased pulmonary blood flow • Higher than normal artery pressure

  32. Symptoms • Size of the defect varies • Loud harsh systolic heart murmur • Right ventricular hypertrophy • O2 level of RV higher than normal on catheterization

  33. Treatment • Small defects • Medical Management (Digoxin, Lasix, K+) • Prophylactic antibiotics to prevent infective endocarditis • Close spontaneously • Large defect • May develop CHF, poor feeding, failure to thrive • Suture or patch hole closed (open heart surgery with cardiopulmonary bypass) • Pulmonary artery banding to reduce blood flow to lungs if not stable for surgery

  34. Atrial Septal Defect (ASD) • Hole in atrial septum • Pressure in LA is greater than RA (blood flows left to right) • Oxygen rich blood leaks back to RA to RV and is then pumped back to lungs • Results in right ventricular hypertrophy

  35. Symptoms • Harsh systolic murmur • Second heart sound is split: “fixed splitting” ** diagnostic of ASD • Pulmonary valve closes later than aortic valve- risk for pulmonary edema • Fatigue and dyspnea on exertion • Poor feeding, failure to thrive • Large defect may cause CHF

  36. Treatment • Medical Management (Digoxin, Lasix, K+) • Prophylactic antibiotics to prevent infective endocarditis • Not expected to close on own • Suture or patch hole closed (open heart surgery with cardiopulmonary bypass) • Pulmonary artery banding to reduce blood flow to lungs if not stable for surgery

  37. Patent Ductus Arteriosus (PDA) • Failure of ductus arteriosus to close completely at • Blood from the aorta flows into the pulmonary arteries to be reoxygenated in the lungs, returns to LA and LV • More common in preemies H to L

  38. Symptoms • Preterm infants born with CHF and respiratory distress • Fullterm infants may be asymptomatic with a continuous “machinery” type murmur • Tire easily, growth retardation (shorter, weigh less, less muscle mass) • Prone to frequent respiratory tract infections

  39. Treatment • Administration of Indomethacin (prostaglandin inhibitor) to stimulates ductus to constrict • Surgical management ductus is divided and ligated • Usually performed in first year of life to decrease risk of bacterial endocarditis

  40. Summary of Acyanotic Defects • VSD & ASD • Rt hypertrophy • Pulm edema • Pulm htn • PDA • Pulm edema • Pulm htn

  41. Cyanotic Defects

  42. Cynaotic Defects- decreased pulmonary blood flow Right to left shunting- sends unsaturated blood into O2 saturated blood and circulates to body • Pulmonic Stenosis • Coarctation of the Aorta • Tetralogy of Fallot

  43. Pulmonary Stenosis • Valve Stenosis • Obstruction of the right ventricular outflow tract • Decreased pulmonary blood flow

  44. Symptoms • Systolic ejection murmur with a palpable thrill • Right ventricular hypertrophy • Mild to moderate cyanosis from reduced pulmonary blood flow • High ventricular pressure may cause blood to back up into right atrium and force foramen ovale to open to allow blood to flow from right to left atrium • Can lead to right ventricular failure, CHF

  45. Treatment • Medical Management (Digoxin, Lasix, K+) • Oxygen • Prophylactic antibiotics to prevent infective endocarditis • Surgical Management • Pulmonary balloon valvuloplasty via cardiac cath • If unsuccessful valvotomy

  46. Coarctation of Aorta • Constriction of the aorta at or near the insertion site of the ductus arteriosus • Reduces cardiac output (impedes blood flow from heart to body=pink blood) • Aortic pressure is high proximal to the constriction and low distal to the constriction-Risk for CVA Higher pressure Pink Blood

  47. Symptoms • Systolic murmur • BP is about 20 mm/Hg higher in arms than in lower extremities • Upper extremity hypertension • Diminished pulses in lower extremities • Poor lower body perfusion • Lower extremity cyanosis

  48. Treatment • Medical Management (Digoxin, Lasix, K+) • Oxygen • Administration of PGE1 (prostaglandin) infusions • Maintain ductal patency and improves perfusion to lower extremities- although will cause increased pulmonary flow • Surgical repair within first 2 years

  49. Tetralogy of Fallot Blood is light blue • Consists of 4 Defects • VSD • RV hypertrophy • Pulmonic Stenosis • Overriding aorta Blood is purple

  50. Symptoms • cyanotic at birth when PDA closes • increased respiratory rate, may lose consciousness • “tet spells” or hypercyanotic episodes often preceded by crying, feeding or stooling • tire easily especially with exertion, difficulty feeding and gaining weight • become increasingly cyanotic over the first few months • symptoms of chronic hypoxemia

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