‘ The Pedi-Cardiac Lecture ’ Part 3

Pediatric Cardiovascular DisordersJerry Carley MSN, MA, RN, CNE

Concept Map: Pediatric Cardiac Conditions

AS

Aortic Stenosis

6% of CHD defects Aortic valve: has two rather than three

leaflets. Leaflets are thickened or fused. Obstruction of blood flow from left ventricle Mild symptoms: dizziness, syncope, angina,

fatigue 30% incidence of sudden death

Pathophysiology Partially fusedAortic Valve Leaflets

Frequently found inAssociation with:

Mitral valveStenosis

Effects / Symptoms

DecreasedExerciseTolerance

PossiblyAsymptomatic

Heart FailureTreatments

Surgery Heart Catheterization

Nursing Care

Closed HeartSurgery

Coarctation of The Aorta

Possible (L)VentricularHypertrophy

BalloonDilation

Stenting

Aortic Stenosis

Causes obstruction to blood flow between the left ventricle and aorta.

Most common form is obstruction of the valve itself

When the aortic valve does not open properly the left ventricle must work harder to eject blood into the aorta.

Left ventricular muscle becomes hypertrophied.

Diagnosis

Heart murmur or AS is a turbulent noise caused by ejection of blood through the obstructed valve.

Electrocardiogram is usually normal Echocardiogram will show the obstruction

and rule out other heart anomalies Exercise stress test – provides information on

impact of the stenosis on heart function

Treatment

Cardiac catheterization – balloon dilation of the narrowed valve.

Surgical valvotomy if the closed procedure does not work – often done when patient is older when severe calcium deposits further obstruct the valve.

Recurrent valve obstruction is a complication and if valve replacement is done too early the child may outgrow the valve.

Antibiotic prophylaxis especially if valve replacement

HLH

Hypoplastic Left Heart (HLH) One of the most complex defects seen in the

newborn and the most challenging of all the congenital defects

All the structures on the left side of the heart are severely underdeveloped.

Mitral and aortic valves are either completely closed or are very small – left ventricle is tiny – aorta is small and often only a few millimeters in diameter

(HLH)

HLH

Life threatening shock develops when the ductus arteriosis closes

Low oxygen saturations – will not increase with oxygen administration

Pulses will be weak in all extremities Plan to deliver infant in a hospital capable of

providing the aggressive treatment needed

Treatment HLH

Three staged procedure to reconfigure the cardiovascular system Norwood Procedure – right ventricle becomes the

systemic ventricle pumping blood to the body Glenn Procedure-- done at 3-6 months Fontan Procedure-- done at 2 -3 years of age

Long Term Complications

Easily tiring when participating in sports or other exercises

Formation of blood clots – heparin or Coumadin use

Heart arrhythmias – pace maker Cardiac failure

Concept Map: Pediatric Cardiac Conditions ( Acquired )

‘Acquired’ Pediatric Cardiac Conditions

Frequent CHD Complication:

Bacterial Endocarditis Infection of endocardial surface of the heart History of CHD, Kawasaki Disease,

Rheumatic Fever, or prosthetic valves are more susceptible to infection

Prophylactic antibiotics with dental care, throat, intestinal, urinary or vaginal infections or surgery.

●● an inflammatory disease that occurs as a reaction to Group Aβ-hemolytic streptococcus (GABHS) infection of the throat.

Assessment●● Risk Factors◯◯ usually occurs within 2 to 6 weeks following an untreated or partiallytreated upper respiratory infection (strep throat) with GABHS.

●● Subjective and Objective Data◯◯ History of recent upper respiratory infection◯◯ Fever◯◯ Fatigue◯◯ Sore throat

Rheumatic Fever

◯◯ Activity intolerance

◯◯ Poor appetite

◯◯ Tachycardia, cardiomegaly, prolonged PR interval, new or changed heart murmur, muffled heart sounds, pericardial friction rub, and reports of chest pain, which may indicate carditis

◯◯ Nontender, subcutaneous nodules over bony prominence

◯◯ Large joints (knees, elbows, ankles, wrists, shoulders) that have painful swelling indicating polyarthritis

■■ Symptoms last a few days and then disappear without treatment, frequently returning in another joint.

Rheumatic Fever…S/S Continued

◯◯ Pink, nonpruritic macular rash on the trunk and inner surfaces of extremities that appears and disappears rapidly, indicating erythema marginatum.

◯◯ CNS involvement (chorea) including involuntary, purposeless muscle movements; muscle weakness; involuntary facial movements; difficulty performing fine motor activities; labile emotions; and random, uncoordinated movements of the extremities

◯◯ Irritability, poor concentration, and behavioral problems

Rheumatic Fever……

Kawasaki Disease

Acute-self limiting disease Generalized vasculitis Peak incidence 6 months to 2 years More common in males and Japanese

http://www.aafp.org/afp/990600ap/3093.html

Clinical Manifestations

High fever Conjunctivitis – no drainage Strawberry tongue Edema of hands and feed Reddening of palms and soles Lymph node swelling

Child with Kawasaki Disease:

Red eyes, dry cracked lips, beefy red tongue

Edema – Hands and Feet

Peeling Finger Tips

Blood Values

Elevated WBC

Elevated ESR

Elevated platelets

Interdisciplinary Interventions

Intravenous gamma globulin High dose of ASA while in hospital Low dose ASA upon discharge Base-line echocardiogram to assess

coronary artery status

Pye, S. & Green, A. (2011) Parent Education After Newborn Congenital Heart Surgery. Retrieved from http://www.medscape.com/viewarticle/458206

Cyanosis Prior to Surgery…

18HoursPost-op

TOF: The Tatoo !

Cardiac

24 Hours Post-Op

http://www.youtube.com/watch?v=KFfCKy0nKr0