CONGENITAL HEART DEFECTS

Dobertlo B. Villegas RN

1. Objectives:

At the end of the discussion, the students will be able to:

1. define congenital heart defect,2. explain each congenital heart defect and its

respective classification,3. know the different signs and symptoms of each

congenital heart defect,4. identify the treatments and nursing interventions

in patients with congenital heart defects,5. apply the knowledge learned in the clinical

setting.

Introduction:

•Congenital means inborn or existing at birth.  •The word "defect" is more accurate than "disease."  •A congenital cardiovascular defect occurs when the heart or blood vessels near the heart don't develop normally before birth •Congenital heart defects are the most common birth defects.

Normal Heart

Anatomy and Physiology•The shunting or flow of the blood is from lower oxygen concentration to higher oxygen concentration.•The septum that divides the heart longitudinally is referred to as the interventricular or interatrial septum.

Predisposing factors:

•Maternal rubella during pregnancy•Maternal alcoholism•Maternal age over 40 years old•Maternal insulin-dependent diabetes•Sibling(s) with heart disease•Parent with congenital heart defect

Types of defects1.Acyanotic- mixing of poorly oxygenated venous blood in systemic circulation

Ventricular septal defect

Atrial septal defect

Pulmonary valve stenosis

Aortic stenosis

Coarctation of the aorta

Patent ductus arteriosus

2. Cyanotic-poorly oxygenated venous blood enters systemic circulation

Tetralogy of Fallot

Transposition of the great arteries

Truncus arteriosus

Hypoplastic left heart syndrome

Nursing Intervention:Assessment:Acyanotic

•Ventricular septal defect-characterized by loud, harsh murmur

•Atrial septal defect– small defect high on the septum may not cause clinical symptoms-audible murmur

•Pulmonary artery stenosis- resistance to blood flow causes right ventricular hypertrophy-commonly seen with PDA

•Aortic stenosis- mumur usually heard

•Coarctation of the aorta- high blood pressure and bounding pulses in areas receiving blood from vessel proximal to the defect; -weak or absent pulses distal to the defect, cool extremities, muscle cramps•Patent ductus arteriosus-increased pulmonary vascular congestion and right ventricular hypertrophy-murmur, tachycardia, bounding pulse

Cyanotic

•Tetralogy of Fallot- cyanosis, clubbing of fingers, delayed physical growth and development- child squats or assumes knee-chest position•Transposition of the great vessels- severe cyanosis to mild CHF

•Truncus arteriosus-cyanosis, left ventricular hypertrophy, dyspnea, marked activity intolerance and growth retardation-CHF, murmur

•Hypoplastic left-heart syndrome-cyanosis, difficulty to feed and breathe

Nursing diagnosis:-Impaired gas exchange-Altered peripheral tissue perfusion related to CHF-Altered cardiopulmonary tissue perfusion-Altered nutrition, less than body requirements-Anxiety-Ineffective family coping: disabling-Risk for impaired growth & development-Risk for infection

Planning/Implementation

1. Prevent congenital heart defect•Optimal maternal nutrition, prenatal care, and avoidance of drugs and alcohol•Immunization against rubella in females2. Recognize early signs/ symptoms- cyanosis, poor weight gain, poor feeding habits, exercise intolerance, unusual posturing, heart murmurs3. monitor vital signs and heart rhythm4. provide support for patient as well as restful environment5. Monitor intake and output

6. Give medications as ordered:•Digoxin- in cardiac contractility- take apical pulse 1 min, check for bradycardia•Iron preparations (ex. ferrous sulfate)•Diuretics (ex. lasix)- check for patients BP•Potassium•Anti-inflammatory (Indomethacin) to indibit Prostaglandin E•Antibiotics

7. Change feeding pattern for infant•Small amounts every 2 hours•Enlarged nipple hole•Diet- low sodium, high potassium

8. Prepare patient for diagnostic procedures•Cardiac Catheterization- confirm the diagnosis through visualization of defects and measurement of oxygen saturation•Cardiac Magnetic Resonance Imaging Examination •Echocardiogram: Sound Imaging of the Heart •Echocardiography (Ultrasound of the Heart) •Electrocardiogram (EKG or ECG) •Exercise Tests •CBC- reveals polycythemia•Arterial blood gas- diminishing arterial oxygen saturation•Chest x-ray

9. Prepare patient for invasive procedures

a. Ventricular septal and Atrial septal defect- purse-string closure or patching- pulmonary artery banding to prevent heart failure

b. Pulmonic artery stenosis - open-heart surgery to separate the pulmonary valve

leaflets- pulmonary valvulotomy

c. Atrial septal defect- valvulotomy

d. Coartation of Aorta- resection of the coarted portion and end-to-end

anastomosis or replacement of the constricted sectione. Patent ductus arteriosus

- ligation

f. Tetralogy of Fallot- repair or palliative treatment during 1 year to increase blood flow to the lungs bypassing pulmonic stenosis (Blalock-

Taussig anastomosis – right pulmonary artery to the right subclavian artery)

g. Transposition of great arteries- corrective surgery to redirect blood flow by switching the position of the major blood vessel; performed first year of life

h. Truncus arteriosus- closing ventricular septal defect so

truncus originates from left ventricle and creating pathway from right ventriclei. Hypoplastic left-heart syndrome

- may perform heart transplant

Evaluation

1. Check child’s growth and development2. Check for family and child’s coping towards the defect.3. Check for the effectiveness of the treatments and medications given.