Download The Child with a Cardiovascular Disorder

The Child with a Cardiovascular
Disorder
Chapter 26
The Cardiovascular System
Signs R/T Suspected
Cardiac Pathology
FTT
cyanosis, pallor
pulsations in neck veins
tachycardia, dyspnea
irregular pulse rate
clubbing of fingers
fatigue during feeding or activity
excessive perspirations (esp. over forehead)
Congenital Heart Defects
Causes:
– Genetic
Maternal factors:
– drug use,
– rubella illness,
– environmental
factors
Classification
Acyanotic:
Atrial septal defect
Ventricular septal
defect
Patent ductus
arteriosus
Cyanotic:
Tetralogoy of Fallot
Defects increasing Pulmonary Blood
Flow
Defects that cause blood
to return to the right
ventricle and
recirculate through the
lungs before exiting
the left ventricle
through the aorta
Defects that increase pulmonary blood
flow
After birth, the pressure is
 in left atrium
• If the atrial opening
persist, the blood flows
back into the right
atrium (left-to right
shunt) and then
recirculates to the
lungs, causing
increased pulmonary
flow.
• In heart defects that
result in  in
pulmonary flow
because of left-to-right
shunt, the oxygenated
blood recirculates to
the lungs, and cyanosis
is rare.
Defects that increase pulmonary blood
flow
Atrial Septal Defect
• Abnormal opening
between right and left
atria.
• Blood that already
contains oxygen is
forced from left atria
back to right atria.
Atrial Septal Defect
Surgical repair:
• Low dose aspirin
therapy is usually
prescribed for 6
months.
• Prognosis is excellent.
Ventricular Septal Defect
Most common type of heart
anomaly.
• Opening between the right
and left ventricles of the heart.
• Increased pressure w/in left
ventricle forces blood back
into right ventricle (left-toright) shunt.
• The apical pulse is heard
through a stethoscope at the
apex of the heart. The nurse
counts for 1 full min.
• A loud, harsh murmur
combined w/a systolic thrill is
characteristic of this defect.
Patent Ductus Arteriosus
The ductus arteriosus is the
passageway (shunt) through
which blood crosses from
pulmonary artery to aorta and
avoids deflated lungs.
• It closes shortly after birth.
…. If it does not close, blood
continues to pass from aorta,
where pressure is , into
pulmonary artery.
• This causes oxygenated blood to
recycle through lungs,
overburdening the pulmonary
circulation and making heart
pump harder.
Patent Ductus Arteriosus
Symptoms:
Older child – dyspnea
• Radial pulse-full &
bounding on exertion
• Pulse pressure
Defects that Restrict Ventricular Blood
Flow
“Stenosis” (narrowing) of a
vessel.
• Coarctation of the aorta
• Constriction or narrowing of
aortic arch or descending
aorta.
• Hemodynamics consists of
 pressure proximal to
defect and  pressure
distally.
• Pulses and B/P will differ in
upper & lower extremities.
Defects that Decrease Pulmonary
Blood Flow
Occurs when blood that
has not passed through
the lungs is allowed to
pass to aorta and
systemic circulation.
• A characteristic feature
of this defect is
cyanosis.
• Tetralogy of Fallot
Tetralogy of Fallot
“Tetra” = four
Four Defects:
1. narrowing of
pulmonary artery
2. Hypertrophy of right
ventricle
3. Dextroposition of
aorta.
4. VSD
Tetralogy of Fallot
Child rests in “squatting”
position to improve venous
return.
• Polycythemia
• Cyanosis
• “tet” spells or paroxysmal
hypercyanotic episodes
• Symptoms: cyanosis,
respiratory distress,
weakness, and syncope.
• Parents, caregivers are
instructed to place child in a
knee-chest position when
tet spell occurs.
Acquired Heart Disease
CHF
• s/s: tachypnea at rest
• Fatigue during feeding
• Sweating around scalp
or forehead
• Dyspnea
• Sudden weight gain
Cyanosis
 General or localized
 Clubbing of fingers due
to chronic hypoxia
 Rapid respirations > 60
breaths/min
 Rapid pulse
 Feeding difficulties
 Poor weight gain
 Edema
 Frequent respiratory
tract infections
CHF
• Organize care to avoid disturbing
infant unnecessarily.
• Frequent and small feedings
• Soft nipple w/holes large enough
to prevent infant from tiring
• Formulas w/increased caloric
density
• NG tube feedings
• O2 administration
• Digitoxin and digoxin (Lanoxin) are
common oral digital preparations
• It is preferred because of rapid action
& shorter half life. It slows &
strengthen the heartbeat. Pulse is
counted for 1 full min. , before
administering medication.
• A resting apical pulse at rest is best.
As a rule, if pulse rate of an infant or
child is below 100 beats/min the med
is withheld and physician is notified.
• Tachycardia and irregularities in
rhythm of pulse are significant and
should be reported.
• Toxicity symptoms: n/v, anorexia,
irregularity in rate and rhythm of
pulse, and sudden change in pulse
• Diuretics are also prescribed:
furosemide (Lanoxin)
Rheumatic Fever
• Systemic disease
involving the joints,
heart, CNS, skin and SQ
tissues. Collagen
diseases. Common
feature- destruction of
connective tissue. RF is
particularly detrimental
to the heart, causing
scarring of the mitral
valves.
Rheumatic Fever
• RF is an autoimmune
disease that occurs as a
complication of untreated
group A beta-hemolytic
streptococcus infection of
the throat.
• Migratory polyarthritis
(wandering joint pains)
• An elevated
antistreptolysin O titer
(ASO) is standard
diagnostic
• Sydenham’s chorea
Rheumatic Carditis
• Inflammation of heart
• Tissues covering heart
and heart valves are
affected
• The mitral valve is often
involved
Rheumatic Carditis
Diagnosis is difficult to make
• Jones Criteria
• Presence of two major or
one major & two minor
criteria, supported by
evidence of recent
streptococcal infection,
indicates high probability of
RF.
• ERS is elevated.
• Treatment: prevent
permanent damage to heart
• Antibacterial therapy
• Pain relief/fever
• PCN X 10 days
• Chemoprophylaxis, IM
benzathine PCN G monthly
w/history of RF or evidence
of RH disease for minimum
of 5-year period or until age
18 years of age
Rheumatic Fever
Prevention
• Prompt treatment of
group A beta-hemolytic
streptococcal infections
can prevent occurrence
of RF.
• All throat infections
should be cultured.
Hyperlipidemia
•
•
•
•
Excessive lipids
HDL
LDL
No more than 300 mg
cholesterol/day
• No more than 30% of
total dietary calories
from fat
Kawasaki Disease
Mucutaneous lymph node
syndrome
• Leading cause of acquired
cardiovascular disease in
the US.
• Usually affects children
under 5 years of age.
• May be reactions to toxins
produced by previous
infection w/organism as
staphylocci
• Causes inflammation of
vessels in cardiovascular
system.
• Inflammation weakens
walls of the vessels and
often result in an
aneurysm.
• Aneurysms can cause
thrombi (blood clots) to
form.
Kawasaki Disease
About 40 % of untreated
children develop
aneurysms of coronary
vessels, which can be
life threatening.
Kawasaki Disease
Manifestations:
“Strawberry tongue”
Peeling of fingertips and
soles of feet.
Treatment:
• IV gamma globulin given
early to prevent
development of artery
pathology.
• Salicylate therapy
• Warfarin (coumadin)
• Postpone immunizations
for 11 mos.
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