Download Types of Congenital Heart Defects

Congenital Heart Defects
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‫م عدي فارس الفرطوسي‬.‫م‬
PhD Pediatric Nsg St.
Congenital heart defects are problems with the heart's
structure that are present at birth. These defects can involve:
The interior walls of the heart
The valves inside the heart
The arteries and veins that carry blood to the heart or the body
Congenital heart defects change the normal flow of blood through the heart. The heart has two
sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the
lungs to pick up oxygen. The left side of the heart receives the oxygen-rich blood from the lungs
and pumps it to the body.
Other Names for Congenital Heart Defects
Congenital heart disease
Heart defects
Congenital cardiovascular malformations
How the Heart Works
The heart has four chambers and four valves and is connected
to various blood vessels. Veins are blood vessels that carry
blood from the body to the heart. Arteries are blood vessels
that carry blood away from the heart to the body.
Heart Chambers
The heart has four chambers or "rooms."
The atria are the two upper chambers that collect blood as it flows into the heart.
The ventricles are the two lower chambers that pump blood out of the heart to the lungs or other
parts of the body.
Heart Valves
Four valves control the flow of blood from the atria to the ventricles and from the ventricles into
the two large arteries connected to the heart.
The tricuspid valve is in the right side of the heart, between the right atrium and the right
ventricle.
The pulmonary valve is in the right side of the heart, between the right ventricle and the
entrance to the pulmonary artery. This artery carries blood from the heart to the lungs.
The mitral valve is in the left side of the heart, between the left atrium and the left ventricle.
The aortic valve is in the left side of the heart, between the left ventricle and the entrance to the
aorta. This artery carries blood from the heart to the body.
Valves are like doors that open and close. They open to allow blood to flow through to the next
chamber or to one of the arteries. Then they shut to keep blood from flowing backward.
When the heart's valves open and close, they make a "lub-DUB" sound that a doctor can hear
using a stethoscope.
The first sound—the "lub"—is made by the mitral and tricuspid valves closing at the beginning of
systole . Systole is when the ventricles contract, or squeeze, and pump blood out of the heart.
The second sound—the "DUB"—is made by the aortic and pulmonary valves closing at the
beginning of diastole . Diastole is when the ventricles relax and fill with blood pumped into them
by the atria.
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Arteries
The arteries are major blood vessels connected to your heart.
The pulmonary artery carries blood from the right side of the heart to the lungs to pick up a fresh
supply of oxygen.
The aorta is the main artery that carries oxygen-rich blood from the left side of the heart to the
body.
The coronary arteries are the other important arteries attached to the heart. They carry oxygenrich blood from the aorta to the heart muscle, which must have its own blood supply to function.
Veins
The veins also are major blood vessels connected to your heart.
The pulmonary veins carry oxygen-rich blood from the lungs to the left side of the heart so it can
be pumped to the body.
The superior and inferior vena cava are large veins that carry oxygen-poor blood from the body
back to the heart.
Types of Congenital Heart Defects
A. Simple Congenital Heart Defects (Septal Defects)
Atrial septal defect (ASD). An ASD is a hole in the part of the septum that separates the atria—
the upper chambers of the heart. The hole allows oxygen-rich blood from the left atrium to flow
into the right atrium, instead of flowing into the left ventricle as it should.
Ventricular septal defect (VSD). A VSD is a hole in the part of the septum that separates the
ventricles—the lower chambers of the heart. The hole allows oxygen-rich blood to flow from the
left ventricle into the right ventricle, instead of flowing into the aorta and out to the body as it
should.
Patent Ductus Arteriosus(PDA) is a fairly common heart defect that can occur soon after birth.
In PDA, abnormal blood flow occurs between the aorta and the pulmonary artery.
Valves can have the following types of defects:
Stenosis This defect occurs if the flaps of a valve thicken, stiffen, or fuse together. As a result, the
valve cannot fully open. Thus, the heart has to work harder to pump blood through the valve.
Atresia. This defect occurs if a valve doesn't form correctly and lacks a hole for blood to pass
through. Atresia of a valve generally results in more complex congenital heart disease.
Regurgitation .This defect occurs if a valve doesn't close tightly. As a result, blood leaks back
through the valve.
B. Complex Congenital Heart Defect
The most common complex heart defect is tetralogy of Fallot (teh-TRAL-o-je of fah-LO), which
is a combination of four defects:
Pulmonary valve stenosis.
A large VSD.
An overriding aorta. In this defect, the aorta is located between the left and right ventricles,
directly over the VSD. As a result, oxygen-poor blood from the right ventricle can flow directly
into the aorta instead of into the pulmonary artery.
Right ventricular hypertrophy . In this defect, the muscle of the right ventricle is thicker than
usual because it has to work harder than normal.
In tetralogy of Fallot, not enough blood is able to reach the lungs to get oxygen, and oxygen-poor
blood flows to the body.
2. Transposition of great vessels
Causes Congenital Heart Defects
1) Heredity
2) genetic disorders, such as Down syndrome
3) Smoking during pregnancy
Signs and Symptoms of Congenital Heart Defects
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They depend on the number, type, and severity of the defects. Severe defects can cause signs and
symptoms, usually in newborns. These signs and symptoms may include:
Rapid breathing
Cyanosis (a bluish tint to the skin, lips, and fingernails)
Fatigue (tiredness)
Poor blood circulation
chest pain or other painful symptoms.
heart murmurs (extra or unusual sounds heard during a heartbeat).
This can lead to heart failure. Heart failure is a condition in which the heart can't pump enough
blood to meet the body's needs. Symptoms of heart failure include:
Shortness of breath or trouble breathing
Fatigue with physical activity
A buildup of blood and fluid in the lungs
Swelling in the ankles, feet, legs, abdomen, and veins in the neck
Diagnosis of Congenital Heart Defects :
A. Specialists Involved
Pediatric cardiologists are doctors who specialize in the care of babies and children who have
heart problems. Cardiac surgeons are specialists who repair heart defects using surgery.
B. Physical Exam :
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Listen to your child's heart and lungs with a stethoscope
Look for signs of a heart defect, such as cyanosis (a bluish tint to the skin, lips, or fingernails),
shortness of breath, rapid breathing, delayed growth, or signs of heart failure
Diagnostic Tests
Echocardiography is a painless test that uses sound waves to create a moving picture of the heart.
During the test, the sound waves (called ultrasound) bounce off the structures of the heart. A
computer converts the sound waves into pictures on a screen.
EKG (Electrocardiogram) An EKG is a simple, painless test that records the heart's electrical
activity.
Chest X Ray is a painless test that creates pictures of the structures in the chest, such as the heart
and lungs. This test can show whether the heart is enlarged. It also can show whether the lungs
have extra blood flow or extra fluid, a sign of heart failure.
Pulse Oximetry a small sensor is attached to a finger or toe (like an adhesive bandage). The
sensor gives an estimate of how much oxygen is in the blood
Cardiac Catheterization a thin, flexible tube called a catheter is put into a vein in the arm, groin
(upper thigh), or neck. The tube is threaded to the heart.
Congenital Heart Defects Treated
The treatment child receives depends on the type and severity of his or her heart defect. Other
factors include your child's age, size, and general health. Some children who have complex
congenital heart defects may need several catheter or surgical procedures over a period of years,
or they may need to take medicines for years.
1. Catheter Procedures
Catheter procedures are much easier on patients than surgery. They involve only a needle
puncture in the skin where the catheter (thin, flexible tube) is inserted into a vein or an artery.
Doctors don't have to surgically open the chest or operate directly on the heart to repair the
defect(s). This means that recovery may be easier and quicker.
The use of catheter procedures has increased a lot in the past 20 years. They have become the
preferred way to repair many simple heart defects, such as atrial septal defect (ASD)
andpulmonary valve stenosis.
2. Surgery
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A child may need open-heart surgery if his or her heart defect can't be fixed using a catheter
procedure. Sometimes one surgery can repair the defect completely. If that's not possible, the
child may need more surgeries over months or years to fix the problem.
Cardiac surgeons may use open-heart surgery to:
Close holes in the heart with stitches or a patch
Repair or replace heart valves
Widen arteries or openings to heart valves
Repair complex defects, such as problems with the location of blood vessels near the heart or how
they are formed
Rarely, babies are born with multiple defects that are too complex to repair. These babies may
need heart transplants. In this procedure, the child's heart is replaced with a healthy heart from a
deceased child. The heart has been donated by the deceased child’s family.
Caring of Congenital Heart Defects:
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A. Provide adequate nutritional and fluid intake to maintain the growth and developmental
needs of the child
Feed in semi-erect position
Provide small frequent feedings
Provide foods with high nutritional value
Determine child’s likes and dislikes
Strict input and output
Daily weight
B. Prevent infection
Prevent exposure to communicable diseases
Immunizations should be up-to-date
Handwashing should be observed
Be certain that the child receives prophylactic medication for infective endocarditis
C. Reduce the workload of the heart since decreased activity and expenditure of energy will
decrease oxygen requirements
Uninterrupted rest
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Avoid unnecessary activities
Prevent excessive crying
Provide diversional activities
Prevent constipation
Relieve the respiratory distress associated with increased pulmonary blood flow or oxygen
deprivation
Determine degree of respiratory distress
Include specific information in nursing record
Position child at 45 degree angle to decrease pressure of the viscera on the diaphragm and
increase lung volume
Pin diapers loosely and provide loose-fitting pajamas for older children
Feed slowly
Tilt infant’s head slightly
Suction the nose and throat if unable to cough out secretions
Provide oxygen therapy as needed
Improve oxygenation o that the body functions may be maintained
Provide effective oxygen environment
Observe response to oxygen therapy
Observe response to oxygen weaning therapy
Relieve Hypoxic spells associated with cyanotic types of Congenital heart disease
Observe for “tet” spells
Encourage fluid intake
Obtain vital signs
D. Observe child for symptoms of Congestive Heart Failure that occur frequently as a
complication of Congenital Heart Disease
E. Observe for the development of symptoms of infective endocarditis that may occur as a
complication of congenital heart disease
F. Observe for the development of thrombosis that may occur as a complication of congenital
heart disease
G. Prepare the child for diagnostic and treatment procedures
H. Explain cardiac problems to child and parents
IV. Health Education
A. Instruct the family in necessary measures to maintain the child’s health
B. Teach the family about the defect and its treatment
C. Encourage the parents and other persons to treat child in a normal manner as possible