PEDIATRIC CARDIAC DISORDERS

Tachycardia
- an abnormal rapidity of heart action that usually is defined as a heart rate more than 100 beats per minute (bpm) in adults. In children, the normal heart rate is age dependent, and the definition of tachycardia varies Classification: - Atrial Tachycardia - Atrial Ectopic Tachycardia - Ventricular Tachycardia - Supraventricular Tachycardia Pathophysiology: The heart is innervated primarily by the vagus nerve and the sympathetic ganglion. Pain sensation travels through afferent fibers associated with the sympathetic ganglia. In most patients, the sensation of a normal heartbeat is not felt. Some children may complain of palpitations or rushing or pounding in the ears. Treatment: - Start intravenous (IV) fluids when indicated - Administration of prescribed medications (Antiarrhythmic agents) - Administer oxygen Nursing Intervention: - Assess and stabilize airway, breathing, and circulation - Place a cardiorespiratory monitor - Monitor VS - Monitor the patient - Monitor medication doses and adverse effects

Congenital Heart Disease

- a defect of the heart that has developed within the womb. It can range in severity from a minor opening within the walls of the heart itself to a missing portion of the organ Pathophysiology: The reason why some children are born with congenital heart disease is still unknown, there are factors that can play a role in their development. Of all the causes of heart defects, genetics is one of the main culprits. This is largely because many cases of pediatric congenital heart disease not only run in families, but are also linked to certain disorders, such as Down syndrome, Noonan syndrome and Marfan syndrome. Treatment: - Administration of prescribed medications - Surgery (Heart Transplant)

Nursing Intervention: - Monitor VS - Monitor the patient - Monitor medication doses and adverse effects - Assess and stabilize airway, breathing, and circulation - Place a cardiorespiratory monitor

Prolonged QT Syndrome
- is a genetically transmitted cardiac arrhythmia caused by ion channel protein abnormalities. It is characterized by electrocardiographic abnormalities and a high incidence of syncope and sudden cardiac death Classification: - Jervell and Lang-Nielsen (JLN) syndrome autosomal recessive form - Romano-Ward syndrome (RWS) dominant form Pathophysiology: This syndrome, once diagnosed by clinical profile, has been more clearly defined by specific genetic defects that cause ion channel abnormalities, resulting in a syndrome that predisposes to lethal cardiac arrhythmias. Initial studies using monophasic action potentials have shown evidence of early after depolarizations (EADs) in congenital and acquired long QT syndrome. Excessive prolongation of action potential results in reactivation of certain L-type calcium channels, leading to after depolarizations. Treatment: (Short-term treatment) - intravenous (IV) magnesium and potassium administration - temporary cardiac pacing - withdrawal of the offending agent - correction of electrolyte imbalance - IV isoproterenol administration (Long term treatment) - Beta-Adrenergic Blocking Agents Nursing Intervention: - Monitor VS - Monitor the patient - Monitor medication doses and adverse effects - Monitor ECG

Congestive Heart Failure

- occurs when the heart can no longer meet the metabolic demands of the body at normal physiologic venous pressures Classification: - Acute Heart Failure

- Chronic Heart Failure

Pathophysiology: The first manifestation of congestive heart failure is usually tachycardia. An obvious exception to this finding occurs in congestive heart failure due to a primary bradyarrhythmia or complete heart block. As the severity of congestive heart failure increases, signs of venous congestion usually ensue. Left-sided heart failure is generally associated with signs of pulmonary venous congestion, whereas right-sided heart failure is associated with signs of systemic venous congestion. Marked failure of either ventricle, however, can affect the function of the other, leading to systemic and pulmonary venous congestion. Later stages of congestive heart failure are characterized by signs and symptoms of low cardiac output. Generally, congestive heart failure with normal cardiac output is called compensated congestive heart failure, and congestive heart failure with inadequate cardiac output is considered decompensated. Treatment: - Administration of prescribed medications (ACE Inhibitors, Inotropic Agents) - Reducing the preload - Enhancing cardiac contractility - Reducing the afterload - Improving oxygen delivery - Enhancing nutrition Nursing Intervention: - Monitor VS - Monitor the patient - Monitor medication doses and adverse effects - Assess and stabilize airway, breathing, and circulation - Place a cardiorespiratory monitor

Pericarditis
- an inflammation of the pericardium Classification: - Infective Pericarditis (Fungal, Viral, Bacterial Pericarditis) - Constrictive Pericarditis Pathophysiology: Inflammation of the pericardium secondary to an infection leads to an increase in permeability to proteins and inflammatory cells, and fluid accumulates between the visceral and parietal layers (pericardial effusion). Because the pericardium has a limited ability to stretch acutely, rapid accumulation of fluid leads to increased intrapericardial pressure and hemodynamic compromise. The capacity of the pericardial space is influenced by its natural stiffness, and infection is known to increase this stiffness, contributing to the symptomatology. Treatment: - Administration of prescribed medications (non-steroidal Anti-inflammatory drugs)

Nursing Intervention: - Monitor VS - Monitor the patient - Monitor medication doses and adverse effects

Myocarditis
- a disease of adult and pediatric patients, is an inflammatory disorder of the myocardium that is typically caused by a viral infection Classification: - Active myocarditis -Borderline myocarditis - Non-myocarditis Pathophysiology: Myocarditis generally results in a decrease in myocardial function, with concomitant enlargement of the heart and an increase in the end-diastolic volume caused by increased preload. Normally, the heart compensates for dilation with an increase in contractility (Starling law), but because of inflammation and muscle damage, a heart affected with myocarditis is unable to respond to the increase in volume. Treatment: - Administer oxygen - Administration of prescribed medications Nursing Intervention: - Monitor medication doses and adverse effects - Avoid negative inotropes - Monitor VS - Monitor the patient - Assess and stabilize airway, breathing, and circulation

Rheumatic Heart Disease

- is the most serious complication of rheumatic fever Classification: - Acute Rheumatic Heart Disease - Chronic Rheumatic Heart Disease Pathophysiology: Rheumatic fever develops in some children and adolescents following pharyngitis with group A beta-hemolytic Streptococcus (ie, Streptococcus pyogenes). The organisms attach to the epithelial cells of the upper respiratory tract and produce a battery of enzymes allowing them to damage and invade human tissues. After an incubation period of 2-4 days, the invading

organisms elicit an acute inflammatory response with 3-5 days of sore throat, fever, malaise, headache, and an elevated leukocyte count. Treatment: - Administration of prescribed medication (Antibiotics, Anti-inflammatory agents, ACE inhibitors) Nursing Intervention: - Monitor VS - Monitor the patient - Monitor medication doses and adverse effects

Endocarditis
- an infection of the endothelial surface of the heart Classification: - Bacterial Endocarditis - Fungal Endocarditis Pathophysiology: High-velocity flow through a stenotic or incompetent valve or an abnormal communication between systemic and pulmonary circulations causes turbulence at the valve, within the communication, or downstream where the flow eddies. This turbulence damages or denudes the endothelium, to which platelets and fibrin can adhere, and a small, sterile nonbacterial thrombotic endocardial lesion forms. Treatment: - Administration of prescribed medications Nursing Intervention: - Monitor VS - Monitor the patient - Monitor medication doses and adverse effects