

Congenital Heart Disease Harsh sytolic murmur

2 types 
Diagnostic tests
1. Acyanotic
 Cardiac catheterization
- arterial to venous
Nursing responsibilities
-left to right shunting
-consent
-oxygenated to unoxygenated
-assess v.s 

Acyanotic heart - inform that fluttering feeling and

desire to cough may be experience
diseases during the procedure
-affected limb should be immobilzed
and extended

ASD- Atrial septal  Echocardiography - cardiac

dysrythmias
defect  Chest xray
- abnormal opening in the intra atrial
septum. ! No restrictions with client with small
-failure of foramen ovale to close ASD

3 types Sx management :small ASD-dacron

1.ostium primum-opening on the lower end
of ostium
2.ostium secundum- opening near the
center
3.sinus venosus- junction in the superior
vena cava and right atrium
Manifestations
 Failure to thrive
 Murmur and thrill heard best on left 2-
3rd intercostal space
patch
VSD -Ventricular
septal defect
- opening is present in the septum between
the 2 ventricles 
- abnormal opening in the right
ventricle and left ventricle 
-this impairs the effort of the heart because
blood that should go into the aorta and out
of the body is shunted back into
the pulmonary circulation resulting in right
ventricle hypertrophy and increase pressure
in the pulmonary artery.
-increase pressure in left side of the heart ,
o2 blood from left ventricle to right ventricle
= increase blood volume in right ventricle=
increase blood flow to the lungs =
pulmonary congestion
Signs and symptoms of left ventricle
failure  One reason that the ductus remains
-loud harsh pansystolic murmur
-pulmonary manifestation
-slow wt. Gain and poor growth
-mur mur = during ventricular systole
Diagnostic tests
 Cardiac catheterization
 Electrocardiograph
 Chest x ray
! Small VSD - Dacron patch
! Large VSD - Pulmonary artery
banding =to prevent pulmonary
congestion
PDA- Patent ductus
arteriosus
- opening in the pulmonary artery and
aorta
- ventricular hypertrophy and increase
pressure in pulmonary artery
! Ductus arteriosus is an accessory
fetal structure that connects the
pulmonary artery to the aorta. 
!Ductus Arteriosus -closure should
begin at the first breath , and the
complete closure should be 3months
Functional closure - partial closure, 15
to 24 hours
Anatomic closure- complete closuee,
3-4 weeks 
open in fetal life is because of the
stimulation of prostaglandins
particularly PGE from the placenta and
the low o2 level of the fetal blood 
Manifestations
-wide pulse pressure 
-Bounding peripheral pulses or apical
pulses
-Machinery murmur
Diagnostic tests
-Cardiac catheterization
-Echocardiograph
-Chest x ray
Treatment
Ibuprofen
Antibiotic prophylaxis
Drug of choice - INDOMETHACIN-
prostaglandin inhibitor , can be given
in 3 doses effective when given to
clients less than 13 days old and not
effective when given after 4 - 6 weeks.

Contraindicated with: necrotizing
enterocolitis, sepsis, renal failure,
bleeding disorders
COA -Coarcation of
aorta
- narrowing of the aortic arch segment
- narrowing of the lumen of the aorta
due to constricting band  
2 locations where it commonly occurs
1. Preductal - the constriction exists
between the subclavian artery and the
ductus arteriosus, or narrowing occurs
before the ductus arteriosus .
2. Postductal- the constriction is distal
to the ductus arteriosus or the
narrowing occurs after the ductus
arteriosus.
3 major vessels of aortic arch-they supply
blood on the upper half of the body  -Stent
- brachio cephalic
- left subclavian 
-left common artery
Manifestations
 Absent or weak femoral pulse
 Cool lower extremities
 Epistaxis
 Headache
 Upper limb hypertension
 Lower limb hypertension
 Intermittent claudication- decrease o2
! Nursing responsibility - monitor blood
pressure in all 4 extremities
Diagnostic tests 
-ECG
-EOG
-Cardiac catheterization
-Chest x ray
 Treatment
Prostaglandin E
Dopamine - support or enhance
myocardial contraction (left ventricle)
 Surgical Treatment
-End to end anastomosis
-Balloon angiography
2. Cyanotic Heart Disease
- Right to Left Shunting
-Venous to Arterial
-Unoxygenated to Oxygenated
Cyanotic heart disease

Tetralogy of fallot
- it consists of 4 anomalies : over
ridding of the aorta, large VSD,
pulmonary stenosis and right
ventricle hypertrophy due to
pulmonary stenosis.
Manifestations
Cyanosis -tet spells or hyper cyanotic
spells- acute episode of cyanosis when
o2 requirement exceeds blood supply.
Diagnostic test
-Chest xray- BOOT SHAPED HEART
Non pharmacologic management:
knee chest position, fetal position,
shrimp position, squat position
Pharmacologic management  the ventricular level
Morphine sulfate
Propranolol( inderal) - DOC -
decreases pulmonary stenosis
Side effects – impotence
Surgical Management
Palliative : Blalock taussig shaunt
Complete repair: closure of the large VSD
and resection of the stenosis with pericardial
paetch to enlarge the right ventricular
outflow tract.
TGA- Transposition of
the great arteries
- in TGA the aorta arises from the right
ventricle instead of the left and the
pulmonary artery arises from the left
ventricle instead of the right.
-mixed blood flow
-reverse of the major vessels
- no communication between pulmonary
and systemic circulation
- vital organs are supplied with
deoxygenated blood
Diagnostic tests
-Chest xray - EGG SHAPED HEART
Surgical management
-Balloon atrio septostomy/ rashkind
procedure- switching of the great vessels in
-Jatene procedure-switching of the great
vessels in atrial level
! Disorders with increased pulmonary
blood flow
Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus