Cardiovascar Disorders

CARDIOVASCULAR
DISORDERS IN
PEDIATRICS
Chapter 29
Dr. Nouran Katooa

Child Health Nursing 2019-2020
1
OBJECTIVES
At the end of this lecture, students will be able to:
• Identify the types of congenital heart diseases

• Differentiate between cyanotic and acyanotic congenital
heart diseases
• Understand the pathophysiology and clinical manifestations
of each type
• Identify the common acquired heart diseases in pediatrics
• Identify the nursing care of the child and the family
• Identify the types of cardiac transplantation
• Able to draw an accurate nursing care plan for pediatric
heart disorder

2
OUTLINES
• Cardiac structure and function

• Fetal circulation
• What are causes of congenital heart defects?
• Diagnostic tests for heart diseases
• Clinical consequences of congenital heart disease
• Classifications of congenital heart defects
• Clinical manifestations and treatment of each classifications
• Acquired heart disorders and treatments
• Heart transplantation
• Nursing care plan for cardiac disorders pediatric patients

3
CARDIAC STRUCTURE AND FUNCTION
Cardiovascular disorders in children are divided into two

major groups: congenital cardiac defects and acquired heart
disorders.
Congenital heart defects: are anatomic abnormalities present

at birth that result in abnormal cardiac function. It occurs in
around 1% of live births.
Acquired heart disorders: are disease processes or

abnormalities that occur after birth and can be seen in the
normal heart or in the presence of congenital heart defects.
They result from various factors, including infection,
autoimmune responses, environmental factors and familial
tendencies. 4
FETAL CIRCULATION
5
CAUSES OF CONGENITAL HEART
DEFECTS
• Maternal and fetal infections during the first trimester (e.g.
Rubella, mumps)
• Teratogenic effects of drugs taken during early pregnancy
• Maternal diabetes mellitus (gestational diabetes)
• Maternal dietary deficiencies
• Genetic factors (e.g. Down syndrome)
• 90% of the cases have no known causes

6
DIAGNOSTIC TESTS FOR CARDIAC
DEFECTS

7
CONT.
o Pulse oximetry (SPO2): to detect the level of oxygen

saturation in the blood.
o Electrocardiogram (ECG or EKG): detects the normal and

abnormal cardiac rhythms via using 12-leads electrodes.
o Holter monitor: it’s a 24 hr. ECG recorder. This is used if

symptoms and arrhythmia occur daily and a diary is kept
with the child’s caregiver while the holter is worn.

8
CONT.
o Chest radiograph (CXR): is used to determine the heart

size, contour, and alteration in pulmonary vascularity.
o Echocardiogram (ECHO): it is a two dimensional and

Doppler evaluation of the cardiac anatomy, size and
function. It also utilizes sound waves.
o Cardiac Catheterization (Cardiac Cath): an invasive

procedure performed under fluoroscopy that allows
determination of cardiac anatomy, function, pressure, and
oxygen saturations. Child Health Nursing 2019-2020
9
CONT.
o Magnetic resonance imaging (MRI): uses large magnet. Assists in

defining cardiac anatomy that can not be well evaluated by ECHO.

10
CLINICAL CONSEQUENCES OF
CONGENITAL HEART DISEASE
Depending on the severity of the cardiac defect and the
altered hemodynamics, two principal clinical consequences
can occur: Heart Failure (HF) and hypoxemia.
o The conditions can occur alone or together.
o Nursing care plays a critical role in the early identification

and supportive management of these conditions.

11
HEART FAILURE
HF is the inability of the heart to pump an adequate amount of

blood to the systemic circulation at normal filling pressures to
meet the body’s metabolic demands.
Causes of HF:
Volume overload, pressure overload, decreased contractility of
the myocardium, or high cardiac output.

12
CONT.
Pathophysiology:
• Right-sided failure: RV function is reduced. RV end-
diastolic pressure rises, causing increased CVP and systemic
venous engorgement. Systemic venous hypertension causes
hepatomegaly and may cause edema in the extremities.
• Left-sided failure: LV dysfunction occurs and LV end-

diastolic pressure rises; the result is increased pressure in
the LA and also in the pulmonary veins. The lungs become
congested with blood, which leads to elevated pulmonary
pressures and pulmonary edema.

13
CONT.
Clinical Manifestations:
o Impaired myocardial function
o Pulmonary congestion
o Systemic venous congestion
Therapeutic Management:
• Improve cardiac function (increase contractility and decrease
afterload)
• Remove accumulated fluid and sodium (decrease preload)
• Decrease cardiac demands
• Improve tissue oxygenation and decrease oxygen consumption.

14
HYPOXEMIA
Hypoxemia refers to an arterial oxygen tension (or pressure,

PaO2) that is lower than normal and can be identified by
measuring arterial oxygen saturation (SaO2) or PaO2 to detect
decreased levels.
It is a reduction in tissue oxygenation that is caused by low

SaO2 and PaO2 and results in impaired cellular processes.
Causes of Hypoxemia: Cynosis

15
CONT.
• Chronic hypoxemia:
o Polycythemia
o Clubbing
• Mild hypoxemia: asymptomatic except for cyanosis and exhibit
near-normal growth and development
• Sever hypoxemia: signs of poor perfusion “pale and dusky
infant with increased cyanosis; cool to the touch with
diminished pulses; and lethargic with signs of respiratory
distress”

16
CONT.
Therapeutic Management:
o Place infant in knee-chest position

o Employ a calm, comforting approach
o Administer 100% oxygen by face mask
o Monitor blood parameters
o Administer Morphine subcutaneously or through existing
intravenous line (to reduce infundibular spasm)
o Begin intravenous fluid replacement and volume expansion,
if needed
o Administer Prostaglandin E1 (for vasodilation and
reestablish pulmonary blood flow)

17
CLASSIFICATION OF CONGENITAL
HEART DEFECTS
Left-to-Right shunt Right-to-Left shunt

18
CLINICAL FEATURES OF CONGENITAL
HEART DEFECTS
Acyanotic:
Acyanotic heart defects are more common and the majority of
the cases are due to left-to-right shunt (cause symptoms of
HF) .
• No cyanosis
• The heart defect is picked by the presence of murmurs
• Enlargement of the heart
• Failure to thrive: a syndrome in which young children
fails to have satisfactory weight gain and height due to
chronic illness or psychosocial reasons.

19
CONT.
• Recurrent respiratory infections, due to increase blood flow

through the lungs.
• May have features of congestive heart failure: like, rapid

breathing, difficulty in breathing during feeding, marked
sweating while feeding, tachycardia, puffiness of face and
swelling of feet or sacral region, enlarging liver size.
• At risk to develop infective endocarditis: characterized by

prolonged unexplained fever, anaemia, mild splenomegaly,
subtle bleeding manifestations (e.g. hematuria, hemorrhage
under the nail bed, and mild nail clubbing).
20
CLINICAL FEATURES OF CONGENITAL
HEART DEFECTS
Cyanotic (blue baby):
Cyanotic heart defects are less common and occur if the blood
does not pass through the lungs , or there is mixing of blood.
• Blue lips, tongue, fingers and toe nails

• Clubbing of fingers
• Chronic hypoxia leads to polycythemia (increase in RBCs
and hematocrit)
• Cyanosis with crying
• Rapid breathing and squatting
• These children generally do not develop congestive heart
failure
• They are most likely to develop recurrent chest infection 21
ACQUIRED HEART DISORDERS
o Endocarditis
o Rheumatic Fever
o Kawasaki Disease
o Systemic Hypertension
o Dyslipidemia
o Cardiac Dysrhythmias
o Pulmonary Artery Hypertension
o Cardiomyopathy
o Congestive Heart Failure

22
Acyanotic Congenital Heart defects
“Left-to-right shunt”

23
ACYANOTIC CONGENITAL HEART DEFECTS
“LEFT-TO-RIGHT SHUNT”
Atrial Septal Defect (ASD):

It is an abnormal connection between
the right and left atria. It is usually
present in combination with other
heart defects.
Pathophysiology:
The blood flows from the left to the
right across the ASD. This leads to
increased volume on the right side of
the heart.
24
CONT.
o Generally asymptomatic
o Soft systolic murmur which may be detected during
physical examination
Treatment:
o Diuretics are given preoperatively to control the
symptoms of congestive heart failure
o Surgical repair is performed in the preschool age
because there is possibility of spontaneous closure in the
first 2 years of life

25
CONT.
o Traditionally, surgical repair was performed via median

sternotomy (vertical incision along the sternum). The defect
is repaired via stitch closure or patch closure.
o Recently, the closure of ASD has been done via non-surgical

procedure performed in Cardiac catheterization. A device is
placed via a catheter in the femoral vein and up into the
heart and across the ASD, occluding the opining with certain
device.

26
CONT.
Main Complication:
o Atrial arrhythmia
o Heart block secondary to edema or surgery
o Periodic check up is needed

27
Ventricular Septal Defect (VSD):

It is an abnormal connection between the
right and left ventricles.
Pathophysiology:
The blood will flow through the VSD and
recirculate through the pulmonary artery to
the lungs. This leads to left heart
enlargement and pulmonary venous
congestion.

28
CONT.
o Infants with small VSD are a symptomatic
o Infants with moderate to large VSD will show signs and
symptoms of congenital heart failure:
• Tachypnea
• Diaphoresis
• Fatigue
• Under weight
• Usually no cyanosis
• Tired during feeding
o If the VSD diagnosed in an older child, it is because the
defect is small to present symptoms
29
CONT.
Diagnosis:
It is often detected during examination and loud murmur is
heard. Echocardiogram is indicated to determine the size and
location of the defect.
Treatment:
o 75-80% of the cases require no treatments and the defect
will close spontaneously
o If the defect is small, the infant will be treated medically
(Dioxin and diuretics) and watched closely for few months
for weight gain
o Surgical repair is indicated between 3 to 12 months of age
o The defect is closed with stitch or synthetic material
30
Patent Ductus Arteriosus (PDA):
It is a direct connection between the main
pulmonary artery and the aorta.
In fetus, the ductus is necessary for survival.

In term newborn, the ductus begin to close
Within 12 hrs. and completely closed by
2-3 weeks.
PDA results from the failure of normal closure.

The blood flows from the high pressure aorta to the lower
pressure pulmonary artery.
31
CONT.
The signs and symptoms depend on the size of the shunt.
o Small PDA – asymptomatic
o Large PDA - shows signs of congestive heart failure
Diagnosis:
• Hearing murmurs during examinations
• Echocardiogram is done for the diagnosis

32
CONT.
Treatment:
Premature infant, the closure treated medically with infusion

of indomethacin (inhibits synthesis of prostaglandin which is
responsible for the patency of ductus arteriosus)
Full term infants, indomethacin is not effective here.

o Non-surgical closure via using coil occlusion through
cardiac catheterization
o Surgical incision (via left thoracotomy) for surgical ligation
is indicated if the PDA is too large

33
Atrioventricular Canal Defect (AVC):

It is a septal defect in the atrium and
ventricles and the involvement of
AV valves.
The atrial and ventricular septum are
not completed and never meet.
Pathophysiology:
The blood flows left to right causing increased blood flow to
the lungs. As a result, increased venous return to the left side
of the heart and left heart enlargement.
34
CONT.
Signs and symptoms of congestive heart failure. Murmurs
during examination. Usually, infants are symptomatic
immediately after birth.
Treatment:
o The infant should be treated for congestive heart failure
prior surgery
o Surgical repair is done by the 1 year of age to prevent
development of irreversible pulmonary vascular disease
o The goal for the surgery is to close the atrial and
ventricular septal defects. Then, construct new mitral and
tricuspid valves
35
Acyanotic Congenital Heart Defects
“Obstructive lesions”

36
“OBSTRUCTIVE LESIONS”
Coarctation of the Aorta (COA):

It is a stenosis or narrowing in the aorta. Located most
commonly in the thoracic aorta.
The area of the stenosis and degree of
obstructions are vary.
Pathophysiology:
There is increase in resistance of blood flow out the left
ventricle. This may lead to increase pressure and work on the
left ventricle result in left ventricle hypertrophy.

37
CONT.
oSevere coarctation demonstrates symptoms of congestive

heart failure
o Older child is generally asymptomatic
o The classic symptom is upper extremity hypertension and
noticeable difference in blood pressure between arms and
legs
o Diminished pulses in the lower extremity

38
CONT.
Treatment:
o Relief of the obstruction by either surgical or balloon

dilation
o Common surgical repair, is to dissect the stenotic area and
end-to-end anastomosis
o Balloon angioplasty, can be used to dilate the stenotic part
through cardiac catheterization. The balloon is inflated and
the area of stenosis is dilated
o Medications are used postoperatively to control the
residual hypertension

39
Aortic Stenosis (AS):

It refers to narrowing or stricture of the aortic
valve, causing resistance to blood flow in the
left ventricle, decreased cardiac output, left
ventricular hypertrophy, and pulmonary
vascular congestion.
Pathophysiology:
A stricture in the aortic outflow tract causes resistance to ejection
of blood from the left ventricle causes hypertrophy.
If left ventricular failure develops, left atrial pressure will increase

-> increased pressure in the pulmonary veins -> pulmonary vascular
congestion (pulmonary edema).
40
CONT.
• Murmur
• Decreased cardiac output with faint pulses, hypertension,
tachycardia and poor feeding
• In long period: signs of exercise intolerance, chest pain, and
dizziness
Treatment:
oPreoperative management with medications and exercise
restrictions
oPS balloon valvuloplasty can be performed during cardiac
catheterizations
oSurgical valvotomy can be performed in sever cases
41
Pulmonary Stenosis (PS):

It refers to the narrowing of the
pulmonary valve and obstruction of blood
flow from the right ventricle to the lung.
Pathophysiology:
oThe blood is obstructed to flow from, the right ventricle to
the pulmonary artery
oLead to significant increase in right ventricular pressure
oEventually lead to right ventricle failure

42
CONT.
Mild to moderate PS: asymptomatic, and generally murmur is
heard during examination. No cyanosis is seen.
Severe PS: shows symptoms like dyspnea, fatigue and
cyanosis.
Treatment:
oPreoperative management with medications and exercise
restrictions
oIn vacuolar, PS balloon valvuloplasty can be performed
during cardiac catheterizations
oSurgical valvotomy can be performed in sever cases
(incision into cardiac valve to correct the defect)
43
Cyanotic Congenital Heart Defects
“Right-to-left shunt”

44
CYANOTIC CONGENITAL HEART
DEFECTS
“RIGHT-TO-LEFT SHUNT”
Tetralogy of Fallot (TOF):
Is made up of four component, Ventricular Septal Defect,
Pulmonary Stenosis, right ventricle hypertrophy, and
overriding aorta.
o The degree of PS is the most

Important component in TOF.
o The right ventricle

have resistance to pump the blood
through pulmonary artery.

45
CONT.
Clinical Manifestation:
o It depends on the degree of PS

o The child may be profoundly cyanotic or may have no
signs of cyanosis
o Murmur result from the right ventricular outflow tract
obstruction
o Hyper cyanotic episodes is common condition in TOF
o Unoxygenated blood leads to a decrease in arterial oxygen
saturation

46
CONT.
Treatment:
o Medical management prior surgery, but surgery is
definitive for TOF
o Place the child in the knee-chest position to decrease
venous return of unoxygenated blood
o Oxygen administration
o Medications to increase systemic vascular resistance, such
as Phenylephrine
o Surgical intervention: the complete repair usually
performed between 3 to 12 months of age
o The goal of the surgical repair is to widen the PS and
close the VSD
47
DEFECTS
“RIGHT-TO-LEFT SHUNT”
Tricuspid Atresia (TA):
It is characterized by absence or
complete closure of the tricuspid
valve. Therefore, no connection
between RA and RV.
It is associated with ASD, VSD and degree of RV hypoplasia

(incomplete or underdeveloped ventricle).

48
CONT.
Generally cyanotic during the first day of life, due to the
right-to-left shunt.
Treatment:
o Surgical repair: Three palliative procedures to be done to
repair the defect through applying shunt and monitoring
the infant closely. The final surgical repair performed when
the child is greater than 2 years old
o Some cases: ventricular failure may occur and need for

heart transplantation is possible
49
Cyanotic Congenital Heart Defects
“Mixed blood flow”

50
DEFECTS
“MIXED BLOOD FLOW”
Transportation of the Great Artery (TGA):
It is a defect in which the great arteries (aorta and pulmonary
artery) are transported or reversed.
The aorta comes off the right ventricle and the pulmonary artery
comes off the left ventricle.
• Unoxygenated blood enters the RA

to the RV then flows out the aorta to
The entire body
• Oxygenated blood from the lungs to

the LA to the LV and flows out to the
lungs again. Child Health Nursing 2019-2020
51
CONT.
• Infant’s chance of survival depends on the presence of ASD

and PDA. It allows mixing of oxygenated and unoxygenated
blood.
o Cyanosis within the first hours of life
o Acute cyanosis which can not response to oxygen therapy
o The child is usually quite and healthy in weight and height

52
CONT.
Treatment:
o The infant may placed under mechanical ventilator

o Prostaglandin is given “to ensure the patency of ASD or
PDA, preoperatively”
o If there is no ASD, procedure called a balloon atrial
septostomy through cardiac catheterization is performed to
tear the atrium and create ASD
o The arteries switch is the treatment of choice in TGA.
The surgery is done through median sternotomy

53
DEFECTS
“MIXED BLOOD FLOW”
Total Anomalous Pulmonary Venous Return:
It is a rare defect characterized by
failure of the pulmonary veins to join
the left atrium.
The pulmonary veins are abnormally
connected to the systemic venous
circuit via the right atrium or various
veins draining toward the right atrium,
such as the superior vena cava.
Pathophysiology:
The right atrium receives all the blood that normally would
flow into the left atrium. As a result, the right side of the
heart hypertrophies, whereas the left side will remain small.54
CONT.
Generally cyanotic during the first day of life.
Treatment:
o Surgical repair is performed in early infancy

55
Acquired Heart Disorders

56
RHEUMATIC FEVER
• It is a post-infective disorder that

affect the joints, the heart and other
organs.
• The common age is between 5-14

years old.
• The cause: beta hemolytic

streptococcal infection of the throat,
that has been inadequately treated or
not treated.

57
CONT.
• Two weeks of sore throat, the child develops high grade fever,
with pain, swelling in several joints.
• The main danger of the rheumatic fever is that it may affect and
damage the heart.
Tachycardia, chest pain,
dilatation of the heart,
murmurs, joint pain and
Swelling. It may lead to
congestive heart failure.

58
CONT.
Treatment:
o During the acute phase is administering anti-inflammatory

agents. Penicillin is used for the initial treatment
o Aspirin is given for the polyarthritis
o The child is placed on bed rest until the inflammation
resolved
o Routine and frequent cardiac follow up is recommended

59
CONGESTIVE HEART FAILURE (CHF)
• It may occur due to a variety of

cardiac and non-cardiac disorders.
• It is when the heart is unable to

maintain satisfactory cardiac out put
to meet the metabolic needs of the
body. Or unable to receive blood into
the ventricles during diastole.
Common Causes: congenital heart diseases, rheumatic heart

disease, myocarditis, severe anaemia and hypertension.
60
CONT.
o Fatigue
o Anorexia
o Palpitation
o Cough and breathlessness on walking
or going upstairs
o Dyspnea at rest in severe cases
o Elevated jugular venous pressure
o Edema feet
o Tachycardia
o Cardiomegaly
o Enlarged liver
61
CONT.
Treatment:
The goal is to reduce the volume overload, improve contractility,
and decreasing cardiac load.
o Diuretics (e.g. Furosemide or Lasix) therapy for volume

overload
o Inotropes (e.g. Digoxin – Dopamine – Doputamine) to improve
cardiac contractility
o Vasodilator (e.g. Captopril – Nitrates- Enalopril) to reduce
vascular resistance and increase cardiac output
o Angiotensin-converting enzyme (ACE) inhibitors to decrease
systemic vascular resistance and vasodilation
o In severe cases, cardiac surgery is indicated for heart
transplantation
62
HEART TRANSPLANTATION
Heart transplantation has become a treatment option for

infants and children with worsening heart failure and a limited
life expectancy despite maximum medical and surgical
management.
Indications for cardiac transplantation in children are

cardiomyopathy and end-stage CHD.
It is also an option for patients with some forms of complex

congenital cardiac defects such as hypoplastic left heart
syndrome for which conventional surgical approaches have a
high mortality.
63
CONT.
The heart transplant procedure may be:

Orthotopic refers to removal of the recipient’s own heart and
implantation of a new heart from a donor who has experienced
brain death but whose heart is healthy. The donor and
recipient are matched by weight and blood type.
Heterotopic refers to when the recipient’s own heart is left in

place and a new heart is implanted to act as an additional
pump or “piggyback” heart. This type of transplantation is
rarely done in children .

64
NURSING CARE OF THE CHILD WITH
CONGENITAL HEART DISEASE AND
FAMILY
• Help the family adjust to the disorder

• Educate the family about the disorder
• Help the family manage the illness at home
• Prepare the child and family for invasive procedures
• Provide postoperative care
• Plan for progressive activity
• Observe for complications of heart surgery
• Provide emotional support
• Plan for discharge and home care

65
NURSING CARE PLAN
Diagnosis Planning Intervention Rationale

1) Ineffective - Child will have 1)Assess breathing sounds - To detect any signs of pleural
breathing pattern adequate frequently. effusion or pneumothorax.
related to respiratory
pulmonary edema function 2) Provide analgesia or - A child who is in pain is
or poor respiratory sedation. unlikely to take deep breath.
effort, evidenced - Child will have
by tachypnea, and no respiratory 3) Obtain chest x-ray as - To evaluate the presence of
signs of respiratory distress. ordered. pneumothorax or plural
distress. effusion.
4) Administer diuretics as - To prevent fluid
prescribed. accumulation in the lung.
5) Provide supplemental - To maintain oxygen

oxygen as needed. saturation in normal range.
6) Obtain arterial blood -To evaluate for CO2 retention

gases as ordered. or hypoxia.
Evaluation Oxygen saturation is within the normal range and there is no respiratory distress.
CONT.

2) Decreased 1) Administer volume
cardiac output - Child will have resuscitation for - To prevent hypotension.
related to decrease well-perfused hypovolemia.
stroke volume, extremities. - To maintain normal perfusion.
evidenced by poor 2) Add pharmacological
perfusion, - Cardiac rhythm support if the child shows - To detect any arrhythmia.
hypotension, will be regular. signs of decreased cardiac
decrease out put, out put. - To maintain normal electrolyte
and arrhythmia. which will prevent arrhythmia
3) Record rhythm strips for that is related to electrolyte
any change in rhythms. imbalance.
4) Monitor calcium,
magnesium, and potassium
level for replacement as
needed.
Evaluation Extremities are well perfused.
-Heart rhythm and rate are normal 67
CONT.

3) Acute pain The child's 1) Perform neurologic check - Evaluate baseline data and
related to pain will be frequently. observe for signs of pain.
operative site controlled.
evidenced by 2) Administer analgesia as - To prevent post operative
crying, ordered. pain.
tachycardia,
diaphoresis, and 3) Administer sedative as - To alleviate anxiety and help
hypertension. ordered while on mechanical the child to calm
ventilator.
4) Provide non- - To augment pharmacological

pharmacological measures to intervention in controlling the
relief the pain (e.g. relaxation pain.
exercise, music).
Evaluation Child’s pain and anxiety are controlled

68
REFERENCES
Ber man, A.T, Snyder, S.J. & F rand sen , G. (20 16 ). Kozier & Erb’s Fundamentals
of Nursing : Concepts, Process, and Practice (1 0 th ed .). Pearso n Edu cation :
Boston . ISBN: 9780133974362.
Hockenb erry, M.J. & Wilson , D. (201 4 ). Wong's Nursing Care of Infants and
Children (10th ed.). St. Louis: Elsevier. ISBN: 0323222412. (Chapter 29)
Po lts , N. L. & Mand teo , B.L. (2 011 ). Pediatric Nursing Caring for Children and
Their Families (3rd ed). Delmar Cengage Learning : Australia .
Ricci, S. ( 2013). Essentials of Maternity, Newborn & Women's Health Nursing

(3rd ed.). Philadelph ia: Wolters Kluwer/Lipp in co tt Williams & Wilkins.
Singh,M. (2014). Essential Pediatric for Nurses . CBS Publishers & distribu ters.
New Delhi, India.

69

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Cardiovascar Disorders

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CARDIOVASCULAR

Dr. Nouran Katooa

At the end of this lecture, students will be able to:

• Identify the types of congenital heart diseases

Child Health Nursing 2019-2020

• Cardiac structure and function

Child Health Nursing 2019-2020

Cardiovascular disorders in children are divided into two

Congenital heart defects: are anatomic abnormalities present

Acquired heart disorders: are disease processes or

• Teratogenic effects of drugs taken during early pregnancy

• Maternal diabetes mellitus (gestational diabetes)

• Maternal dietary deficiencies

• Genetic factors (e.g. Down syndrome)

• 90% of the cases have no known causes

Child Health Nursing 2019-2020

o Pulse oximetry (SPO2): to detect the level of oxygen

o Electrocardiogram (ECG or EKG): detects the normal and

o Holter monitor: it’s a 24 hr. ECG recorder. This is used if

Child Health Nursing 2019-2020

o Chest radiograph (CXR): is used to determine the heart

o Echocardiogram (ECHO): it is a two dimensional and

o Cardiac Catheterization (Cardiac Cath): an invasive

o Magnetic resonance imaging (MRI): uses large magnet. Assists in

Child Health Nursing 2019-2020

o The conditions can occur alone or together.

o Nursing care plays a critical role in the early identification

Child Health Nursing 2019-2020

HF is the inability of the heart to pump an adequate amount of

Child Health Nursing 2019-2020

• Left-sided failure: LV dysfunction occurs and LV end-

Child Health Nursing 2019-2020

Child Health Nursing 2019-2020

Hypoxemia refers to an arterial oxygen tension (or pressure,

It is a reduction in tissue oxygenation that is caused by low

Causes of Hypoxemia: Cynosis

Child Health Nursing 2019-2020

Child Health Nursing 2019-2020

o Place infant in knee-chest position

Child Health Nursing 2019-2020

Left-to-Right shunt Right-to-Left shunt

Child Health Nursing 2019-2020

Child Health Nursing 2019-2020

• Recurrent respiratory infections, due to increase blood flow

• May have features of congestive heart failure: like, rapid

• At risk to develop infective endocarditis: characterized by

• Blue lips, tongue, fingers and toe nails

Child Health Nursing 2019-2020

Child Health Nursing 2019-2020

Atrial Septal Defect (ASD):

Child Health Nursing 2019-2020

o Traditionally, surgical repair was performed via median

o Recently, the closure of ASD has been done via non-surgical

Child Health Nursing 2019-2020

Child Health Nursing 2019-2020

Ventricular Septal Defect (VSD):

Child Health Nursing 2019-2020

In fetus, the ductus is necessary for survival.

PDA results from the failure of normal closure.

Child Health Nursing 2019-2020

Premature infant, the closure treated medically with infusion

Full term infants, indomethacin is not effective here.

Child Health Nursing 2019-2020