NCM 102

HIGH RISK Children

CONGENITAL HEART DEFECT

CONGENITAL HEART DEFECT – anatomic abnormalities present at birth that results in abnormal cardiac
function
Acquired heart disorder- the disorder happens after birth, after infection or autoimmune

Review:

• Veins- carry blood to the heart

• Arteries- carry blood away from the heart
• Atrium- upper/filling
• Ventricles- lower/pumping
• Right side- deoxygenated blood/ going to the lungs
• Left side- oxygenated/going to the system

4 chambers of the heart/valves

1.Right atrium
2.Triscupid valve
3.Right ventricle
4.Pulominic valve
5.Left atrium
6.Mitral valve ( bicuspid valve)
7.Left ventricle
8.Aortic valve

Valve-to protects back flow

•Inferior vena cave- lower body/ deoxygenated blood
•Superior vena cava- upper body/head/deoxygenated blood
•Pulmonary artery- deoxygenated blood from the heart to the lungs

•Pulmonary veins- oxygenated blood from lungs to the LA

•Aorta- oxygenated from the LV to the rest of the body

1.The deoxygenated blood comes from superior and inferior vena cava
2Will go to the right atrium the will go to tricuspid valve
3.Then go to pulmonic valve, the pulmonary artery (deoxygenated blood) to the lungs
4.The return by the pulmonary veins (oxygenated blood) going to left atrium
5.Then go inside the left ventricle through mitral valve then left ventricle, aortic valve going to the aorta
and distribute to the body
Video:
Veins- towards heart
Arteries away from the heart

1.INC/SVC

2.RA

3. Tricuspid valve

4.RV

5.Pulmonic

6.Pumonary artery

7.Lungs

8.Lungs

9.Pulmonary veins

10.LA

11.Mitral

12.LV

13.Aortic

14.Aorta
T P M A- toilet paper my assets

Hemodynamics
•As blood is pumped through the heart
1.Flows from an area of high pressure to one of low pressure
2.Takes the path of last resistance
•The higher the pressure of the gradient, the faster the rate of flow
•The higher the resistance, the slower the rate of flow

•Normally:
1.Pressure on the right side of the heart is lower than the left side
2.Resistance in the pulmonary circulation is less than that in the systemic circulation
•Pulmo- less resistance
•Systemic high resistance

Fetal circulation – use by placenta ni mother

3 shunts- to by pass the lungs

1.Ductus venous -( lapit lang sa umbilical cord ) liver/helps to shunt blood to the IVC
(naga close sya during cord clamping)
2.Foramen ovale- shunt between R atrium/L atrium
( normally circulation: no shunts between right and left atrium)
(mag close sya pagwasa ni baby kay nag exchange naman ang pressure)kaya si left
naman ang higher
3.Ductus arteriosus- connects the pulmonary artery to the aorta
(close during cutting of umbilical cord) there is an inhibition of prostaglandin
- dapat ang kaning tatlo mawala na after birth
Normal circulation mas taas sa left but during feta; circulation mas taas sa right

•1 umbilical vein (oxygenated)

•2 umbilical arteres (deoxygenated blood)
Bakit increase ang pressure ni right? – kasi dito papasok si blood kay hindi ginagamit si lungs
kaya naga by pass sya

ACYANOTIC TYPE -dili sya mag blue

A. ATRIAL SEPTAL DEFECT – di nag close si foramen ovale
•Abnormal opening in the septum between left and right atria
•Usually detected after neonatal period
S/S: - decrease activity tolerance
- dyspnea- left atrium mag adto sya sa right atrium dayun
+ murmur – upper left sternal border
Mgt: Surgery – 2 and 4 yrs of age –( surgical patch closure called pericardial patch,
Dacron patch, cardiac catheterization
B.VENTRICULAR SEPTAL DEFECT (most common heart defect)
•Opening in the septum between ventricles, causing a left to right shunt
•Small VSD – asymptomatic (mostly naga close spontaneously)
•Large –hypertrophy and/or failure of right ventricle ( needs surgery na)
S/S: increase respiratory effort Frequent respiratory infection
+ murmur – heard best @ lower left sternal border Congestion - pulmonary
Mgt : Surgery
Cause hypertrophy if the right ventricle unable to accommodate increase workload

Video:
- This causes some red blood to mix with blue blood in the right ventricle
- VSDs are often first detected as heart murmurs when a doctor examines a child
- the treatment depends on the other factors as well

C.PATENT DUCTUS ARTERIOSUS

•Connects pulmonary trunk to aorta
S/S: + murmur – machinery type @ middle to upper left sternal border poor feeding
tiring easily
Mgt: Indomethacin- it is a prostaglandin inhibitor
Surgery – ligation -tahiun sya from pulmonary artery to aorta
Pulmonary artery- deliver deoxygenated blood form heart to lungs
Prostaglandin- inhibit the closure
D.COARCTATION OF AORTA
•Narrowing of the aorta
•Significant decrease in blood flow to abdomen and legs
•Blood shunted to head and arms
S/S: BP /pulse – higher in arms than legs
High pulse pressure in carotid and radial pulses Warm upper body
Mgt: surgery – angioplasty – repaired of narrowed vessel
 E.VALVULAR DEFECTS – most common in pulmonic valve
a. right side – tricuspid
pulmonic valve
b.left side – mitral
aortic valve
S/S: palpitations ,Pain ,Edema
Weakness, dizziness
Mgt: Surgery – valvotomy (cutting of the valve to relives obstruction),
valvuloplasty (insertion of catheter)valve replacement
Congenital pulmonary stenosis- a heart condition that characterized by obstruction of blood
flow from right ventricle to pulmonary artery gong to lungs
-it depends on the valve that is affected
- regurgitation- makikita sa 2D echocardiogram

Video:
A newborn with extreme pulmonary stenosis present an emergency situation because the
right ventricle cannot eject sufficient blood to pulmonary artery to maintain normal oxygen
level
Balloon dilation – surgery

CYANOTIC TYPE
A. TRANSPOSITION OF GREAT VESSELS
✓ Aorta arises from right ventricle (nakabit sa apulmonary artery), pulmonary artery arises from
left ventricle (dapat sya aorta) oxygenated blood therefore circulates through left side of
heart to lungs and back to left side
✓ unoxygenated blood enters the right atrium from body ,goes back to right ventricle and back to
circulation without being oxygenated

S/S:
 Blueness of the skin
 Shortness of breath
 Poor feeding
 Clubbing of the fingers or toes
 peripheral hypoxemia
 severe progressive pulmonary hypertension.
 Complications:
 Arrythmias
 Heart failure
 Mgt: Balloon Atrial Septostomy (Rashkind Procedure)
 Video:
Oxygen poor (blue) blood goes to the body via the aorta
Oxygen-rich (red) blood goes back to the lungs via the pulmonary artery
1.Aorta and pulmonary artery are connected to the wrong ventricles
2.Deoxygenated blood is pumped back to the body

B. TETRALOGY OF FALLOT

 This condition is characterized by the following four defects:

 an abnormal opening, or ventricular septal defect, that allows blood to pass from the
right ventricle to the left ventricle without going through the lungs

 a narrowing (stenosis) at or just beneath the pulmonary valve that partially blocks the
flow of blood from the right side of the heart to the lungs

 the right ventricle is more muscular than normal

 the aorta lies directly over the ventricular septal defect

 Tetralogy of Fallot results in cyanosis (bluish color of the skin and mucous membranes due to
lack of oxygen).

 Cyanosis develops within the first few years of life.

 First presentation may include poor feeding, fussiness, tachypnea, and agitation.

 Cyanosis occurs and demands surgical repair.

 Dyspnea on exertion is common.

 Hypoxic "tet" spells are potentially lethal, unpredictable episodes that occur even in
noncyanotic patients with TOF. These spells can be aborted with relatively simple procedures.
  Birth weight is low.

 Growth is retarded.

 Development and puberty may be delayed.

 Right ventricular predominance on palpation

 May have a bulging left hemithorax

 Systolic thrill at the lower left sternal border

 Single S2 - Pulmonic valve closure not heard

 Systolic ejection murmur

 Cyanosis and clubbing - Variable

 Squatting position

 Scoliosis - Common

 Retinal engorgement

 Hemoptysis

Video:

VSD

Overriding aorta

Pulmonary stenosis

Right ventricular

Hypertrophy