Nursing Care of a Family

When a Child Has a

Cardiovascular
Disorder
Heart Problems

CONTINUE
 Cardiovascular

The blood circulatory system is a

system of organs that includes the
heart, blood vessels, and blood which
is circulated throughout the entire body
of a human or other vertebrate.

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Adult Circulation

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Fetal Circulation

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 1
Congestive Heart Failure
Inability of the heart to supply oxygenated blood to
meet the metabolic demand of the body.

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Right Side Congestive Heart Failure

When heart failure affects the right

side of the heart, it has a hard time
pumping blood to the lungs. This
causes blood to back up in the
liver and veins, which can cause
fluid retention in the body

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 Cause
● Stenosis
● COR Pulmunale
● Scarring of lung tissue

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Left Side Congestive Heart Failure

The left ventricle of the heart no

longer pumps enough blood around
the body. As a result, blood builds up
in the pulmonary veins.

Left sided heart failure can ultimately

lead to right sided failure.

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 Cause
● Stenosis
● Diabetes.
● Obesity.
● Sleep apnea.
● High blood pressure
● Smoking.

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Pathophysiology
Stenosis

Blood Unable to
flow

Back flow of
the blood

Excess CO2
in body

Cyanosis

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 Diagnostic

● Chest X-Ray
● Pulmonary Arterial Pressure
● Pulmonary Capillary Wedge
Pressure
● Echocardiogram

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Sign / Symptoms

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 Medication
Antiarrythmic
Class III agent prolong the
cardiac action potential.
Digoxin
Vasodilator;
(+) inotropic (contractility), (-)
chronotropic (↓HR), (-)
dromotropic (Electrical
conductivity)

Morphine
Diuretic
Vasodilator

Aminophylline
Oxygen
Bronchodilator

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 Nursing Management:

High Fowler
Monitor vital signs
Assess Heart Rate / Low sodium,Low fat diet
Apical Pulse
Be wary of Toxicity Restriction in sodium, fats,
coffee, and Chocolate
-Nausea and vomiting
-G.I Upset
-Xanthopsia - Yellow Halo Vision Restricted Activity of
Monitor Intake & Output Daily Living

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 REMEMBER!!

In left-sided heart failure, the left side of the heart is weakened and
results in reduced ability for the heart to pump blood into the body. In
right-sided heart failure, the right side of the heart is weakened and
results in fluid in your veins, causing swelling in the legs, ankles, and
liver.

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Congenital Heart Disease 2

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 Congenital Heart
Disease
Congenital heart disease is a general
term for a range of birth defects that
affect the normal way the heart
works. The term "congenital" means
the condition is present from birth.

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 Cause
● Genetics- underlying
genetic problems
● Environmental problems
● Maternal causes.

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Pathophysiology
Congenital heart
Disease

Increased Pulmonary
blood flow

Pulmonary
Hypertension

Pulmonary
vascular
obstructive
Disease

(↓)
Pulmonary
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blood flow
 Diagnostic

● Chest X-Ray
● Pulmonary Arterial Pressure
● Pulmonary Capillary Wedge
Pressure
● Echocardiogram

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 SIGNS AND SYMPTOMS

● Cyanotic
● Heart Murmur
● Rapid Breathing
● Swelling
● Shortness of breathing

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 SIGNS AND SYMPTOMS

● Cyanotic
● Heart Murmur
● Rapid Breathing
● Swelling
● Shortness of breathing

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Management
 Medication
Digoxin Furosemide
(+) inotropic (contractility), (-)
chronotropic (↓HR), (-) Diuretic
dromotropic (Electrical
conductivity)

Morphine
Vasodilator, Anxiolytic
Diuretic

Aminophylline
Oxygen
Bronchodilator

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 Nursing Management:

High Fowler
Monitor vital signs
Assess Heart Rate / Low sodium,Low fat diet
Apical Pulse
Be wary of Toxicity Restriction in sodium, fats,
coffee, and Chocolate
-Nausea and vomiting
-G.I Upset
-Xanthopsia - Yellow Halo Vision Restricted Activity of
Monitor Intake & Output Daily Living

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 Disorder with increased
A. pulmonary blood flow

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Ventricular Septal Defect
(VSD)
● Hole between the lower heart chamber. This wall is
called ventricular septum. It causes higher pressure in
the heart or reduced oxygen to the body.
● A ventricular septal defect happens during pregnancy
if the wall that forms between the two ventricles does
not fully develop, leaving a hole. A ventricular septal
defect is one type of congenital heart defect.
Congenital means present at birth.

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 Cause/Risk
Factors
● Genetics- underlying
genetic problems
● Environmental problems
● Maternal causes.

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 Diagnostic

● Chest X-Ray
● Ultrasound
● Pulmonary Capillary Wedge
Pressure
● Echocardiogram
● Pulse Oximetry

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 SIGNS AND SYMPTOMS

● Shortness of breath,
● Fast or heavy breathing
● Sweating,
● Tiredness while feeding, or
● Poor weight gain.
● Heart murmur

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 Management
Medical Management Nursing Management

● Furosemide- Diuretic · Monitor Vital Signs

- Prior HR, 02 saturation, Blood pressure and

● Digoxin Respiratory rate.

Surgical Management · Be wary of Toxicity

- Nausea and vomiting

● Open heart Surgery
● Catheter procedure - G.I Upset

- Xanthopsia -Yellow Halo Vision

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Atrial Septal Defect (ASD)
An atrial septal defect (ASD) is a hole in the heart between the upper chambers (atria). The
hole increases the amount of blood that flows through the lungs. The condition is present at
birth (congenital heart defect).

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Cause/Risk Factor
· Genetics- underlying genetic problems

· Environmental problems
· Maternal causes

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Sign/Symptoms
· Shortness of breath,

· Fast or heavy breathing,

· Sweating,

· Tiredness while feeding, or

· Poor weight gain.

· Heart murmur

· Irregular heartbeats (arrhythmias)

· Cyanotic
Management
Medical Management

· Indomethacin

· Digoxin

Surgical management

· Open-heart surgery. This is the preferred procedure for repairing most ventricular septal defects. A
surgeon uses a patch or stitches to close the hole between the lower heart chambers. This type of VSD
surgery requires a heart-lung machine and an incision in the chest.

· Catheter procedure. Some ventricular septal defects can be repaired using thin, flexible tubes
(catheters) without the need for open-heart surgery. The health care provider inserts a catheter into a
blood vessel, usually in the groin, and guides it to the heart. A small device is inserted through the
catheter to close the hole.
Nursing management
· Monitor Vital Signs

- Prior HR, 02 saturation, Blood pressure and Respiratory rate.

· Be wary of Toxicity

- Nausea and vomiting

- G.I Upset

- Xanthopsia -Yellow Halo Vision

· Observe the patient for complications and adverse reactions to drug therapy.

· Regularly assess the patient’s cardiopulmonary function.

Patent Ductus Arteriosus (PDA)
Patent ductus arteriosus (PDA) is a persistent opening between the two major blood
vessels leading from the heart. The heart problem is present from birth. That means it is
a congenital heart defect.
An opening called the ductus arteriosus is part of a baby's blood flow system in the
womb. It usually closes shortly after birth. If it remains open, it's called a patent ductus
arteriosus.
Cause/Risk Factor
The exact causes of congenital heart defects are unclear. During the first
six weeks of pregnancy, a baby's heart starts to form and beat. The major
blood vessels to and from the heart grow. It's during this time that certain
heart defects may begin to develop.
· Premature Birth
· Genetics
· German measles during pregnancy (Congenital rubella syndrome
[CRS])
Diagnostic
● Echocardiogram
● Chest X-Ray
● Blood test
● Pulse oximetry
● Ultrasound
Sign/Symptoms
● CALL
○ Cardiac: Continuous “Machinery Like “Murmur”. Endocarditis Risk
(↑) HR. Heart Failure
○ Activity intolerance: Fatigues easily, Sweat in basic activity
○ Lung: Pulmonary Hypertension; increased blood flow, ↑ pressure.
Feeding issues
○ Loss weight- burning calories to breath
Management

Medical
Surgical
● Indomethacin
● Digoxin Cardiac catheterization
● Oxygen
● Prostaglandin Inhibitors: Inflammation

Nursing

· Monitor Vital Signs

o Prior HR, 02 saturation, Blood pressure and Respiratory rate.

· Activity and rest

· Be wary of Toxicity

o Nausea and vomiting

o G.I Upset

o Xanthopsia -Yellow Halo Vision

B. Disorders with Obstruction to blood flow
Pulmonary Stenosis

Aortic Stenosis

Coarctation of the Aorta

Pulmonary Stenosis
Pulmonary valve stenosis is a type of heart valve disease that
involves the narrowing of the pulmonary valve, which controls
the flow of blood from the heart's right ventricle into the
pulmonary artery to carry blood to the lungs.
Cause/Risk Factor
· Congenital (genetics)
· Premature
· Maternal Causes
Diagnostic
· Chest X-Ray
· Electrocardiogram (ECG)
· Fetal Echocardiogram
· Cardiac catheterization
Sign/Symptoms
· Hard or fast breathing
· cyanotic
· Shortness of breath
· being very tired
· poor weight gain
· Fast heart rate
· Swelling of the legs, ankles, feet, face, or belly (abdomen)
· Fainting (syncope)
Management
Surgical

· Balloon valvuloplasty

· Valve Replacement

Medical

· Oxygen

· Alprostadil (Prostaglandin E1, PGE1) is used to treat ductal-dependent

cyanotic congenital heart disease, which is caused by decreased pulmonary blood
flow.

· Digoxin

· Morphine
Nursing
· Monitor Vital Signs
o Prior HR, 02 saturation, Blood pressure and Respiratory
rate.
· Observe the patient for complications and adverse
reactions to drug therapy.
· Regularly assess the patient’s cardiopulmonary function.
Aortic Stenosis
Aortic valve stenosis causes a thickening and narrowing of the valve between
the heart's main pumping chamber (left ventricle) and the body's main artery
(aorta). The narrowing creates a smaller opening for blood to pass through. Blood
flow from the heart to the rest of the body is reduced or blocked. Typically, the
aortic valve has three cusps (tricuspid aortic valve), but some people are born with
an aortic valve that has two cusps (bicuspid aortic valve)
Cause/Risk Factor

· Congenital heart Defect

· Rheumatic fever

Risk Factor

· Certain heart conditions present at birth (congenital heart defects), such as a bicuspid aortic
valve

· Chronic kidney disease

· Having heart disease risk factors, such as diabetes, high cholesterol and high blood pressure

· History of infections that can affect the heart, such as rheumatic fever and infective
endocarditis

· History of radiation therapy to the chest

Diagnostic
· Echocardiogram
· Electrocardiogram
· Chest X-Ray
· CT Scan
· Cardiac catheterization
Sign/Symptoms
·
Heart Murmur
· Shortness of Breathing
· Not eating Enough
· Rapid Heart Beat
Management
Medical
· Morphine- Vasodilator
· ACE inhibitors- which can open blood vessels more fully
· Beta Blockers- to slow your heart rate
· Diuretics- to lessen the amount of fluid in your body and ease stress on your
heart
Surgical
· Balloon valvuloplasty
· transcatheter aortic valve replacement, or TAVR
Nursing
· Monitor Vital Signs
o Prior HR, 02 saturation, Blood pressure and
Respiratory rate.
· Observe the patient for complications and adverse
reactions to drug therapy.
· Regularly assess the patient’s cardiopulmonary
function.
Coarctation of the Aorta
Coarctation of the aorta is a birth defect in which a part of
the aorta is narrower than usual. If the narrowing is severe
enough and if it is not diagnosed, the baby may have serious
problems and may need surgery or other procedures soon after
birth. For this reason, coarctation of the aorta is often
considered a critical congenital heart defect.
Cause/Risk Factor
· The causes of heart defects, including coarctation of the aorta,
among most babies are unknown. Some babies have heart defects
because of changes in their genes or chromosomes. Heart defects,
like coarctation of the aorta, are also thought to be caused by a
combination of genes and other risk factors, such as things the
mother comes in contact with in the environment, what the mother
eats or drinks, or medicines the mother uses.
Diagnostic
· Echocardiogram
· Electrocardiogram
· Ultrasound
· Cardiac catheterization
Sign/Symptoms
· pale skin
· irritability
· heavy sweating
· difficulty breathing
· Cyanotic
· Weak pulse on extremities
Management

Medical

· Morphine- Vasodilator

· ACE inhibitors- which can open blood vessels more fully

· Beta Blockers- to slow your heart rate

· Diuretics- to lessen the amount of fluid in your body and ease stress on your heart

Surgical

· Balloon angioplasty and stenting- The term "angioplasty" means using a balloon to stretch
open a narrowed or blocked artery. However, most modern angioplasty procedures also
involve inserting a short wire mesh tube, called a stent, into the artery during the procedure.
The stent is left in place permanently to allow blood to flow more freely.
Nursing
· Monitor Vital Signs
o Prior HR, 02 saturation, Blood pressure and Respiratory
rate.
· Observe the patient for complications and adverse reactions
to drug therapy.
· Regularly assess the patient’s cardiopulmonary function
 Disorder with Mixed
C. blood flow

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Transposition of the
great Arteries
➢ A congenital heart defect which the
two main arteries carrying blood
out of the heart - the aorta and the
pulmonary artery - are switched
hence, transposed.

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Transposition of the Great Arteries

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 Cause/Risk Factor
of TGA
➢ A history of German measles
(rubella) or another viral illness
in the mother during
pregnancy.
➢ Drinking alcohol or taking
certain medications during
pregnancy.
➢ Smoking during pregnancy.
➢ Mother has diabetes.
➢ Mother is 40 years of age and
older.

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Pathophysiology

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 Diagnostics
● ECHOCARDIOGRAM
- uses sound waves to create
detailed images of the unborn baby's
heart. It can help a health care provider
confirm the diagnosis of transposition of
the great arteries.

➢ CARDIAC CATHETERIZATION
- it is not necessary unless the
coronary arteries cannot be
visualized by cardiogram.

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Sign and Symptoms

➢ Severe cyanosis
➢ Hypoxemia
➢ Fast or labored breathing
➢ Low appetite
➢ Rapid heart rate
➢ Slow weight gain
➢ Weak pulse

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 Management
MEDICAL
➢ Prostaglandin E1 - used to keep the ductus arteriosus patent

SURGICAL
➢ Balloon Atrial Septostomy
- a procedure where a small hole is made in the wall
between the left and right atria of the heart. (temporary)

➢ Arterial Switch operation or Jatene procedure

- This is the most common surgery used to correct
transposition of the great arteries. During an arterial switch
operation, the pulmonary artery and the aorta are moved
to their correct positions.
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Balloon Atrial Septostomy

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Nursing Management:
NURSING
➢ maintaining ductal patency with
continuous intravenous (IV)
prostaglandin E1 (PgE1) infusion
to promote pulmonary blood flow,
increase left atrial pressure, and
promote left-to-right
intercirculatory mixing at the atrial
level.
➢ Monitor and supply oxygen.

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 TOTAL ANOMALOUS
PULMONARY VENOUS
RETURN
➢ It is a congenital heart defect in
which the pulmonary veins do
not connect
normally to the left atrium.
➢ In a baby with TAPVR,
oxygen-rich blood does not
return from the lungs to the
left atrium. Instead, the
oxygen-rich blood returns to the
right side of the heart.
Here, oxygen-rich blood mixes
with oxygen-poor blood.

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PATHOPHYSIOLOGY
Congenital heart defect
↓
Pulmonary vein does not connect to
the left atrium
↓
Oxygen-rich blood returns to the
right side of the heart (RA) instead
of LA
↓
Oxygen-rich blood mixes with
oxygen-poor blood
↓
Slightly oxygen-poor blood goes to
systemic circulation
↓
Mild cyanosis

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 DIAGNOSIS

➢ EKG
- To check right ventricle hypertrophy.

➢ FETAL ECHOCARDIOGRAM
- To check ASD. R→L shunt.

➢ CHEST X-RAY
- To check the pulmonary edema.

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 SIGNS AND SYMPTOMS
➢ Mild cyanosis
➢ Weak pulse
➢ Poor feeding
➢ Extreme sleepiness
➢ Crackles
➢ Loud 2nd heart sound
➢ Snowman sign
➢ Pulmonary edema

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 MANAGEMENT

Surgery is done right away for

newborns with obstructed
total anomalous pulmonary
venous return. Some of these
children will need
extracorporeal life support
(ECMO) prior to surgery
because of their blood flow
instability.

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 MANAGEMENT
NURSING

While your child is in the CICU, special equipment will be used to help him/her recover:
➢ Ventilator
➢ intravenous (IV) catheters
➢ Arterial line
➢ Nasogastric (NG) tube
➢ Urinary catheter
➢ Chest tube
➢ Heart monitor

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D.
DISORDERS WITH
DECREASED
PULMONARY BLOOD
FLOW

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TRICUSPID ATRESIA
Tricuspid atresia is a birth defect
of the tricuspid valve, which is the
valve that controls blood flow from
the right atrium (upper right
chamber of the heart) to the right
ventricle (lower right chamber of
the heart). Tricuspid atresia occurs
when this valve doesn’t form at all,
and no blood can go from the right
atrium through the right ventricle
to the lungs for oxygen.
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 TYPES OF TRICUSPID ATRESIA

TYPE 1:
● The pulmonary artery and aorta (or “great arteries”) are in the correct place. However, they
may have a hole in their ventricle wall (ventricular septal defect) or a problem with the
pulmonary valve.

TYPE 2:
● The pulmonary artery and aorta are in each other’s places. Also, there’s a ventricular septal
defect and possibly a problem with pulmonary valve.

TYPE3:
● There are different problems with the position of the pulmonary artery and aorta and the
right and left ventricles.
 CAUSES
Most congenital heart defects, including tricuspid atresia, result from changes that occur early as the baby's heart is
developing before birth. The exact cause is usually unknown.

RISK FACTORS

Most congenital heart defects, including tricuspid atresia, result from changes that occur early as the baby's heart is
developing before birth. The exact cause is usually unknown.

Other things that might increase your baby's risk of tricuspid atresia include:

● Having German measles (rubella) or another viral illness during early pregnancy
● Family history of congenital heart disease
● Drinking alcohol during pregnancy
● Smoking before or during pregnancy
● Poorly controlled diabetes during pregnancy
● Use of certain medications during pregnancy, including some used to treat acne, bipolar disorder and seizures
 PATHOPHYSIOLOGY

Atresia of tricuspid valve Blood enters RV through VSD

No communication between RA and RV From RV blood enters Pulm trunk

RV is underdeveloped Blood enters pulm trunk via PDA

Systemic venous blood received by RA Increased pulmonary blood flow

Enters LA through PFO or ASD LA and LV hypertrophy

Mixing of systemic and pulmonary blood CHF

Enters LV
 DIAGNOSIS

1. pulse oximeter monitoring

2. a chest X-ray
3. electrocardiogram (also called ECG or EKG, a recording of the heart's
electrical activity)
4. echocardiogram (ultrasound images and videos of the heart)

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 SIGNS AND SYMPTOMS
● Blue or gray skin and lips
● Difficulty breathing
● have problems feeding
● Tiring easily, especially during feedings
● Slow growth and poor weight gain
● Less active than most babies
 MANAGEMENT

Medical: Nursing:

● Prostaglandin e1 (0.05-0.1ug/kg/min ● Position the child in a semi-Fowler’s

● Digitalis position
● Diuretics
Administer oxygen therapy as prescribed

Surgical:

● Shunting
● Glenn procedure
● Fontan procedure
● Pulmonary artery band placement
● Atrial septostomy
● Cardiac Catheterization
TETRALOGY OF FALLOT

Tetralogy of Fallot is a heart

condition in which a baby is
born with four abnormalities
in how the heart developed.
These issues make it hard
for the baby’s heart to send
enough oxygen to their
entire body.
 FOUR CHARACTERISTICS TO CONSIDER AS
TETRALOGY OF FALLOT :
1. Ventricular septal defect (VSD):

● a hole between the two bottom chambers (the ventricles) of the heart that sends blood to the body
and lungs.

1. Overriding aorta:

● the aorta, the large artery that takes blood to the body, is on top of both ventricles, instead of just
the left ventricle as in a normal heart.

1. Pulmonary stenosis :

● a narrowing of the pulmonary valve, the area below the valve, or the pulmonary arteries, which carry
blood from the heart to the lungs.

1. Hypertrophy:

● the right ventricle becomes thicker and more muscular than normal as a result of working harder to
pump blood through the narrow pulmonary valve.
 CAUSE

It happens when a baby’s heart does not form correctly as the baby grows and develops in the mother’s womb
during pregnancy.

RISK FACTORS
● A viral illness during pregnancy, such as rubella (German measles)
● Drinking alcohol during pregnancy.
● Poor nutrition during pregnancy.
● A mother older than age 40.
● A parent who has tetralogy of Fallot.
● The presence of Down syndrome or DiGeorge syndrome in the baby.
 DIAGNOSTICS

● Oxygen level measurement

● Echocardiogram
● Electrocardiogram
● Chest X-ray
● Cardiac catheterization
 SIGNS AND SYMPTOMS

● A bluish coloration (cyanosis) of the skin and lips

● Shortness of breath (dyspnea) and rapid, shallow breathing
● Fainting spells
● Clubbing of fingers and toes
● Failure to thrive and poor weight gain in the baby
● Inability to play or exercise for long periods
● Poor feeding and irritability
● Prolonged crying
● Heart murmur
● Tet spells
 MANAGEMENT

Medical: Surgical:

● Monitoring for hypoxemia ● Temporary shunt surgery

● Hemoglobin levels and hematocrit ● Intracardiac repair
values may be evaluated to assess
the anaemia
● Monitoring for hypercynotic
Nursing:
episodes (10-15 minutes)
● Balloon dilation of R.V outflow ● Knee chest position
tract ● Oxygen
 Kawasaki Disease
3 You can enter a subtitle here in case you need it

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Kawasaki Disease
Kawasaki disease is defined as
an acute febrile syndrome

1 associated with generalized

VASCULTIS affecting blood
vessels through the body,
coronary arteries.

Kawasaki disease has also been

2
called mucocutaneous lymph
node syndrome and infantile
periarteritis nodosa.

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Cause/Risk Factor

● Genetic factors
● Infections
(superantigens)
● Age
● Sex
● Ethnicity

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 PATHOPHYSIOLOGY
Unknown etiology Scarring, calcification

Inflammation of small and medium Coronary thrombosis

sized blood vessel
Stenosis
Damage coronary artery
MI
Aneurysms
DEATH
Myointimal proliferation

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 Diagnostic

● Urine proteins
● CBC
● Platelet count
● Cholesterol
● Echocardiography
● Imaging studies
● Electrocardiography
● Cardiac enzymes

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 SIGNS AND SYMPTOMS
1. ACUTE STAGE (1-2 weeks)
● fever : more than 5 days, usually higher than
39 degree celsius
● C - conjunctivitis
● R - rash (polymorphous, groin, and trunk)
● E - edema
● A - adenopathy
● M - mucosa (strawberry tongue, dry lips, and
pharyngeal/lip redness

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Sign and symptoms

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 SIGNS AND SYMPTOMS
2. Subacute stage (2-4 weeks)
● Desquamation begins
● Cardiac abnormalities
3. Convalescent stage (4-8 weeks)
● Cardiac aneurysms

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 MANAGEMENT
Medical:
● Intravenous immunoglobulins
● Aspirin
● Warfarin

Surgical:
● Coronary artery bypass

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 MANAGEMENT
Nursing:
Monitor pain

Monitor temperature

Cardiac monitor

Comfort measure

Hygiene

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ENDOCARDITIS
ENDOCARDITIS
➢ Inflammation or infection of the
endocardium, the inner layer of the heart
or the valves.
➢ Endocarditis occurs when germs enter
the bloodstream and then travel to the
heart. Endocarditis can involve the heart
muscle, heart valves, or lining of the
heart. Children with endocarditis may
have an underlying condition such as:
Birth defect of the heart.

Endo = inner
Cardio = heart
Itis= inflammation
INFECTIVE
ENDOCARDITIS

➢ Infective endocarditis (IE) is an infection

of the endocardium and/or heart valves
that involves thrombus formation
(vegetation), which may damage the
endocardial tissue and/or valves.
CAUSE/S OF INFECTIVE ENDOCARDITIS

➢ caused by an infection with bacteria, fungi or other germs. The germs enter the
bloodstream and travel to the heart. In the heart, they attach to damaged heart
valves or damaged heart tissue.
- Streptococcus viridans
- Staphylococcus aureus
- Fungal organisms have also been noted. (Candida and Aspergillus species)
RISK FACTORS OF INFECTIVE
ENDOCARDITIS

➢ those with underlying congenital heart disease

➢ children infected with certain virulent organisms
➢ Invasive procedure (Dental work, Central line, Iv drug use)
 PATHOPHYSIOLOGY

Underlying congenital heart defects

Entry of pathogens

Colonization of pathogens to the underlying CHD

Vegetation forms and promotes activation of clotting cascade

Fibrin and platelet deposition over cluster of bacteria

Valve failure or destruction

DIAGNOSIS

➢ ECHOCARDIOGRAM
- allowing for visualisation of the vegetations as well as the damage
to the heart itself such as valve destruction and perforation, rupture
of chordae and development of valvar leaks.

➢ BLOOD CULTURES
- several blood samples are taken within 24 hours. These are
checked for bacteria.
SIGNS AND SYMPTOMS
- Symptoms of IE vary for each child and many children may
not have any specific symptoms. Symptoms can include:
➢ FEVER
➢ MALAISE AND LETHARGY
➢ ANOREXIA
➢ SPLINTER HEMORRHAGE
➢ MURMUR
➢ MUSCLE ACHES AND PAIN
➢ PETECHIAE
SPLINTER HEMORRHAGE PETECHIAE
MANAGEMENT

MEDICAL
- IE can be treated with certain antibiotics like penicillin, ampicillin, or
ceftriaxone for 4 weeks, combined with gentamicin for the first 2 weeks.

SURGICAL
- valve repair or valve replacement

NURSING
- Monitor and supply oxygen.
- Educate px on how to take antibiotics and complete all antibiotics.
- Educate px on how to do proper oral hygiene.
 DYSRHYTHMIA
The overall incidence of clinically significant
dysrhythmias in children without underlying
CHD is low. A 2020 review of ED visits
among children with structurally normal
hearts found 0.05% experienced an
arrhythmia before age of 18. This data
demonstrate that outside of an ICU or
postoperative setting, dysrhythmia incidence
is low, rhythm disturbances that are noted do
not routinely require defibrillator use and
have low mortality.
 All electrical impulses in the heart
originate from the sinoatrial (SA)
node. These impulses travel down
the right atrium and across the
internodal tracts to the left atrium.
The impulse on the right side
terminates at the atrioventricular
(AV) node where it slows to allow
for complete filling of the
ventricles. It then continues to
bundle of his and down the right
and left bundle branches,
terminating in the purkinje fibers,
which ultimately cause ventricular
contraction.

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 A usual ECG waveform consist of a
P wave (denoting atrial contraction),
a brief period of iso-electricity
depicted as a flat line, and then a
prominent QRS wave as the
ventricles contract. This is followed
by T wave, which is a result of
ventricular repolarization.

A rhythm is considered sinus (originating

from the SA node) if in lead II there is an
upright P wave before an upright QRS
comple followed by a T wave
immediately afterward.

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SINUS ARRHYTHMIA
Sinus arrhythmia is a common
occurrence in the children and
decreases with age. This is a normal
variation in the child’s heart rhythm
based on their respiratory pattern. As
they breathe in, the heart rate slows, and
as they exhale there is a light increase in
rate. This is thought to be due to
changes in autonomic tone during
respirations. The ECG pattern itself is
completely normal. There is no need for
concern, and there is no intervention.
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There are three types of sinus arrhythmias.
Tachycardia: a fast heartbeat with a resting heartbeat of
more than 100 beats per minute
Bradycardia: a slow heartbeat with a resting heartbeat of 60
beats or less per minute. Interestingly, athletes may have a
heart rate below 60 beats per minute, as intense cardio
training can make the heart more efficient.
Premature heartbeat: an extra heartbeat that occurs earlier
than expected. It’s commonly described as a “thump” or a
skipped heartbeat.
RISK FACTORS

1. Hypertension
2. Diabetes
3. Low Blood Sugar
4. Kidney Disease
5. Lung Disease
6. Smoking
7. High Cholesterol
8. Overweight or Obese
9. Regularly eating High Fat Diet
10. Drinking too much alcohol
11. Un-manage Stress
12. Sleep Apnea
13. Sepsis

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 SIGNS AND SYMPTOMS

1. Shortness of breath
2. Chest Pain
3. Feeling Faint or Fainting
4. Anxiety
5. Blurred vision
6. Extremely Tired
7. Sweating

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 DIAGNOSTIC

1. Electrocardiogram (ECG or EKG)

2. Chest X-ray
3. Exercise stress test
4. Tilt table test, which changes your position rapidly from vertical
to horizontal to see if your blood pressure changes or if you faint
5. Echocardiogram or transesophageal echocardiogram
6. MRI of the heart
7. Holter and event monitors - a portable ECG that records heart
activity for 24 hours or more

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MANAGEMENT
MEDICAL:

Antiarrhythmic Medication (Amiodarone) - to restore normal heart rhythm or control heart rate and/or blood thinners
to mitigate blood clots.

SURGICAL:

Cardioversion - a procedure that restores a normal rhythm with a painless electrical shock (or sometimes
medication) to your heart

Catheter Ablation - doctors thread a thin tube through the blood vessels and into your heart to destroy the cells
responsible for abnormal electrical signals.

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 Nursing Management:

Monitor vital signs

- Assess Heart Low sodium,Low fat diet
Rate / Apical
Pulse Restriction in sodium, fats,
- Respiratory coffee, and Chocolate, Alcohol,
Rate Smoking.
- BP
- O2 saturation

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SINUS BRADYCARDIA
Sinus bradycardia is defined as a heart rate that
is less than the stated normal rate for a child’s
age. Sinus bradycardia may be physiologically
normal, as seen in athletes: may be secondary to
medications such as beta-blockers: or may be an
indicator of a pathologic state.
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Bradycardia is a slow heart rate. The hearts
of adults at rest usually beat between 60 and
100 times a minute. If you have
bradycardia, your heart beats fewer than 60
times a minute.
NEX
T
RISK FACTORS

1. Older age
2. High blood pressure
3. Smoking
4. Heavy alcohol use
5. Illegal drug use
6. Stress and anxiety

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 SIGNS AND SYMPTOMS

1. Chest pain
2. Confusion or memory problems
3. Dizziness or lightheadedness
4. Easily tiring during physical activity
5. Fatigue
6. Fainting (syncope) or near-fainting
7. Shortness of breath

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 DIAGNOSTIC

1. Electrocardiogram (ECG or EKG)

2. Chest X-ray
3. Exercise stress test
4. Tilt table test, which changes your position rapidly from
vertical to horizontal to see if your blood pressure changes or if
you faint
5. Echocardiogram or transesophageal echocardiogram
6. MRI of the heart
7. Holter and event monitors - a portable ECG that records heart
activity for 24 hours or more
MANAGEMENT
MEDICAL:

Atropine - is the first line medication for the treatment of bradycardia. The administration of atropine
typically causes an increase in heart rate. This increase in the heart rate occurs when atropine blocks the
effects of the vagus nerve on the heart. When the vagus nerve is blocked, the SA node increases its rate of
electrical discharge and this, in turn, results in the increased HR.

Epinephrine and dopamine - are second-line drugs for symptomatic bradycardia. They are both used as
infusions in the bradycardia algorithm if atropine is ineffective.

SURGICAL:

When other treatments aren't possible and bradycardia symptoms are severe, a device called a pacemaker is necessary to
control the heart rhythm. Pacemakers work only when needed. When the heart beats too slowly, the pacemaker sends
electrical signals to the heart to speed up the beat.

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 Nursing Management:

Monitor vital signs

- Assess Heart Low sodium,Low fat diet
Rate / Apical
Pulse Restriction in sodium, fats,
- Respiratory coffee, and Chocolate, Alcohol,
Rate Smoking.
- BP
- O2 saturation

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SINUS TACHYCARDIA

Sinus tachycardia is defined as a heart rate
that is greater than the stated normal rate
for a child’s age. Sinus tachycardia may
be expected as with a fever, anxiety, or
pain: may be secondary to medications
such as albuterol: or may be an indicator
of a pathologic state such as dehydration,
anemia, or infection. Sinus tachycardia is
also one of the earliest signs of decreased
cardiac output in children because they
have limited ability to increase their stroke
volume when cardiac output begins to fall.
When you have tachycardia, your heart
rate is faster than 100 beats per minute.
With sinus tachycardia, electrical signals
from your heart’s sinoatrial (SA) node
are telling your heart to beat faster than
normal. This is a common condition that
is usually a result of stressors like fear,
exercise or not drinking enough fluids.

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RISK FACTOR

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SIGN AND SYMPTOMS

1. Dehydration
2. Anemia
3. Hyperthyroidism
4. Palpitation
5. Chest Pain
6. Shortness of breath

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DIAGNOSTIC

1. Electrocardiogram (ECG or EKG).

2. Echocardiogram.
3. Holter monitor.
4. Chest CT.
5. Blood tests.
6. Chest X-ray.
7. Pulse oximetry to check how much oxygen is in your blood

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MANAGEMENT
MEDICAL:

● Beta-blockers.
● Calcium channel blockers.

SURGICAL:

● Catheter ablation.
● Cognitive-behavioral therapy.

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 Nursing Management:

● Observe the patient

Monitor vital signs for complications
and adverse
- Assess Heart reactions to drug
Rate / Apical therapy.
Pulse ● Regularly assess
- Respiratory the patient’s
Rate cardiopulmonary
- BP function.
- O2 saturation

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Supraventricular Tachycardia (SVT)

Supraventricular tachycardia (SVT) is a condition where your heart

suddenly beats much faster than normal. It's not usually serious, but
some people may need treatment

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Cause/Risk factor
● some medications, including asthma medications, herbal
supplements and cold remedies.
● drinking large amounts of caffeine or alcohol.
● stress or emotional upset.
● smoking lots of cigarettes
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Diagnostic
● Echocardiogram
● Electrocardiogram

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Sign/Symptoms

● usually lasts for a few minutes, but can sometimes last for
several hours
● can happen several times a day or once a year – it varies
● can be triggered by tiredness, caffeine, alcohol or drugs – but
often there's no obvious trigger
● can happen at any age, but often starts for the first time in
children and young adults – many people have their first
symptoms between 25 and 40
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You may get no other symptoms, but sometimes people also:

● have chest pain

● feel weak, breathless or lightheaded
● feel tired
● feel sick or are sick

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Management
Medical

First line medical treatment

● Adenosine
● Calcium Channel Blocker

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Surgical

● Cardioversion – a small electric shock to the heart to help it get

back to a normal rhythm
● catheter ablation – a treatment where thin tubes are placed
through a vein or artery into your heart to correct the problem
with the electrical system; this permanently cures the problem in
most patients

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Nursing
● Monitor Vital Signs

o Prior HR, 02 saturation, Blood pressure and Respiratory

rate.
● Observe the patient for complications and adverse reactions
to drug therapy.
● Regularly assess the patient’s cardiopulmonary function.
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LETHAL DYSRHYTHMIAS ( VENTRICULAR TACHYCARDIA,
VENTRICULAR FIBRILLATION, TORSADES DE POINTES )

Life-threatening dysrhythmias in children are rare. They may be seen after cardiac
surgery or during a life threatening event.

Torsades de pointes - is the terminal rhythm associated with LQTS. LQTS is a disorder of
delayed ventricular repolarization characterized by prolongation of the QT interval. This
may be hereditary or acquired due to medications.

Pulseless ventricular tachycardia and ventricular fibrillation - are rare in children and are
usually seen late in child suffering cardiopulmonary arrest. Both are treated with
defibrillation.

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ARIGATHANK YOU <3

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