Disorder Pathophysiology
Diagnostic
Tetralogy of fallot - a birth
defect that affects normal blood
flow through the heart.
4 major anomalies:
● Ventricular septal
defect
● Right ventricular
Hypertrophy
● Pulmonic stenosis
● Aorta overriding
ventricular septal
defect
Tricuspid Atresia:
Laboratory and
● Pulmonic stenosis
impedes the flow of
blood to the lungs
increased pressure
in the right ventricle
forcing
deoxygenated blood
through the septal
defect to the left
ventricle
● Increase workload
on the right ventricle
RV hypertrophy
● Overriding aorta
receives blood from
both right and left
ventricles
● Associated with PS and
transposition of the great
vessels.
Nursing Management Clinical Manifestation
findings:
● Echocardiography
and ECG - shows
● Provide family teaching about
treatment options for tetralogy
● Acute episodes of cyanosis
("tet spells") and transient
enlarged of Fallot cerebral ischemia
chambers of the Elective repair is Tet spells are
○ ○
right side of the usually performed characterised
heart during the infant's by irritability,
● first year of life, but pallor, blackouts
Echocardiography palliative repairs or convulsions
demonstrates the may be warranted ● Cyanosis occurring at rest
decrease in the for infants who (as PS worsens)
size of the cannot undergo ● Squatting
pulmonary artery primary repair ● Slow weight gain
and the reduced ○ Total repair involves ● Clubbing, exertional
blood flow ventricular septal dyspnea, fainting, or
through the lungs defect closure, fatigue slowness due to
● Cardiac infundibular hypoxia
catheterization stenosis resection, ● Pansystolic murmur may
and angiography and pericardial be heard at the
allow definitive patch to enlarge mid-lower-left sternal
evaluation of the right ventricular border
extent of the outflow tract
defect, ● Provide preoperative and
particularly the PS postoperative care
and the
ventricular septal
defect
● Palliative procedures,
such as a
pulmonary-to-systemi
 Occurs when the tricuspid
valve fails to develop, Without
the tricuspid valve, there is no
communication between the
right atrium and the right
ventricle.
● Causes complete mixing c artery anastomosis
of oxygenated and
deoxygenated blood in the
are performed on
left side of the heart, children with heart
resulting in systemic
failure
desaturation and variable
pulmonary obstruction ● Corrective surgery
● Blood flows through an may be performed
associated atrial septal
defect or patent foramen
ovale to the left side of the
heart and through an
associated ventricular
septal defect to the right
ventricle and to the lungs

Transposition of ● Defect results in two ● Echocardiogr ● Prostaglandin ● Severe respiratory

separate circulatory
aphy reveals E-administered to depression and
great arteries: The patterns; the right side of
an enlarged maintain PDA and cyanosis evident at
the heart manages
pulmonary artery leaves the left systemic circulation and heart further blood mixing birth associated
ventricle and the aorta exits the the left manages ● Cardiac ● A balloon atrial defects)
pulmonary circulation
right ventricle, No catheterizatio septostomy also may be ● Possible symptoms of
● Associated defects, such
communication between as septal defect or PDA, n reveals low performed during heart failure (with
permit oxygenated blood oxygen cardiac catheterization associated defects,
systemic and pulmonary
into the systemic saturation to increase mixing and but less cyanosis)
circulation. circulation, but cause
resulting from maintain cardiac output ● Easily fatigued
increased cardiac
workload the mixing of over a long period ● Failure to thrive
● potential complications: blood in the ● An arterial switch ● No murmur or
heart failure, infective heart procedure within the first presence of a
endocarditis, brain
chambers week of life is the murmur that is
abscess, and stroke
resulting from hypoxia or surgical procedure of characteristic of an
thrombosis choice associated defect
Atrial Septal defect: ● Left atrial ● May be
Abnormal opening between the atria□ pressure exceeds asymptomatic
allowing blood from higher lower right atrial ● May develop
pressure right atrium pressure left pressure blood congestive heart
atrium. flows from the left failure
3 types to the right ● Systolic ejection
● Ostium primum (ASD 1) increased flow of murmur - prominent
○ Opening at lower end
oxygenated at the 2nd ICS
of septum; associated
blood into the ● Risk for atrial
with mitral valve
right side of the dysrhythmias
abnormalities
heart (caused by atrial
● Ostium secundum (ASD 2) ● Right ventricle enlargement and
○ Opening near centre and pulmonary stretching of
of septum artery enlarge conduction fibres)
● Sinus venosus defect due to handling ● Pulmonary vascular
○ Opening near of more blood obstructive disease
junction of superior
● cardiac failure is and emboli
vena cava and right
unusual in an formation due to
atrium; associated
uncomplicated chronic increased
with partial
anomalous pulmonary ASD in pulmonary blood
venous connection ● Pulmonary flow
changes occurs ● Fatigue and
only after several dyspnea on exertion
decades if the are most common
defect is ● Slow weight gain
unrepaired and frequent
respiratory tract
infections
Ventricular Septal ● Echocardiograph ● Family teaching on treatment ● May be
y with doppler options
asymptomatic
defect: Most common CHD, ultrasound or ○ Some VSD close
spontaneously Failure to thrive
Abnormal opening between the right and MRI
○ Some are closed with ● Excessive sweating
left ventricle, Vary from a pinhole ○ Right
Dacron patch ● Fatigue
between ventricles to an absent septum ventric requiring
ular
● More susceptible to
cardiopulmonary
hypertr bypass, recommended pulmonary
ophy for children with large infections
and defects, pulmonary ● Signs and
arterial hypertension,
possibl symptoms of heart
heart failure, recurrent
e failure
respiratory tract
pulmon
infections and failure
ary to thrive
artery ○ Pulmonary artery
dilatati banding may be done
on due as a palliative
to procedure for infants
increas who are poor surgical
candidates
ed
● Provide preoperative and
blood
postoperative care
flow
● ECG
○ Right
ventric
ular
hypertr
ophy

Patent Ductus ● Blood from aorta ● ECG usually ● F amily teaching about treatment ● Small defect- may
options
through the PDA normal but may be asymptomatic
Arteriosus: Fetal ductus ○ Some close
back to the show ventricle spontaneously, some ● Loud machine like
arteriosus ( artery connecting the pulmonary artery enlargement if murmur
may be close
aorta and pulmonary artery) fails to and lungs surgically or non ● Frequent RTIS
close completely after birth surgically
 ● Continued patency of this increased left the shunt is ○ Surgical closure is ● May have heart
accomplished by 1 of 2
vessels allows blood to flow ventricular large failure with poor
methods
from the higher pressure workload and ● Cardiac ● Left feeding, fatigue,
aorta to the lower pressure increased catheterization thoracotom hepatosplenomegal
pulmonary artery, causing a pulmonary is usually not y without y, poor weight gain,
pulmonary
left-to-right shunt vascular necessary tachypnea, and
bypass
congestion ● Visual Irritability
● assisted ● Widened pulse
thoracosco pressure and
pic surgery
bounding pulse rate
- eliminates
the need for
thoracotom
y
● Premature neonates and some
other neonates, PDA sometimes
can be closed using
prostaglandin synthetase
inhibitors (indomethacin), which
stimulates closure of the ductus
arteriosus

Atrioventricular
canal: Results from the incomplete
fusion of endocardial cushions
● Consist of a low atrial septal
defect that is continuous with a
high ventricular septal defects
and clefts of the mitral and
tricuspid valves, creating a
large central AV valve that
allows blood to flow between all
heart chambers
Coarctation of Aorta: ● Characterised by ● ECG, ● Family teaching on ● Asymptomatic
Localised narrowing of the aorta increased echocardiogra treatment options ● Difference in blood
3 types depending on location pressure phy, and chest ○ Surgical removal pressure and pulse
● Preductal coarctation of proximal to the radiograph - of the stenotic quality between the
aorta defect and enlarged left area or upper and lower
○ Proximal to the decreased side of the enlargement of extremities
insertion of the pressure distal to heart the constricted ○ Blood
ductus arteriosus - it ● Radiograph-rib section with a pressure is
● Postductal coarctation of ● Restricted blood notching from graft elevated in
aorta flow through the enlarged ○ Bypass surgery is the upper
○ Distal to the ductus narrowed aorta collateral not necessary extremities
arteriosus increases the vessels ○ Non surgical and
pressure on the repair via balloon decreased
● Juxtaductal coarctation of left ventricle and angioplasty in the lower
aorta causes dilatation ● Pre and post operative extremities
○ At the insertion of of the proximal care ○ Pulse is
the ductus aorta and left bounding
arteriosus ventricular in the
hypertrophy left upper
sided heart extremities
failure and
● Collateral vessels decreased
develop to or absent
bypass the in the lower
coarctation extremities
segment and ○ Femoral
supply circulation pulses are
to the lower weak or
extremities absent
● Epistaxis
● Headaches
 ● Fainting
● Lower leg muscle
cramps

Aortic Stenosis: Involves an ● Stricture in the ● Family teaching on ● Decrease cardiac

obstruction to the left ventricular outflow aortic outflow treatment options output with faint
of the valve tract > resistance ○ Balloon pulses
resistance to to ejection of angioplasty-to ● Hypotension
● Narrowing or stricture of the blood from the dilate the narrow ● Tachycardia
aortic valve blood flow in the left ventricle > valve, widely used ● Poor feeding
left ventricle, decreased
extra workload ○ Surgical ● Exercise intolerance
cardiac output, left ventricular
on the left valvotomy ● Chest pain
hypertrophy, and pulmonary
ventricle > ● Pre and postoperative ● Dizziness when
vascular congestion
● Valvular stenosis hypertrophy care standing for a long
○ Most common type ● Left ventricular period
○ Caused by malformed failure > left atrial ● Murmur
cusps resulting in a pressure
bicuspid rather than increases >
tricuspid valve or increased
fusion of the cusps
pressure in the
○ Serious defect
pulmonary veins
■ Obstruction
> blood flows
tends to be
progressive back to the lungs
■ Sudden > pulmonary
episodes of congestion
myocardial (pulmonary
ischemia, or edema)
low cardiac ●
output
 sudden
death
■ Surgical
repair rarely
results in a
normal valve

● Subvalvular stenosis
○ Stricture caused by
fibrous ring below a
normal valve
● Supravalvular
○ Occurs infrequently