1.

Patent Ductus Arteriosus - a condition in which the ductus arteriosus does not
close
Causes:
❖ CHD arise from problems early in the heart's development but there's often no
clear cause.
❖ Genetic factors might play a role.
Risk Factors:
❖ Premature birth
❖ Family history and other genetic conditions
❖ Rubella infection during pregnancy
❖ Being born at a high altitude
❖ PDA is twice as common in girls.
Diagnostic Test:
❖ ECHOCARDIOGRAM
❖ CHEST X RAY
❖ ELECTROCARDIOGRAM
❖ CARDIAC CATHETERIZATION
Management:
❖ Watchful waiting
❖ Medications
❖ Surgical closure
❖ Catheter procedures

2. VENTRICULAR SEPTAL DEFECT (VSD)

❖ Normally there is no hole between the two ventricles, but some infants are born
with these holes called ventricular septal defects.
❖ The blood flowing through the hole creates an extra
noise, which is known as a heart murmur.
Diagnostic:
● Chest X-ray
● Electrocardiogram
● cardiac catheterization: provides information about
the heart's structures and the blood pressure and
blood oxygen levels in its chambers.

Management & Treatment:

● Treatment depends on a child's age and the size,
location, and severity of the VSD.
● A child with a small defect which no symptoms may
only need to visit a cardiologist regularly to make
sure there are no other problems.
● Kids with medium to large VSDs might need prescription medicines to aid
circulation and help the heart work better. Medicines alone, though, won't close
the VSD
● Cardiologist may recommend heart surgery to fix the hole
● In rare cases, the VSD could be closed by cardiac catheterization instead.
 3. Atrial Septal Defects (ASD)
- a hole in the heart between the
upper chambers (atria).
- Present at birth
- Increases the amount of blood that
flows through lungs
- Small atrial septal defects might be
found by chance and never cause
a concern
Symptoms:
Children with larger, more severe ASDs,
though, might have some of these signs or
symptoms:
● poor appetite
● poor growth
● extreme tiredness
● shortness of breath
● lung problems and infections (pneumonia)
Diagnostic:
● chest X-ray
● electrocardiogram (EKG)
● echocardiogram (echo)
Management:
● Treatment of an ASD will depend on a child's age and the size, location, and
severity of the defect.
● Very small ASDs might not need any treatment follow-up visits for observation.
Non closure cardiac catheterization or heart surgery.

2. ACYANOTIC:OUTFLOW OBSTRUCTION
2.1. Pulmonary Stenosis
● when the pulmonary valve is too
small, too narrow, and can't open all
the way, causes the right ventricle to
pump harder to send blood out to the
lungs.Over time, can cause thickening
of the right ventricle and strain the
heart.
Symptoms:
● Mild: heart murmur.
● Severe pulmonary stenosis can
include
- in newborns, a bluish tint to the
skin caused by blood that is low in oxygen
- being very tired poor weight gain
- shortness of breath
 - palpitations
- chest pain
- fainting
- a swollen abdomen
Management:
● Echocardiogram.
● Heart catheterization: insertion of as a catheter into an artery and vein that lead
to the heart.
● Balloon valvuloplasty during heart catheterization., threads an unopened balloon
through the pulmonary valve and inflates it to open the valve.
● Valve replacement involves using an artificial valve or a valve from a donor

2.2. Aortic Stenosis

● aortic valve (the valve between the left
ventricle and the aorta) is too small, narrow,
or stiff.
● Mild cases may not need any treatment. But
kids with more severe aortic stenosis will
need surgery to fix the aortic valve so that
blood flows properly through the body.
Symptoms:
● symptoms depend on how small the
narrowing of the valve is.
● Many people have no symptoms at all, and others have only mild symptoms.
● Infants with more serious aortic stenosis may show signs of heart failure, such
as trouble gaining weight, problems with feeding, and breathing problems that
develop soon after birth.
Management:
● Echocardiogram.
● Heart catheterization - insertion of a catheter into an artery and vein that lead to
the heart.
● Mild cases of aortic stenosis may not need treatment
● Medicines sometimes can treat symptoms, but in severe cases the valve will
need to be fixed or replaced.
● Young children with a severe problem may undergo a
balloon valvuloplasty during heart catheterization.,
threads an unopened balloon through the aortic valve
and inflates it to open the valve.
● Valve replacement involves using an artificial valve or
a valve from a donor to replace the child's abnormal
valve

2.3 Coarctation of Aorta

 ● a birth defect in which a part of the aorta is narrower than usual. If left untreated,
the baby may have serious problems and may need surgery or other procedures
soon after birth.
Risk Factors:
● Common in females
● increased chance of having the condition if another family member has it
● Turner Syndrome - a condition that affects only females, results when one of the
X chromosomes (sex chromosomes) is missing or partially missing
● other cardiac defects
Sign and Symptoms:
● Grouchiness
● Pale skin
● Sweating
● Heavy or fast breathing
● Enlarged liver (hepatomegaly)
● Poor feeding or eating
● Poor weight gain
● No/Weak pulses in the feet
● Blood pressure in the arms that is much higher than the blood pressure in
the legs
● Chest pain
● Pain in lower legs with walking (Claudication)
Diagnostic Test:
● CHEST X-RAY
● Electrocardiogram (ECG)
● Echocardiogram
● Cardiac catheterization
● CT scan
● MRI.
Management:
● Cardiac catheterization - puts a catheter through a blood vessel to the narrowed
part of the aorta. A balloon at the tip of the catheter is inflated to stretch the area
open. The provider may put a small metal mesh tube (stent) in the narrowed
area to keep the aorta open
● Surgery

CYANOTIC
1. Teralogy of Fallot
● is a birth defect that affects normal blood flow through the heart. It
happens when a baby’s heart does not form correctly as the baby
grows and develops in the mother’s womb during pregnancy.
Etiology:
● Teralogy of Fallot among most babies are unknown.
● changes in their genes or chromosomes.
● tetralogy of Fallot also are thought to be caused by a combination of genes
 ● Risk factors such as the things the mother or fetus come in contact with in the
environment or what the mother eats or drinks or the medicines she uses.
Treatment:
● Tetralogy of Fallot can be treated by surgery soon after the baby is born.
● Widen or replace the pulmonary valve and enlarge the passage to the pulmonary
artery. They also will place a patch over the ventricular septal defect to close the
hole between the two lower chambers of the heart. These actions will improve
blood flow to the lungs and the rest of the body.

2. Tricuspid Atresia

● 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. Because
a baby with tricuspid atresia may need surgery or other procedures soon after
birth
Etiology:
● tricuspid atresia, among most babies are unknown.
● changes in their genes or chromosomes.
● caused by a combination of genes and other factors, such as the things the
mother comes in contact with in the environment, or what the mother eats or
drinks, or certain medicines she uses.
Symptoms:
● bluish looking skin color
● Problems breathing
● Ashen or bluish skin color
● Poor feeding
● Extreme sleepiness

Treatment:

● some babies and children will need medicines to help strengthen the heart
muscle, lower their blood pressure, and help the body get rid of extra fluid.
● Surgery: Surgical treatment for tricuspid atresia depends on its severity and
presence of other heart defects.

3. Transposition of great vessels

● a birth defect of the heart in which the two

main arteries carrying blood out of the heart –
the main pulmonary artery and the aorta – are
switched in position, or “transposed.”
Etiology:
● Transposition of great vessels among babies
are unknown
● changes in their genes or chromosomes.
 ● Heart defects are also thought to be caused by the combination of genes and
other risk factors such as things the mother comes in contact with in her
environment, or what the mother eats or drinks, or certain medications she uses.
Symptoms:
● Problems breathing
● Pounding heart
● Weak pulse
● Ashen or bluish skin color
● Poor feeding

Treatment:
Surgery is required for all babies born with Transposition of great vessels. Other
procedures may be done before surgery in order to maintain, enlarge or create
openings that will allow oxygen-rich blood to get out to the body.

4. Truncus Arteriosus
● Truncus arteriosus is a birth defect of
the heart. It occurs when the blood
vessel coming out of the heart in the
developing baby fails to separate
completely during development, leaving
a connection between the aorta and
pulmonary artery.
Etiology:
● truncus arteriosus among most babies
are unknown.
● changes in their genes or
chromosomes.
● caused by the combination of genes and
other risk factors such as things the
mother comes in contact with in her environment, or what the mother eats or
drinks, or certain medications she uses.
Symptoms:
● Problems breathing
● Pounding heart
● Weak pulse
● Ashen or bluish skin color
● Poor feeding
● Extreme sleepiness

Treatment:
 ● Medication: Some babies with truncus arteriosus also will need medicines to help
strengthen the heart muscle, lower their blood pressure, and help their body get
rid of extra fluid.
● Surgery:Surgery is needed to repair the heart and blood vessels. This is usually
done in the first few months of life. The goal of the surgery to repair truncus
arteriosus is to create a separate flow of oxygen-poor blood to the lungs and
oxygen-rich blood to the body.

5. Total Anomalous Pulmonary Venous Return(TAPVR)

Total anomalous pulmonary venous return (TAPVR) is a birth defect of the heart. 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.

Types of TAPVR
There are different types of TAPVR, based on where the
pulmonary veins connect:

● Supracardiac– In supracardiac TAPVR, the

pulmonary veins come together and form an
abnormal connection above the heart to the
superior vena cava, which is a main blood vessel
that brings oxygen-poor blood from the upper part
of the body to the heart. In this type of TAPVR, a
mixture of oxygen-poor and oxygen-rich blood
returns to the right atrium through the superior
vena cava.
● Cardiac – In cardiac TAPVR, the pulmonary veins
meet behind the heart and connect to the right
atrium. The coronary sinus, which is a vein that
helps bring oxygen-poor blood from the heart muscle back to the heart, helps
connect the pulmonary veins to the right atrium in this type of TAPVR.
● Infracardiac – In infracardiac TAPVR, the pulmonary veins come together and
form abnormal connections below the heart. A mixture of oxygen-poor blood and
oxygen-rich blood returns to the right atrium from the veins of the liver and the
inferior vena cava, which is the main blood vessel that brings oxygen-poor blood
from the lower part of the body to the heart.

Etiology:

● TAPVR, among most babies are unknown.

● changes in their genes or chromosomes.
● caused by a combination of genes and other risk factors, such as the things the
mother or fetus come in contact with in the environment or what the mother eats
or drinks or the medicines she uses.
Symptoms:Problems breathing

● Pounding heart
● Weak pulse
● Ashen or bluish skin color
● Poor feeding
● Extreme sleepiness

Treatment:

● babies with TAPVR will need surgery to repair the defect.

6. Esbteins Anomaly
● Ebstein anomaly is a rare heart defect that's
present at birth (congenital). In this condition,
your tricuspid valve is in the wrong position
and the valve's flaps (leaflets) are malformed.
As a result, the valve does not work
properly.Blood might leak back through the
valve, making your heart work less efficiently.
Ebstein anomaly can also lead to
enlargement of the heart and heart failure.
● No known cause

Symptoms:

Mild forms of Ebstein anomaly might not cause symptoms until later in adulthood. Signs
and symptoms might include:

● Shortness of breath, especially with exertion

● Fatigue
● Heart palpitations or abnormal heart rhythms (arrhythmias)
● A bluish discoloration of the lips and skin caused by low oxygen
Risk Factors:
● Genetic and environmental factors
● Ebstein anomaly, occur as the baby's heart develops in the mother's womb.
Complications:
possible complications of Ebstein anomaly include:
● Heart failure
● Sudden cardiac arrest
● Stroke
 NURSING CARE OF A CHILD WITH ACQUIRED HEART DISEASE

1. Mitral Valve Prolapse

● “click-murmur syndrome” occurs when the flaps
(leaflets) of the heart's mitral valve bulge
(prolapse) like a parachute into the heart's left
upper chamber (left atrium) as the heart
contracts.
Symptoms:
● A racing or irregular heartbeat (arrhythmia)
● Dizziness or lightheadedness
● Difficulty breathing or shortness of breath, often
during physical activity or when lying flat
● Fatigue
Risk Factors:
● Older than 50 Y.O
● Marfan syndrome
● Ehlers-Danlos syndrome
● Ebstein anomaly
● Muscular dystrophy
● Graves' disease
● Scoliosis
Diagnostic Test:
● Chest X-ray
● Electrocardiogram
● Stress test
● Coronary Angiogram
Management:
Medications: - Beta blockers
- Diuretics
- Heart rhythm medication ( Propafenone)
- Aspirin
- Blood thinner (Warfarin-Coumadin)
Surgery - Valve repair and replacement may be performed using open-heart surgery or
minimally invasive surgery. Minimally invasive surgery involves smaller incisions and
may have less blood loss and a quicker recovery time.
2. Myocarditis
● an inflammation of the heart muscle (myocardium). Myocarditis can affect your
heart muscle and your heart's electrical
system, reducing your heart's ability to
pump and causing rapid or abnormal
heart rhythms (arrhythmias)
Causes:
● Viruses (COVID-19; hepatitis B and C;
parvovirus; herpes simplex virus)
● Bacteria (staphylococcus, streptococcus,
bacteria)
● Parasites (Trypanosoma cruzi and
toxoplasma); Chagas disease
● Fungi (Yeast infections, such as candida;
molds, such as aspergillus; histoplasma)
Symptoms:
● When children develop myocarditis, they might have signs and symptoms
including:
- Fever
- Fainting
- Breathing difficulties
- Rapid breathing
- Rapid or abnormal heart rhythms (arrhythmias)
Diagnostic Test:
● Electrocardiogram
● Chest X-ray
● MRI
● Echocardiogram
● Blood test
● Cardiac Catheterization
● endomyocardial biopsy
Management:
● avoid competitive sports for at least three to six months
● Rest
● Medications
- Angiotensin-converting enzyme (ACE) inhibitors.
- enalapril (Vasotec)
- captopril (Capoten)
 - lisinopril (Zestril, Prinivil)
- ramipril (Altace)
- Angiotensin II receptor blockers (ARBs)
- losartan (Cozaar)
- valsartan (Diovan)
- Beta blockers (Metoprolol)
- Diuretics (Furosemide)
Complications:
● Heart failure
● Heart attack or stroke
● Rapid or abnormal heart rhythms
● Sudden cardiac death
Prevention:
● Avoid people who have a viral or flu-like
illness until they've recovered
● Follow good hygiene
● Avoid risky behaviors
● Minimize exposure to ticks
● Get your vaccines

3. Acute Rheumatic Fever

● an inflammatory disease that can develop
as a complication of inadequately treated
strep throat or scarlet fever.
Pathophysiology:
● Rheumatic fever develops in children and adolescents following pharyngitis with
GABHS (ie, Streptococcus pyogenes).
● The organisms attach to the epithelial cells of the upper respiratory tract and
produce a battery of enzymes, which allows them to damage and invade human
tissues.
● After an incubation period of 2-4 days, the invading organisms elicit an acute
inflammatory response, with 3-5 days of sore throat, fever, malaise, headache,
and elevated leukocyte count.
Causes:
● GABHS infection (group A beta-hemolytic streptococcal (GABHS) pharyngitis,
and only infections of the pharynx initiate or reactivate rheumatic fever.
● Molecular mimicry (mimicry between streptococcal and human proteins is felt )
Streptococcal antigens (hyaluronate; polysaccharides)
● Decrease in regulatory T-cells
Symptoms:
 ● Carditis
● Polyarthritis
● Chorea
● Subcutaneous nodules
● Erythema marginatum
● Fever
● Polyarthralgia
● Prolonged PR interval
● Increased ESR.
Diagnostic Test:
● Throat culture
● Rapid antigen detection test
● Antistreptococcal antibodies
● Acute-phase reactants= C-reactive protein and erythrocyte sedimentation
rate are elevated
● Heart reactive antibodies= Tropomyosin
● Rapid detection test for D8/17
● Chest radiography
● Echocardiography.
Management:
● Anti-inflammatory
● Corticosteroids.
● Anticonvulsant medications.
● Antibiotics.
● Surgical care.
● Diet
● Activity.
Nursing Assessment:
● History
● Physical Examination
Nursing Intervention:
● Provide comfort and reduce pain
● Provide diversional activities and sensory stimulation
● Promote energy conservation
● Prevent injury.
 4. Kawasaki Disease
Kawasaki disease causes swelling
(inflammation) in the walls of
medium-sized arteries throughout the
body. It primarily affects children.
The inflammation tends to affect the
coronary arteries, which supply blood
to the heart muscle.
Causes:
● No known cause for Kawasaki
disease, but scientists don't believe
the disease is contagious from
person to person.
● A number of theories link the disease
to bacteria, viruses or other
environmental factors, but none has
been proved.
● Certain genes may make your child more likely to get Kawasaki disease.
Risk Factors:
● Age - Children under 5 years old are most at risk of Kawasaki disease.
● Sex - Boys are slightly more likely than girls are to develop Kawasaki
disease.
● Ethnicity - Children of Asian or Pacific Island descent, such as Japanese
or Korean, have higher rates of Kawasaki disease.
Symptoms:
● Red, bloodshot eyes
● Red, swollen hands
● Red, swollen feet
● Red, cracked lips and red tongue
● High fever
● Rash involving much of the body
Diagnostic Test:
● Blood test
● Electrocardiogram
● Echocardiogram
Management:
 ● Gamma globulin - Infusion of an immune protein (gamma globulin)
through a vein (intravenously) can lower the risk of coronary artery
problems. • Aspirin - High doses of aspirin may help treat inflammation.
● Aspirin can also decrease pain and joint inflammation, as well as reduce
the fever

5. Infective Endocarditis
● Endocarditis is a life threatening
inflammation of the inner lining of
your heart's chambers and valves
(endocardium).
Causes:
● IMPROPER DENTAL CARE
● CATHETERS
● ILLEGAL IV DRUG USE
Risk Factors:
● AGE
● ARTIFICIAL HEART VALVES
● DAMAGED HEART VALVES
● CONGENITAL HEART DEFECTS
● IMPLANTED HEART DEVICE
● A HISTORY OF ENDOCARDITIS
● A HISTORY OF ILLEGALOLDER DRUG USE
● POOR DENTAL HEALTH
● LONG TERM CATHERTER USE
Symptoms:
● Aching joints and muscles
● Chest pain when you breathe
● Fatigue
● Flu-like symptoms, such as fever and chills
● Night sweats
● Shortness of breath
● Swelling in your feet, legs or abdomen
● A new or changed heart murmur, which is the heart sound made by blood
rushing through your heart
Less common signs and symptoms of endocarditis can include:
- Unexplained weight loss
 - Blood in your urine
- Tenderness in your spleen, which is an infection-fighting organ located just
below your left rib cage
- Red spots on the soles of your feet or the palms of your hands (Janeway
lesions)
- Red, tender spots under the skin of your fingers or toes (Osler's nodes)
- petechiae , on the skin, in the whites of your eyes or inside your mouth
Diagnostic Test:
● BLOOD CULTURE TEST
● COMPLETE BLOOD COUNT
● ECHOCARDIOGRAM
● ELECTROCARDIOGRAM
● CHEST X-RAY
● COMPUTERIZED TOMOGRAPHY SCAN
Management:
MEDICATIONS:
- High doses of IV antibiotics are used to treat endocarditis caused by
bacteria
- If endocarditis is caused by a fungal infection, your doctor will prescribe
antifungal medication.
SURGERY:
- Heart valve surgery may be needed to treat persistent endocarditis
infections or to replace a damaged valve