PEDIATRIC

CARDIOVASCULAR
DISORDERS
Cheene Pearl Clarrisse Olidan- Gonzales
AY: 2022
 The superior vena-cava receives blood from the
head, neck, upper limbs and chest
 The inferior vena-cava received blood from the
trunk, viscera and lower limbs
 Both inferior and superior vena-cava end up in the
atrium (one of the 4 chambers)
 Pulmonary artery then splits into the left and right
which go to each respective lung (where gas
exchange occurs)
 Blood exits the right ventricle through the
pulmonary valve and enters the pulmonary artery
 Blood exits the right atrium through Tricuspid
valve and enters right ventricle
 Blood comes back from the lungs through the
pulmonary veins entering the left atrium
 Blood is pumped into the left into the left ventricle
through the mitral or bicuspid valve
 Oxygenated blood leaves the left ventricle through
the aortic semi-lunar valve, entering the aortic arc
CONGENITAL HEART DISEASE
 Cyanotic
 discoloration of the patient
 cyanosis only when compromised where bluish
discoloration can be seen
 Acyanotic
 changing color of the patient
 cyanosis even when the patient is not compromised, bluish discoloration of the body can
be seen anytime
ACYANOTIC
 PATENT DUCTUS
ARTERIOSUS (PDA)
 Ductus arteriosus – facilitate the placental circulation; should close
within 2 to 3 days for normal babies.

 The abnormal opening causes too much blood to flow to the baby’s lungs and heart.
 Untreated, the blood pressure in the baby’s lungs might increase (pulmonary
hypertension) and the baby’s heart might enlarge and weaken
 Involved decreased alveolar growth associated with chronic lung disease (CLD); and
systemic hypoperfusion that may result in, renal dysfunction and necrotizing
enterocolitis (NEC)
 MANIFESTATIONS

 Bounding pulse
 Machine like murmur
 Wide pulse pressure
 MANAGEMENT
 Indomethacin (Prostaglandin Inhibitor)
 0.2 mg/kg followed by two doses of 0.2 mg/kg at 12- and 24-
hour intervals
 Given through IV with
 Use insulin syringe where metric values are more evident.
 It is renal toxic

 NURSING RESPONSIBILITY?
 Ibuprofen (NSAIDs)
 The dose used for ibuprofen is 10 mg/kg bolus followed by 5 mg/kg for 2 additional day
 Given through PO
 Under NPO, given NGT or OGT closing after 30 minutes then opening after 30 minutes for
air decompression; make sure that the pink color in the tube is gone.
 Using this medication may can cause NEC
 On the 4th day, follow up ECHO will be done. Some PDA will close after the first course,
some will decrease in size, and for some may need 2nd to 3rd course of this medication to
close PDA
 Ligation via left thoracotomy

 If both medicine
fails after 2nd or
3rd course, the
doctor will now
do ligation
 ATRIO SEPTAL DEFECT (ASD)
 A birth defect of the heart in which there is a hole in the
wall (septum) that divides the upper chambers (atria) of
the heart
 The hole increases the amount of blood that flows
 through the lungs and over time, it may cause damage to
the blood vessels in the lungs
 Damage to the blood vessels in the lungs may cause
problems in adulthood, such as high blood pressure in
the lungs and heart failure. Other problems may include
abnormal heartbeat, and increased risk of stroke.
ASD TYPES
 Ostium primum
 Opening at lower end of septum

 Ostium secundum
 center

 Sinus census
 Defect near junction of SVC and R
atrium
 MANIFESTATIONS
 Shortness of breath
 Fast or heavy breathing
 Sweating
 Tiredness while feeding
 Poor weight gain

ShoFast SweT Po
 MANAGEMENT
 Dacron patch
 Cardiac
catheterization –
balloon in the
catheter will block
the hole
 VENTRICULAR SEPTAL DEFECT (VSD)

 A birth defect of the heart in which there is a hole in the wall (septum) that separates the two lower
chambers (ventricles) of the heart
 blood often flows from the left ventricle through the ventricular septal defect to the right ventricle and
into the lungs. This extra blood being pumped into the lungs forces the heart and lungs to work harder.
 This defect can increase the risk for other complications, including heart failure, high blood pressure in
the lungs (called pulmonary hypertension), irregular heart rhythms (called arrhythmia), or stroke.
 TYPES
 Cono VSD
 hole on the meeting point of ventricular septum just below the pulmonary and aortic valves.

 Peri membranous VSD

 hole in upper section of the ventricular septum.

 Inlet VSD
 Hole in the septum near to where the blood enters (entrance) the ventricles through the tricuspid and mitral
valves.
 atrioventricular septal defect (AVSD).

 Muscular VSD
 hole in the lower, muscular part of the ventricular septum and is the most common type of ventricular septal
defect.
MANIFESTATIONS
MANAGEMENT
 1. Dacron patch – big defect
 2. Purse string approach – small
defect
 3. Ratelle procedure

 In older children,
cardiopulmonary bypass is
used.
 Rule of

7
 COARCTATION OF THE
AORTA (COTA)
 Narrowing of the AORTA
 considered a critical CHD
 blocks normal blood flow to the body. This can back up flow into the left
ventricle of the heart, making the muscles in this ventricle work harder to get
blood out of the heart.
 Coarctation can lead to normal or high blood pressure and pulsing of blood
in the head and arms and low blood pressure and weak pulses in the legs and
lower body.
MANIFESTATIONS
 pale skin (mottling of the skin)
 bounding pulse in upper extremities
 irritability
 increased BP in upper extremities, lower BP in
lower extremities
 diaphoresis
 DOB
 absent femoral pulses
MANAGEMENT
 4 limbs BP – taking BP on all the limbs;
commonly ordered in neonates
 For premature use size 0 BP cuff
 For normal baby weighing normal, we
use size 4 BP cuff
 BP is taken on the inner side of the leg

 Antibiotic treatment
 Follow up Cardiology
appointment every 1-2
years
 Surgical MANAGEMENT
 End to end
anastomoses
 Balloon
Angioplasty
 Aortoplasty:
 Subclavian flap
 Patch
 balloon
 AORTIC STENOSIS (AS)
 Stenosis – abnormal narrowing
 occurs when the heart's aortic valve narrows.
The valve doesn't open fully, which reduces or
blocks blood flow from your heart into the main
artery to your body (aorta) and to the rest of
your body.
 the aortic valve between the lower left heart
chamber (left ventricle) and the aorta does not
open completely. The area through which blood
moves out of the heart to the aorta is narrowed
 MANIFESTATIONS
 Infants
 tiredness or fatigue
 tachypnea
 Trouble feeding
 Irregular heartbeats
 Poor weight gain
 Palpitations
 SOB

 cyanosis
TTTIPPS C
 OLDER Child
 Chest pain or pressure
 Syncope
 Dizziness or lightheadedness,
especially with physical activity
 MANAGEMENT
 Balloon aortic valvuloplasty
 Done with cardiac catheterization using a catheter with a deflated balloon in the
tip
 Surgical aortic valvotomy
 Surgery to remove scar tissue from the aortic valve leaflets.
 Aortic valve replacement
 Replaces the aortic valve with a new (artificial or from donor organs or animals)
 Pulmonary autograft (ross procedure)
 Surgery to replace the aortic valve and part of the aorta
 PULMONARY STENOSIS (PS)
 A birth defect of the heart that can happen when
the pulmonary valve doesn’t grow as it
should in a baby during the first 8 weeks of
pregnancy
 The pulmonary valve connects the right ventricle
to the pulmonary artery. It normally has 3 flaps
(leaflets) that work like a 1-way door
 The flaps may be stuck together. Or the flaps, may
be thick and not able to open all the way. In some
cases, the valve may be narrowed. In some cases,
the stenosis may not be related to a problem with
the valve leaflets but with the area directly below
and above the valve.
 MANIFESTATIONS

 Infants:
 Cyanosis
 Cardiomegaly
 Shortness of breath
 Swelling of the legs, ankles, feet, face, or
belly (abdomen)
 Tachypnea
 Tachycardia
 Older Children:
 Fainting (syncope)
 Feeling tired, especially with activity or
exercise
 Chest pain
 MANAGEMENT
 Balloon dilation or valvuloplasty
 Valvotomy
 Surgery to remove scar tissue from the pulmonary valve leaflets. This lets the valve open as it
should
 Valvectomy
 Surgery to remove the valve. Often patch is used to help the blood flow from the right ventricle
into the pulmonary artery. The pulmonary valve may need to be replaced when the child is an
adult
 Patch enlargement
 Patches are used to enlarge narrowed areas
 Pulmonary valve replacement
 A tissue valve (pig or human) may be used. Children who have had valve replacement will need
to take antibiotics before medical and dental procedures in the future
CYANOTIC
 TETRALOGY OF FALLOT (TOF)
 Four defects of the heart and its blood vessels

 D – displaced aorta/ overriding aorta

 R – right ventricle hypertrophy
 O – opening in septum; usually between 2
lower chambers of the heart
 P – pulmonary valve stenosis
MANIFESTATIONS
 Infants:
 boot – shaped heart
 tet spells (fainting spells)
 clubbing of fingers
 S2 click
 Difficulty breathing
 Tiring when feeding
 A heart murmur, or a whooshing sound
that can be heart with a stethoscope
 Swelling of legs, feet, or stomach area
 Stroke
 Shortness of breath when being
active or exercising
 Skipped heartbeats or a sense of
feeling the heartbeat
 Frequent respiratory or lung
infections
MANAGEMENT
 Blalock Taussig – creates a pathway for blood to reach the lungs
 Waterstone connection – b/n previously attached pulmonary artery
to ascending aorta
 Potts – anastomose – descending aorta and left pulmonary aorta
 Ratelle – VSD closure
 TRANSPOSITION OF
GREAT VESSELS (TGV)
 abnormal spatial
arrangement of any of the
great vessels: superior
and/or inferior vena
cava, pulmonary artery,
pulmonary veins, aorta
 DEXTRO-TGA
TYPES
 The aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle. This
switch causes deoxygenated blood from the right heart to be pumped immediately through the aorta and
circulated throughout the body and the heart itself, by passing the lungs altogether.
 LEVO-TGA
 the primary arteries are transposed, with the aorta anterior and to the left of the pulmonary artery, and the
morphological left and right ventricles with their corresponding atrioventricular valves are also transposed.
In other words, the right ventricles is on the left side of the heart and the left ventricle is on the right side
of the heart
 COMPLEX TGV
 TGV is accompanied by other heart defects, the most common type being intracardiac shunts such as atrial
septal defect, and patent ductus arteriosus, stenosis, or other defects of valves and/or vessels may also be
present
 MANIFESTATIONS
 Tiring quickly
 Dyspnea
 Tachypnea
 Tachycardia
 Developing puffiness or swelling
 Sweating easily
 Fewer wet diapers than normal
 Poor feeding
 Poor weight gain
 Bluish tint on skin, lips, and fingernails that becomes worse while eating or crying
 Fainting or near-fainting spells
 MANAGEMENT
 Before surgery
 Prostaglandins to keep the PA open which allows for the mixing of the otherwise isolated
pulmonary and systemic circuits (make sure to monitor the baby closely for
hyperthermia)
 Arterial septostomy performed with a cardiac catheter instead of surgery, to enlarge a
natural connection between the heart’s upper chambers (atria).

 Surgery
 Arterial Switch Operation - the pulmonary artery and the aorta are moved to their normal
positions.

 After surgery
 Lifelong follow-up care with a cardiologist is needed
 TOTAL ANOMALOUS PULMONARY
VENOUS RETURN
 Failure of the pulmonary veins to join the
left atrium and 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
 Oxygen-rich blood does not return from
the lungs to the left atrium. Instead, the
oxygen-rich blood return to the right side
MANIFESTATIONS
 Pounding heart
 Weak pulse
 Ashen or bluish skin color
 Poor feeding
 Extreme sleepiness
MANAGEMENT
 ASD closure
 Anastomoses (between pulmonary vein into the left atrium)
TRUNCUS ARTERIOUSUS
 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
 Failure of normal septation and division of the embryonic bulbar trunk into the pulmonary
artery and the aorta, resulting in a single vessel that overrides both ventricles

 Pulmonic valve is missing

MANIFESTATIONS
 Problems breathing
 Pounding heart
 Weak pulse
 Ashen or bluish skin color
 Poor feeding
 Extreme sleepiness
 Variable cyanosis
 Poor growth
 Activity intolerance
 Characteristic murmur
MANAGEMENT
 Homografts – segments of cadaver aorta
 VSD closure
TRICUSPID ATRESIA

 Absence of the Valve

 the valve that controls blood flow from the right upper chamber of the heart to the right
lower chamber of the heart doesn’t form at all
 Blood can’t go from the right atrium through the right ventricle to the lungs for oxygen
 These defects allow oxygen-rich blood to mix with oxygen-poor blood, so that oxygen-rich
blood has a way to get pumped to the rest of the body.
MANIFESTATIONS
 Problems of breathing
 Ashen or bluish skin color
 Poor feeding
 Extreme sleepiness
 Chronic hypoxemia
MANAGEMENT
 Septostomy (first few days or weeks)
 Creates or enlarges the asd so oxygen-poor blood can mix with
oxygen-rich blood, and more oxygen-rich blood can get to the body.
 Banding (first few days or weeks)
 Surgery performed to place a band around the artery going to the
lungs (PA) to control the blood flow to the lungs.
 Shunt procedure (first 2 weeks)
 Surgeons create a bypass (shunt) from the aorta to the main PA,
allowing blood to get the lungs
 Bi-directional Glenn Procedure (4-6 months of age)
 Creates a direct connection between the main pulmonary artery and the
superior vena cava, the vessel returning the oxygen-poor blood from the
upper part of the body to the heart.
 Main PA to SVC
 Fontan Procedure (2 years of age)
 This procedure connects the main pulmonary artery and the inferior
vena cava, the vessel returning oxygen-poor blood from the lower part of
the body to the heart, allowing the rest of the blood coming back from the
body to go to the lungs. Once this procedure is complete, oxygen-rich and
oxygen-poor blood no longer mix in the heart and an infant's skin will no
longer look bluish
 PA to IVC
 PRINCIPLES IN THE CARE OF
PATIENT WITH CARDIAC
 DEFECTS
Improve efficiency of cardiac function thereby
increase the cardiac output
 Decrease the cardiac workload
 Decrease edema
 Improve tissue perfusion
 CONGESTIVE HEART
FAILURE (Heart Failure)
 Inability of the heart to pump sufficiently to meet the metabolic demands of
the body
 Commonly caused by uncorrected congenital heart defect
 Chronic heart failure – combination of left and right heart congestive heart
failure symptoms
MANIFESTATIONS:
 Lethargy
 Activity limitations
 Cough / Chest congestions
 Edema
 Shortness of breath
2 TYPES
 Left Sided Heart Failure
 the oxygenated is not distributed all throughout the body
 It will affect the lungs, that is why the manifestation relies mainly on respiratory
functions:
 Dyspnea, decreased in 02 saturation,
 Yellow secretion (infection)
 Stridor,
 Pulmonary Crackles, increase pulse (tachycardia & tachypnea)
 Nasal flaring, grunting, and retraction
 Elevated in the RR
 Activity intolerance
 Right Sided Heart Failure
 retention of deoxygenated blood from the body
 It means it will affect the rest of the body where in the symptoms
include:

 Enlarge liver (hepatomegaly)

 Distended neck veins
 Enlarged spleen (splenomegaly)
 Most edema in lower extremities
 Ascites, and anorexia
MANAGEMENT
 Conserve energy – no crying; make the baby stop crying,
do not let the baby keep on crying
 Establish nutritional pattern (TPN – total parenteral
nutrition)
 Supportive oxygenation – with target limit
 PRIORITY INTERVENTIONS
 Evaluate the pulse including the presence and quality
 Promote oxygenations
 Always evaluate infant’s APGAR at birth
 Evaluate trending of weight for first few months
 Monitor for any signs and symptoms of endocarditis
 Promote the use RSV (respiratory syncytial virus vaccination,
should be given to infant and children before winter season
OTHER CARDIAC
DISEASEs
KAWASAKI DISEASE
Thank you
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