Pediatric Cardiology 1 PDF

Cardiovascular Disorders in Pediatrics Prepared by Ust: SAFA MOHAMMED ABDEBAGI MSc: Pediatric Nursing – University of Gezira Bachelor: Nursing Sciences – Alneelain University [email protected] Learning Objectives  Describe the structure and the function of the heart.  Describe fe...

Cardiovascular Disorders in Pediatrics Prepared by Ust: SAFA MOHAMMED ABDEBAGI MSc: Pediatric Nursing – University of Gezira Bachelor: Nursing Sciences – Alneelain University [email protected] Learning Objectives  Describe the structure and the function of the heart.  Describe fetal circulation.  Discuss general assessment of child with heart disease.  Discuss congenital heart disease. The function of the heart The function of the heart is to pump blood in sufficient amount to meet varying need of the body.  Fetal Circulation Umbilical vein, which carries oxygenated blood from the placenta to the fetus. Umbilical arteries, which carry deoxygenated blood from the fetus to the placenta. Foramen ovale, which serves as the septal opening between the atria of the fetal heart.  Ductus venosus: which carries oxygenated blood from the umbilical vein to the inferior vena cava (IVC). Ductus Arteriosus:Shunt between pulmonary artery and aorta.  General Assessment History: Health history of children include : Familial health [genetic diseases] Maternal health. Birth or neonatal health. Clinical Manifestation: Weak cry. Respiratory distress. Tachycardia. Decrease tolerance for exercise. Edema. Tendency to assume squatting position. Diagnostics: ECG X-Ray Echo Laboratory: Platelets, Electrolytes and cardiac enzymes Physical Assessment:  Measurement.  Vital sign.  Physical examination.  Observation of activity.  Pulse area.  Edema.  Abdominal organ.  Skin for capillary refill.  Heart sound.  Types of Heart Disease 1- Congenital heart diseases 2- Acquired heart diseases  Congenital Heart Diseases Congenital Heart Defects (CHDs) are structural defects of the heart ,great vessels ,or both are present from birth. **The incidence of CHDs is 5to8/1000  Etiology of CHDs 1-In more than 90% of CHDs cases the cause is unknown. 2-Factors associated with increased incidence of CHDs includes: Maternal infection diabetic mother Maternal alcoholism Age over 40 y Exposure to radiation Genetic factors  Classification CHD Acyanotic Cyanotic  Tetralogy of Fallot  transposition of the great Left-to-right Outflow arteries shunts obstruction - Ventricular Septal - Pulmonary Stenosis Defect (VSD) - Aortic Stenosis - Atrial Septal Defect -Coarctation of aorta - Patent Ductus Arteriosus (PDA) (ASD ACYANOTIC Left-to-right shunts  Ventricular Septal Defect (VSD)  Its most CHD.  Its an abnormal opening between the right and left ventricle.  Common – 25-30% of all cases of CHD. Pathophysiology:  Oxygenated blood is shunted from left to right side of the heart via defect.  A larger volume of blood than normal mast be handled by the right side of the heart → hypertrophy.  Extra blood passes through the pulmonary artery into the lungs, causing higher pressure than normal in the blood. Clinical Manifestation Tachypnea is typically the first presenting symptom. Dyspnea Excessive sweating Hepatomegaly pan systolic murmur Management Initial treatment – diuretics and digoxin. Continued poor growth requires closure of the defect. Surgery is usually done at 3-6 months of age for : Managing heart failure and failure to thrive. Prevent permanent lung damage from pulmonary HPT and high blood flow.  Atrial Septal Defects ASD Its abnormal communication between the two atria. Patho physiology: Pressure is higher in the left atrium than the right, causing blood to shunt from the left to The right atrium and pulmonary artery enlarge because they are handling more blood. Clinical Manifestation Most infant tend to be a symptomatic until early childhood and defect close spontaneously by 5 years. Symptoms vary with the size of the defect. fatigue, dyspnea on exertion are the most common. Slow weight gain. Systolic ejection murmur. Management - Medication (digoxin). - Cardiac catheterization. - Open heart surgery.  Patent Ductus Arteriosus (PDA) - The ductus arteriosus allows blood to flow from the pulmonary artery to the aorta during fetal life. - In term infants, it normally closes shortly after birth. - In preterm infants, the PDA is not from CHD but due to prematurity. Physical findings - Continuous machinery murmur beneath the left clavicle. Management Medication : Indomethacin ( inhibits prostaglandin) - Surgery - Cardiac catheterization. * Complications include the following: - Endocarditis − - Congestive heart failure − - Aortic rupture − ACYANOTIC Outflow obstruction  Coarctation of Aorta - Narrowing of the aorta causing obstruction of left ventricular blood flow. - Left ventricular hypertrophy. Clinical Manifestation - Difference in blood pressure and pulse quality between upper and lower extremities (elevate blood pressure in the upper extremities and lower in the lower extremities) - pulse is pounding in the upper and decrease or absent in lower extremities. - Additional manifestation may be epistaxis, headache and lower limb muscle crump. Management: Goal of management are to improve ventricular function and restore blood flow to the lower body. - Medical management with medication ( a continuous intravenous prostaglandin is used to open the Ductus Arteriosus. - Baloon valvuplasty - Surgical repair  Pulmonary Stenosis o Pulmonary stenosis is narrowing of the pulmonary valve or the pulmonary artery. Clinical Manifestation In neonate:- Hypoxia Tachycardia In child and adolescent:- Decreased exercise tolerance Dyspnea Chest pain  Therapeutic Management o Management of the defect depends on the severity of the stenosis and the child’s age. o Balloon angioplasty by way of cardiac catheterization is the procedure of choice.