Nurs 302 Alterations in Cardiovasular Function in Children.pdf

# Alteration in Cardiovascular Function in Children ## Nursing 302: Week Six **UNBC** **UNIVERSITY OF NORTHERN BRITISH COLUMBIA** # Congenital Heart Disease - Major cause of death in the first year of life, other than prematurity. - Prenatal, environmental, and genetic risk factors: - Materna...

# Alteration in Cardiovascular Function in Children ## Nursing 302: Week Six **UNBC** **UNIVERSITY OF NORTHERN BRITISH COLUMBIA** # Congenital Heart Disease - Major cause of death in the first year of life, other than prematurity. - Prenatal, environmental, and genetic risk factors: - Maternal rubella or increased age, diabetes, alcoholism, medications, and hypercalcemia. - Antepartal bleeding. - Prematurity. - Chromosome differences. - Hemodynamic alterations: - Left to right shunts are characterized by a "back-leak" of blood from the systemic to the pulmonary circulation. This results in Pulmonary hypertension. - A right-to-left shunt allows deoxygenated systemic venous blood to bypass the lungs and return to the body. This results in Chronic hypoxemia. # Congenital Heart Defects ## Obstructive Defects - Coarctation of the Aorta - Aortic Stenosis - Pulmonary Stenosis ## Defects with Increased Pulmonary Blood Flow - Patent Ductus Arteriosus (PDA) - Atrial Septal Defect - Ventricular Septal Defect ## Defects with Decreasing Pulmonary Blood Flow - Tetralogy of Fallot - Tricuspid Atresia ## Mixing Defects - Transposition of the Great Arteries - Hypoplastic Left Heart Syndrome - Heart Failure # Coarctation of the Aorta - Narrowing of the lumen of the aorta that impedes blood flow. - **Clinical Manifestations:** - If severe: decreased cardiac output, acidosis, hypotension at birth. - If undiagnosed: no manifestations until hypertension detected in upper extremities at older age. # Aortic Stenosis - Narrowing of the left ventricular outlet - Causes increased workload on left ventricle and left ventricular hypertrophy. - **Clinical Manifestations:** - Infant: If significant faint pulses, hypotension, tachycardia, and poor feeding. - Older children: May have complaints of exercise intolerance. - **Valvular Aortic Stenosis:** - Malformed or fused cusps. - Progressive obstruction with episodes of myocardial ischemia. - Strenuous activity limited. # Pulmonary Stenosis - Narrowing of the pulmonary valve causing resistance to flow from right ventricle to pulmonary artery. - Right ventricular hypertrophy. - **Clinical Manifestations:** - If severe: Cyanosis from right-to-left shunt through atrial septal defect; Decreased cardiac output. # Patent Ductus Arteriosus (PDA) - Failure of the ductus arteriosus to close. Allows blood to shunt from the aorta to pulmonary artery, causing left-to-right shunt. - **Clinical Manifestations:** - Asymptomatic or - Pulmonary overcirculation - dyspnea, fatigue, poor feeding - Fixed with surgery. # Atrial Septal Defect - Abnormal opening between the atria; blood flows from left atrium to right atrium. - **Clinical Manifestations:** - Asymptomatic at early age - Pulmonary symptoms on exertion at later age # Ventricular Septal Defect - Abnormal communication between the ventricles. - Most common type of congenital heart lesion. - **Clinical Manifestations:** - May be asymptomatic. - If severe, increased pulmonary blood flow from left-to-right shunt, pulmonary hypertension. # Tetralogy of Fallot - Syndrome represented by four defects: 1. Ventricular septal defect (VSD) 2. Overriding aorta 3. Pulmonary valve stenosis 4. Right ventricle hypertrophy - **Clinical Manifestations:** - Acute cyanosis at birth or gradual cyanosis - Gradual clubbing, poor growth, hypercyanotic or "Tet" spells - If untreated, emboli, stroke, brain abscess, seizures # Transposition of the Great Arteries - Aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle. - Results in two separate, parallel circuits: - Unoxygenated blood circulates continuously through the systemic circulation. - Oxygenated blood circulates continuously through the pulmonary circulation. - Other defects allow mixing of these circuits. - **Clinical Manifestations:** - Depends on size and associated defects. # Kawasaki Disease - Acquired cardiovascular disorder - Acute, self-limiting systemic vasculitis that may result in cardiac sequelae (unwanted outcomes of having a disease). - Usually occurs in children under 5 years of age and in winter or spring. - Inflammation of the vasculature in the heart, can progress to aneurysms, scarring and stenosis. - **Diagnosis (five of six major findings):** - Fever for 5 or more days (unresponsive to antibiotics) - Bilateral conjunctivitis without exudation - Erythema of oral mucosa (strawberry tongue) - Peripheral edema and erythema - Polymorphous rash - Cervical lymphadenopathy