Congenital Heart Defects

acyanotic

no cyanosis, extra blood flow to the lungs, consequence is heart failure

cyanotic

not enough blood flow to the lugns, consequence is chronic hypoxemia

type of acyanotic congenital heart defects

ventricular septal defect VSD, patent ductus arteriosus PDA

type of cyanotic CHD

tetralogy of fallot ToF, transposition of great arteries             

mostly acyanotic CHD

pulmonic stenosis PS, coarctation of the aorta

ventricular septal defect

most common CHD, opening of the two ventricles, increases pulmonary blood flow, allows the blood to go from high pressure area to the path of least resistance

VSD s/s

loud harsh murmur in the left sternal border

VSD treatment

may close on its own, transcatheter/suture closure

transcatheter closure

goes through the cardiac cath, deploys the patch and pull it to the side to completely deploy the patch, occludes the hole between the ventricles 

suture closure

suture the hole to close it depending how big the hole is

patent ductus arteriosus PDA

normal part of fetal circulation, blood is coming through the aorta, back into the pulmonary artery and back into the lungs, increases pulmonary blood flow 

PDA s/s

may be asymptomatic, machine like murmur

what happens if murmur is heard from a healthy baby

notify provider, get echo, referral to cardiologist

prostaglandin

natural hormone the placenta makes, keep circulation open

prostaglandin inhibitor

closes the circulation, NSAIDs can function as an inhibitor

PDA treatment

usually closes on its own in the first few weeks of life, indomethacin, PDA ligation, occlusion coil placed during heart cath 

indomethacin

prostaglandin inhibitor, given IV

PDA ligation

titanium clip or suture occluding the PDA

how does a occlusion coil work

deploys coil and scars up so blood doesn’t get through

pulmonic stenosis PS

typically acyanotic, severity depends on the degree of stenosis

treatment of PS

valvotomy/balloon angioplasty

vvalvotomy/balloon angioplasty

balloon goes into the cath and stretches the valve open, allows more blood flow

can a valvotomy last forever

no it is not a perfectly operational valve afterwards, may need a replacement valve or do it again later on 

most severe form of PS

pulmonary atresia, no opening/blood flow of the pulmonary valve

coarotation of the aorta

narrowing of the aorta

s/s of coarotation of the aorta

more blood flow to upper half of the body, weak pulses in lower half, normal pulses in upper half, cool lower extremities, defferential cyanosis: pink upper half, blue lower half, normal BP upper half, low BP on bottom

how should you check the BP on someone with coarotation of the aorta 

do 4 extremity BP 

surgical correction for a coarotation of the aorta

cut occlusion out and connect the ends together, make sure pt is big enough for the procedure 

complication of the surgical correction for coarotation of the aorta

suture rupture, worry about leakage

how to prevent leakage post op for correction of coarotation of the aorta

keep a low BP to prevent rupture, beta blockers, ACE inhibitors, control BP

tetralogy of fallot ToF

4 defects present: PS, VSD, overriding aorta, reight ventricular hypertrophy, duct dependent

overriding aorta

allows mix of blood to the body, shifted aorta

right ventricular hypertrophy

works harder, thick muscle under the right ventricle

ToF duct dependent

keep the PDA open get blood flow to the lungs, increase pulmonary blood flow, prostaglandin as soon as they’re born

ToF blue spells or tet

hypercyanotic, acute increase in cyanosis

when does ToF blue spells or tet occur

agitation, crying, after feeds, defecating

ToF blue spells or tet increases the risk for what 

emboli, death, seizure, change in LOC 

ToF treatment

kee to chest position, blow by O2, morphine, surgical repairs to correct all 4 defects within the 1st year

knee to chest position for ToF

younger children hold their legs up for them, older chilren will squat on their own

blow by O2 for ToF

vasodilator, open veins up, provides extra O2

morphine for ToF

vasodilator

transposition of the greater arteries

mixed, CHF and hypoxemia are the consequences, duct dependent

transposition of the greater arteries duct dependent

prostaglandin, mixed of blood flow, duct stays open so the deoxygenated lbood can go down into the lungs, create ASD to allow mixing of blood

transposition of the greater arteries treatment

atrialseptomy, switch the arteries where they belong

what CHD results in heart failure

defects that are acyanotic, obstructive defects on the left side of the heart, oxygenated lbood can’t get to the body 

what CHD results in hypoxemia

defects that cause decreased pulmonary blood flow, obstruction on the right side, blood can’t get into the lungs