Fetal Heart Disorders

VSD (Ventricular Septal Defect) Patho

hole in septum between ventricles --> many close early in life

VSD Assessment & Diagnosis

-loud, harsh murmur at left sternal border

-history of heart failure

-Ultrasound or Echo in utero

VSD Treatment

-cardiac cath closure

-closes spontaneously

-diuretics

-surgical (pulmonary artery banding to repair with patch, but increases risk of heart blockage)

-monitor I&O

-apical pulse

VSD Education

-nutrition supplements

-reduce risk for infection

-involve RT, nutrition, cardiologist

VSD Complications

-pulmonary HTN

-heart failure

-poor feeding

-fatigue

ASD (Atrial Septal Defect) Patho

walls between atrium fail to form

ASD Assessment & Diagnosis

-heart murmur

-atrial dysrhythmia

-easily fatigued

-poor feeding

-liver enlargement

-congestion

-Echo

-EKG

-chest X ray

ASD Treatment

-meds (digoxin, diuretics, pain meds)

-surgical closure of defect

-monitor feeding intolerance

-monitor for CHF signs

-monitor for increased work of breathing

-monitor growth patterns

ASD Education

-cardiac cath site care (bleeding)

-may be on blood thinners

-higher risk of clot

-monitor for cyanosis

-poor weight gain

PDA (Patent Ductus Arteriosus) Patho

aorta connected to pulmonary artery outside of heart

PDA Assessment & Diagnosis

-murmur mid to lower left sternal border

-tachypnea

-poor feeding

-poor growth & weight gain

-excessive fluid weight gain

-low diastolic BO

-Echo

PDA Treatment

-thoracotomy to ligate duct

-cardiac cath to place a coil to block the PDA

-post op care

-give O2 if needed

-strict I&O

-daily weights

-monitor feeding intolerance

PDA Education

-monitor I&O

-monitor for irritability and lethargy

-attend cardiac appointments

Congenital Aortic Stenosis Patho

valve stenosis (or malformation in which aortic valve is bicuspid) which obstructs blood from left ventricle into aorta

Aortic Stenosis Assessment & Diagnosis

-chest pain

-fatigue

-exercise intolerance

-syncope

-murmur

-SOB

-EKG

-Chest X-ray

-Cardiac cath

Aortic Stenosis Treatment

-repair or replacement of aortic valve

-monitor for CHF signs

-pain management

-keep PDA open with prostaglandin drip

Aortic Stenosis Education

-teach home care procedures

-teach about bacterial endocarditis

CoA (coarctation of Aorta) PAtho

narrowing of aorta at left subclavian artery (between upper and lower extremities)

CoA Assessment & Diagnosis

-few symptoms

-decreased femoral pulses

-BP mismatch (upper extremities 20mm less than lower extremities)

-HTN

-SOB

-Poor feeding and growth

-Chest X-ray with "3" on aortic arch and left subclavian

-cardiac cath

-rib notching (vessels eroded bone)

CoA Treatment

-stint

-monitor meds

-monitor prefusion

-post op care for cardiac cath

-obtain BP on 4 extremities

CoA Education

-avoid strenuous activities

-prevent bacterial endocarditis

ToF (Tetralogy of Fallot) Patho

4 defects:

-VSD

-over riding aorta

-right ventricle hypertrophy

-pulmonary stenosis

ToF Assessment & Diagnosis

-heart murmur

-failure to gain weight

-dyspnea on exertion

-tet spells (sudden cyanosis)

-syncope

-ultrasound and Echo in utero

ToF Treatment

-surgery to correct defects soon after birth

-cluster care (rest)

-O2, but don't expect to improve SpO2 levels

-keep PDA open with vasopressors and prostaglandin drips

-calm infant with knees up to chest to increase lung perfusion

ToF Education

-prepare family for multiple surgeries

-teach family how to calm baby with knees up to chest to improve lung perfusion

-physical activity restriction

-medication adherence

-attend cardiology appointments