PEDS congenital heart problems

increased pulmonary blood flow

blood shunts from the high-pressure left side to the low-pressure right side, causing extra blood to flow to the lungs. The primary risk and manifestation is Heart Failure.

Right side of heart

atrial septal defect

An abnormal opening between the atria. Blood flows from the Left Atrium to the Right Atrium. This increases flow and pressure on the right side of the heart.

May be asymptomatic or develop Heart Failure (HF). A characteristic murmur is present. Repair can be done via cardiac catheterization or surgery

atrial septal defect intervention

• Small: May close spontaneously.

• Large: Closure via cardiac catheterization (device) or surgical patch/suture.

• Nursing: Monitor for signs of HF and growth failure.

ventricular septal defect

An abnormal opening between the ventricles. Blood flows from the Left Ventricle to the Right Ventricle. This is the most common of the shunting defects.

A characteristic murmur is present.

20–60% of VSDs close spontaneously during the first year of life.

ventricular septal defect intervention

• Small: May close spontaneously (first year of life).

• Symptomatic/Large: Diuretics (Furosemide) and Digoxin to manage HF.

• Surgical/Device closure if HF is unmanageable or if pulmonary hypertension develops.

patent ductus arterius

The fetal ductus arteriosus fails to close. Blood flows from the high-pressure aorta to the low-pressure pulmonary artery. This increases the workload on the left side of the heart.

Can be asymptomatic or develop Heart Failure

decreased pulmonary blood flow

blood shunts from the right side to the left side, bypassing the lungs and sending desaturated (unoxygenated) blood into the systemic circulation. The primary consequence is Hypoxemia/Cyanosis

Left side of lungs

tetralogy of fallot

A combination of 4 defects (VSD, Pulmonary Stenosis, Overriding Aorta, Right Ventricular Hypertrophy). Increased pressure on the right side forces desaturated blood to shunt into the left side.

Patients are hypoxemic and appear cyanotic. This chronic state leads to signs over time:

Polycythemia (increased risk for stroke) and clubbing of the digits.

polycythyemia

An abnormal increase in the number of red blood cells (RBCs) in the blood.

clubbing of digits

A physical sign characterized by the enlargement of the fingertips (or toes) and a downward sloping (convex) of the nail beds.

hypercyanotic spells

Acute, life-threatening episodes of profound cyanosis and hypoxia, often triggered by crying, feeding, or stress. Manifestations include worsening cyanosis,

Hyperpnea (deep, rapid breathing), and limpness/fainting.

hypercyanotic spells intervention

• Calm the child

• Knee-to-Chest position (or squatting): Increases SVR to force blood into the lungs.

• Administer 100% oxygen

• Morphine (to calm the child and relieve infundibular spasm).

• IV Fluids} (increase Preload).

obstructive defect

In this type of defect, there is a resistance to blood flow out of the heart.

coarctation of the aorta

A narrowing of the aorta (obstruction).

coarctation of the aorta manifestations

BP and Pulses are UNEVEN between the upper and lower body.

Proximal (Upper Body) Signs: Increased BP and Bounding pulses in the upper extremities.

Distal (Lower Body) Signs: Weak or absent femoral pulses and cool lower extremities. 

Older children: Headaches, nosebleeds (epistax) due to upper body hypertension

coa intervention

• Newborn Emergency: Administer Prostaglandin E to open the PDA. Treatment: Balloon angioplasty or surgical resection. Long-term: Lifelong monitoring for hypertension.

transportation of the great vessels

The aorta and pulmonary artery are switched, resulting in two separate, parallel circulatory systems with little to no communication. The primary issue is the mixing of saturated and unsaturated blood.

Manifestations: Profound Central Cyanosis immediately after birth that does not improve with %100 oxygen.

transportation of the great vessels intervention

• Prostaglandin E infusion (to keep the PDA open).

• Balloon Atrial Septostomy (Rashkind Procedure): Emergency catheterization to create an ASD, improving mixing.

• Definitive Solution: Arterial Switch Operation (surgery) within the first two weeks of life.