Cardiovascular System Peds

Congenital Heart Disease - Symptoms

Tachycardia, tachypnea, poor feeding, fatigue, diaphoresis, hepatomegaly, murmurs, cyanosis (if severe)

Congenital Heart Disease - Diagnostics

Echocardiogram, chest x-ray, ECG, cardiac catheterization

Congenital Heart Disease - Nursing Interventions

Promote oxygenation, reduce cardiac workload, promote adequate nutrition, prevent infection, post-op care, family education

Congenital Heart Disease - Unique Features

General baseline for all CHD — use as reference point

Congenital Heart Disease - Pathophysiology

Congenital structural defects alter blood flow patterns → can cause pressure overload, volume overload, or mixing of oxygenated/deoxygenated blood → leads to heart failure or cyanosis

Increased Pulmonary Blood Flow (ASD, VSD, PDA) - Symptoms

Acyanotic; pulmonary congestion, frequent respiratory infections, heart failure signs, murmurs

Increased Pulmonary Blood Flow (ASD, VSD, PDA) - Diagnostics

Echocardiogram, CXR showing cardiomegaly and increased pulmonary vascular markings

Increased Pulmonary Blood Flow (ASD, VSD, PDA) - Nursing Interventions

Monitor for respiratory distress, optimize nutrition, prepare for surgical or device closure

Increased Pulmonary Blood Flow (ASD, VSD, PDA) - Unique Features

Extra blood flows to lungs → pulmonary overcirculation

Increased Pulmonary Blood Flow (ASD, VSD, PDA) - Pathophysiology

Left-to-right shunt: blood from the higher-pressure left side leaks into the right side → extra blood volume goes to lungs → pulmonary congestion, CHF risk

Decreased Pulmonary Blood Flow (TOF, Tricuspid Atresia) - Symptoms

Cyanosis, clubbing, polycythemia, chronic hypoxemia, squatting behavior

Decreased Pulmonary Blood Flow (TOF, Tricuspid Atresia) - Diagnostics

Echocardiogram, oxygen saturation studies

Decreased Pulmonary Blood Flow (TOF, Tricuspid Atresia) - Nursing Interventions

Monitor for hypoxic/Tet spells, use knee-chest position, give O₂, morphine PRN

Decreased Pulmonary Blood Flow (TOF, Tricuspid Atresia) - Unique Features

Right-to-left shunting → cyanotic defects

Decreased Pulmonary Blood Flow (TOF, Tricuspid Atresia) - Pathophysiology

Obstruction of pulmonary blood flow + septal defect → blood bypasses lungs and shunts right-to-left → deoxygenated blood enters systemic circulation → cyanosis

Obstructive Defects (Coarctation, PS, AS) - Symptoms

Decreased cardiac output, poor perfusion, murmurs; Coarctation = upper BP > lower BP, weak femoral pulses

Obstructive Defects (Coarctation, PS, AS) - Diagnostics

BP measurement in upper vs. lower extremities, echocardiogram, CXR

Obstructive Defects (Coarctation, PS, AS) - Nursing Interventions

Monitor BP in all 4 extremities, prep for balloon angioplasty or surgery

Obstructive Defects (Coarctation, PS, AS) - Unique Features

Blood flow blocked → pressure load on heart

Obstructive Defects (Coarctation, PS, AS) - Pathophysiology

Narrowing (stenosis) of a vessel or valve creates obstruction → heart must pump harder to push blood past narrowing → ↑ pressure before obstruction, ↓ flow after obstruction

Mixed Defects (TGA, Truncus, HLHS) - Symptoms

Severe cyanosis, respiratory distress, shock if ductus closes

Mixed Defects (TGA, Truncus, HLHS) - Diagnostics

Echocardiogram, oxygen sats, chest x-ray

Mixed Defects (TGA, Truncus, HLHS) - Nursing Interventions

Prostaglandin E1 infusion to keep PDA open until surgery, prepare family for surgical correction

Mixed Defects (TGA, Truncus, HLHS) - Unique Features

Systemic & pulmonary blood mix; ductus-dependent lesions

Mixed Defects (TGA, Truncus, HLHS) - Pathophysiology

Oxygenated and deoxygenated blood mix in systemic circulation, or circulation pathways run in parallel (TGA) → systemic hypoxemia and CHF; survival often depends on PDA or other shunts

Tetralogy of Fallot - Symptoms

Cyanosis, Tet spells (sudden hypoxia), squatting/knee-chest position relieves symptoms

Tetralogy of Fallot - Diagnostics

Echocardiogram, chest x-ray (boot-shaped heart)

Tetralogy of Fallot - Nursing Interventions

Knee-chest during spells, oxygen, morphine, surgical repair

Tetralogy of Fallot - Unique Features

4 defects: VSD, pulmonary stenosis, overriding aorta, RV hypertrophy

Tetralogy of Fallot - Pathophysiology

Pulmonary stenosis + VSD cause right-to-left shunting → deoxygenated blood goes into systemic circulation → cyanosis; RV hypertrophy develops from pressure load, overriding aorta receives mixed blood

Coarctation of the Aorta - Symptoms

High BP upper extremities, weak/absent femoral pulses, headaches, nosebleeds

Coarctation of the Aorta - Diagnostics

BP differences, echocardiogram, CT/MRI angiography

Coarctation of the Aorta - Nursing Interventions

Monitor extremity perfusion, prep for surgery or balloon angioplasty

Coarctation of the Aorta - Unique Features

Classic BP gradient between arms and legs

Coarctation of the Aorta - Pathophysiology

Narrowing of the aorta after vessels to upper body branch off → high pressure to head/arms, reduced flow to lower body → HTN in upper extremities, weak femoral pulses

Hypoplastic Left Heart Syndrome - Symptoms

Cyanosis, tachypnea, poor perfusion, shock when PDA closes

Hypoplastic Left Heart Syndrome - Diagnostics

Echocardiogram, pulse ox, CXR

Hypoplastic Left Heart Syndrome - Nursing Interventions

Prostaglandins to keep PDA open, staged surgeries or transplant

Hypoplastic Left Heart Syndrome - Unique Features

Underdeveloped left heart; systemic perfusion entirely PDA-dependent

Hypoplastic Left Heart Syndrome - Pathophysiology

Left ventricle and aorta are severely underdeveloped → left side can't pump systemic blood → systemic circulation depends on PDA shunting from right heart

Transposition of Great Arteries - Symptoms

Profound cyanosis at birth, minimal response to oxygen

Transposition of Great Arteries - Diagnostics

Echocardiogram, CXR (egg-on-a-string heart)

Transposition of Great Arteries - Nursing Interventions

Prostaglandins to maintain PDA, balloon atrial septostomy, surgical repair

Transposition of Great Arteries - Unique Features

Aorta and pulmonary artery switched → parallel circulation

Transposition of Great Arteries - Pathophysiology

Pulmonary artery arises from left ventricle and aorta arises from right ventricle(Aorta and Pulmonary Artery switch places) → systemic and pulmonary circulations run in parallel, not series → survival depends on mixing via PDA, VSD, or ASD

Heart Failure (Peds) - Symptoms

Tachycardia, tachypnea, diaphoresis, poor feeding, failure to thrive, hepatomegaly, edema, exercise intolerance

Heart Failure (Peds) - Diagnostics

Echocardiogram, chest x-ray, BNP, ECG

Heart Failure (Peds) - Nursing Interventions

Promote oxygenation, monitor for fluid overload, give diuretics (furosemide), digoxin (monitor toxicity), ACE inhibitors, provide small frequent feeds, daily weights

Heart Failure (Peds) - Unique Features

Infants present with poor feeding, diaphoresis, irritability, and growth failure rather than classic adult symptoms

Heart Failure (Peds) - Pathophysiology

Heart unable to pump effectively → blood backs up (left side → pulmonary congestion; right side → systemic congestion) → poor perfusion and fluid overload

Acute Rheumatic Fever - Symptoms

Fever, migratory polyarthritis, erythema marginatum, subcutaneous nodules, Sydenham chorea, carditis (new murmur)

Acute Rheumatic Fever - Diagnostics

Jones Criteria (2 major or 1 major + 2 minor) + recent strep infection (throat culture, ↑ ASO titers)

Acute Rheumatic Fever - Nursing Interventions

Antibiotics (penicillin), anti-inflammatories (aspirin, corticosteroids), monitor for carditis, bed rest, prophylactic antibiotics to prevent recurrence

Acute Rheumatic Fever - Unique Features

Autoimmune inflammatory response after untreated group A strep throat; can damage heart valves (rheumatic heart disease)

Acute Rheumatic Fever - Pathophysiology

Post-streptococcal autoimmune reaction → antibodies cross-react with heart, joints, brain, and skin → inflammation and scarring of heart valves

Kawasaki Disease - Symptoms (Acute phase)

Fever > 5 days, red eyes (conjunctivitis), red cracked lips, strawberry tongue, swollen/red hands and feet, rash, lymphadenopathy

Kawasaki Disease - Symptoms (Subacute phase)

Peeling skin on hands/feet, joint pain, coronary artery aneurysms risk

Kawasaki Disease - Diagnostics

Clinical diagnosis: fever + ≥4 of symptoms (rash, conjunctivitis, mucous membrane changes, extremity changes, lymphadenopathy); echocardiogram for coronary arteries

Kawasaki Disease - Nursing Interventions

High-dose IVIG, aspirin therapy, monitor heart for coronary aneurysms, teach parents about recurrence signs, comfort care for fever/irritability

Kawasaki Disease - Unique Features

Leading cause of acquired heart disease in children; coronary artery aneurysm risk if untreated

Kawasaki Disease - Pathophysiology

Systemic vasculitis of unknown cause → inflammation of medium vessels, especially coronary arteries → aneurysm and clot ris

Atrial Septal Defect(ASD)

Opening dividing the heart's right and left Atrium

Ventricular Septal Defect(VSD)

Opening dividing the heart's right and left Ventricle

Patent Ductus Arteriosus(PDA)

Opening between Pulmonary artery & Aorta

Pulmonary Stenosis(PS)

Thicking of the Pulmonary Valve

Aortic Stenosis

Thicking of the Aortic Valve