PEDS Module 5: Circulation

Notes

• Congentital heart defects

• Alteration in perfusion/cardiovascular disorder

  • Types of defects

    • Congetnital heart disease: structural anomalies that are present at brith

      • Including: interior wall of the hearts, valves inside the heart, arteries and veins that carry blood to the heart

      • Are classified based on hemodynamic characteris

      • Classification of congenital heart defects

        • Increased pulmonary blood flow (Pink babys)

        • Decrease pulmonary blood flow ( Blue babys)

        • Mixed disorders

        • Acquired heart disease

    • Acquired Heart Disease: Disorders that occur after birth

  • Hemodynamic characteristics of cngential heart defects

    • Disorders with decreased pulmonary blood flow

      • Tetralogy of Fallot and tricuspid atresia

    • Disorderes with increased pulmonary blood flow

      • Patent ducuts ateriosus

      • Atrial septal defect

      • Ventriuclar spetal defect

    • Obstructive disorders

      • Coarctation of the aorta

      • Aortic stenosis

      • Pulmonary stenosis

    • Mixed dsioders

      • Transpotiion fo the great vessels

      • Total anomalous pulmonary venous retuern

      • Truncus artioerus hypoplastic

    • Acquuired HD

      • Heart failure

  • Signs of a cardiac disorderds

    • Cyanosis, irregular heart rate, edema, clubbing of fingertips, fever, retractions or increase work of breathing, chest deformities, vrisble, engroemeed, abnomral pulses, abdominal distention

  • Dx

    • Pulse oxitery, ECG, Echo, Chest radiograph, excercise sttress test

  • Medication

    • Digoxin MOA

    • Lasix MOA

    • Cardiac Glycoside

    • ACE inhbitor

    • Beta Blockers

    • Loop diuretcis

• Stetohrrea

Groups

Group 1: Tetralogy of Fallot

• Pathophysiology: Congenital heart failure

  • VSD, hypertrophy

• Clincal manifestiation: Cynaosis, clubing of fingers and toes, heart mrmurs, poor feeding/ failure to thrive, fatigue and dyspnea on exertion

• Treatment and medication

• Labs and Diagnostic Test

• Eductation

Group 2: Patent Ductus Arteriosis

• Pathophysiology

• Clincal manifestiation

• Treatment and medication

• Labs and Diagnostic Test

• Eductation

Group 3: Coarctation of the aorta

• Pathophysiology: Congenital heart defect where the aorta is narrowed/ constricted (obstructive)

• Clincal manifestiation: Elevated blood pressure in upper extermitis and bouding

  • Decreased BP in lowering extermities and weak/absent femoral pulses

  • Dizziness, headaches, faiting, nosebleeds in older children

  • HF in infants

• Treatment and medication

  • Medication: Digoxin, diuretic, oxygen, Dobutamine hydrochloride

  • Prostaglandin E1 infusion

  • Prophylactic antibitiocs

  • Antihypertensives

  • Vasodilator

• Labs and Diagnostic Test

  • Diagnostic test:

• Eductation

  • What is thsi diease/ what is teaching and prognosis

  • Medicaiton

  • S/S, energy conservaiton, measures

  • Activity and excercise

  • Measures to prevent complication

  • Preoperative and post op

  • Importance of follow up care

Group 4: Transposition of great vessesl

• Pathophysiology

• Clincal manifestiation

• Treatment and medication

• Labs and Diagnostic Test

• Eductation

Group 5: Heart Failure ( Meds)

• Pathophysiology

• Clincal manifestiation

• Treatment and medication

• Labs and Diagnostic Test

• Eductation

• You can still give it in the normal since its between parameters

Powerpoint

Pathophysiology

• A congenital heart defect where the aorta is connected to the right ventricle and the pulmonary artery is connected to the left ventricle—the reverse of normal.

• Results in parallel circulation:

  • Systemic blood (low in oxygen) returns to the body without going to the lungs.

  • Pulmonary blood (oxygen-rich) keeps recirculating through the lungs.

• Survival depends on blood mixing through a PDA, ASD, or VSD.

Clinical Manifestations

• Cyanosis shortly after birth that does not improve with oxygen

• Tachypnea

• Poor feeding

• Possible murmur if a defect like VSD is present

• Clubbing or failure to thrive (if untreated)

• Signs of heart failure may appear later

Treatment and Medications

• Emergency Management:

  • Prostaglandin E1 (alprostadil) IV infusion to maintain PDA and improve oxygenation.

  • Balloon atrial septostomy (temporary intervention to create an atrial hole to allow mixing).

• Definitive Treatment:

  • Arterial Switch Operation (ASO), usually done in the first few weeks of life.

• Supportive care:

  • Oxygen therapy (may have limited effect until mixing occurs)

  • Monitor for signs of heart failure

  • Nutrition support (e.g., NG feeding if necessary)

Labs and Diagnostic Tests

• Pulse oximetry: Persistent hypoxemia

• Echocardiogram: Confirms abnormal placement of aorta and pulmonary artery

• Chest X-ray: May show “egg on a string” appearance

• ABG: Metabolic acidosis, low oxygen levels

• Cardiac catheterization: For diagnosis or intervention (septostomy)

Nursing Education for Family

• Explain the nature of the defect and importance of early intervention.

• Teach signs of respiratory distress, poor feeding, and cyanosis.

• Emphasize post-op care: incision care, medication adherence, developmental monitoring.

• Provide emotional support—this is a life-threatening but treatable condition.

• Encourage routine follow-up with pediatric cardiology.

• Connect to support groups or parent networks for congenital heart disease.

Questions