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Alteration on Oxy (cardiac acyanotic) Cheat Sheet by

Nursing care of the newborn with alteration in oxygenation due to cardiac and tissue perfusion.

The Human Heart

Risk Factors

• Cardiac develo­pment occurs very early in fetal life
• maternal factors (rubella, alcohol, diabetes mellitus)
• Genetic factors (history of congenital heart disease)
• Trisomy 21 (Down syndrome)
• Presence of other congenital anomalies or syndrome.

Atrial septal defect (Acyan­otic)

Opening in the atrial septum permitting free commun­ication of blood between the 2 atria
Ostium primum (ASD1) open at lower end of septum
Ostium secundum (ASD2) open near the center septum
Path­oph­ysi­ology
• Blood flows from left to right (oxy to deoxy) because of the stronger contra­ction of the left side of the heart, causing an increase volume in the right.
• Right atrium enlarged, ventri­cular hypert­rophy and increased pulmonary artery blood flow.
Signs and symptoms
•Dyspnea on exertion, fatiga­bility, mild growth failure
•Cyanosis does not occur unless CHF is present.
Diag­nosis
•ECG with color flow doppler reveal enlarged right side of the heart
• Cardiac cather­ization reveal separation in atrial septum
Trea­tme­nts
•Surgical or cather­ization laboratory for ASD2
•Surgery : sutured, completed with cathet­eri­zation
•Cardi­opu­lmonary bypass : open heart surgery
•Silastic or Dacron patch : sutured in place
Comp­lic­ati­ons
• Infectious endoca­rditis and eventual heart failure
• can cause emboli during pregnancy if not treated

Aortic Stenosis (Acyan­otic)

Narrowing at above or below the aortic valve.
Supr­ava­lvu­lar
ascending aorta. least common
Valv­ular
most common
Subv­alv­ular
subaortic. left outflow tract.
Signs & Symptoms
•Mild: exercise intole­rance, easy fatiga­bility, asymp.
•Moderate: Chest pain, dyspnea, diziness & syncope
•Severe: weak pulses, left failure, hypote­nsion, tachy and activity intole­rance chest pain and sudden death.
Trea­tment
•Balloon valvul­oplasty as the standard treatment
•Mild: activity should not be restricted
•Mod-s­evere: no compet­itive sports
•Cardiac cathet­eri­zation: Balloon dilation
•Surgical valvotomy: if closed procedure doesn't work. done to older pts. when severe calcium deposits further obstruct the valve.
•Beta blocker or calcium channel blocker
•Antib­iotic prophy­laxis against endoca­rditis
 

Acyanotic (Conge­nital heart defect)

Incr­eased pulmonary blood flow
• Atrial septal defect
• Ventri­cular septal defect
• Patent ductus arteriosus
• Atriov­ent­ricular canal
Obst­ruction to blood flow from ventri­cles
• Coarction of the aorta
• Aortic stenosis
• Pulmonic stenosis

Diagnostic Tests

Echoca­rdi­ogram
Cardiac Cathet­eri­zation
Electr­oca­rdi­ogram
Chest X-ray
Echoca­rdi­ography
MRI

Ventri­cular Septal Defect (Acyan­otic)

Abnormal opening in ventri­cular septum, allows free commun­ication between R & L ventricles
Small to moderate VSD: 3-6 mm, asympt­omatic
Moderate to large VSD: sympto­matic, require repair
Signs & Symptoms
4-8 weeks
•Easy fatigue, failure to thrive, dyspnea
• A loud, harsh murmur on left sternal border (3rd/4th )
• Thrill may be palpable, respir­atory infections
Trea­tment
•Small VSD: no surgical interv­ention, just reassu­rance
•Sympt­omatic VSD: meds, afterload reducers, diuretics
•Moderate: cardiac cathet­eri­zation
•Larger: 3mm open heart surgery
•Excep­tio­nally large: Silastic or Dacron patch
Comp­lic­ati­ons
• Cardiac or Heart failure
• Endoca­rditis due to recirc­ulating blood flow
Indi­cation for surgery: Large vsd with uncont­rolled sympto­mat­ology, Ages 6-12 mo. with large vsd & pulmonary HTN

Pulmonary Stenosis (Acyan­otic)

Narrowing of the pulmonary valve or PA that results in the obstru­ction of blood flow from the ventri­cles.
Signs & Symptoms
•Mild : Asympt­omatic, split 2nd heart sound w/ delay
•Heart failure (right) & cyanosis with severe
• Systolic ejection murmur, Right ventri­cular enlarg­ement
• Exercise intole­rance
Trea­tment
•Mild: No interv­ention needed, close follow up
•Mid-s­evere: requires relieve of stenosis
•Balloon valvup­lasty, treatment of choice
•Surgical valvotomy is also a consid­era­tion.
•Open-­heart needed only for more complex valve anomaly.
 

Cyanotic (Conge­nital heart defect)

Decr­eased pulmonary blood flow
• Tetralogy of Fallot
• Tricuspid atresia
Mixed blood flow
• Transp­osition of great vessels
• Truncus arteriosus
• Total anomalous pulmonary venous return
• Hypopl­astic left heart syndrome

Atriov­ent­ricular Septal Defects (Acyan­otic)

•Also called an endo­cardial cushion defect, results from incomplete fusion of the endoca­rdial cushion. At the septum of the heart
•Consists of a low atrial septal defect continuous with ventri­cular septal defect & clefts of mitral & tricuspid, creating a large central AV valve
• Allows blood to flow between all heart chambers.
Signs and Symptoms
•CHF in infancy, Failure to thrive, recurrent infections
•Exercise intole­rance, easy fatiga­bility
•Cardiac enlarg­ement on CX-ray
•Late cyanosis from pulmonary vascular w/ R to L shunt
Trea­tment
• Surgery is always required
• Treatment of congestive symptoms.
•Pulmonary banding maybe req. in premature or <5kg

Patent Ductus Arteriosus (Acyan­otic)

Conduit between pulmonary artery & aorta fails to close and results in increased pul. blood flow (L to R shunt)
Ductus Arteri­ousus fetal structure that connects PA to the aorta. Closure at first breath and is incomplete bet. 7 to 14 days. closure not until 3 mos.
• blood will shunt from aorta (oxy) to the PA (deoxy) because of the increased pressure in the aorta.
Signs & Symptoms
• Small PDA: usually asympt­omatic
• Large PDA: symptoms of CHF & growth restri­ction
• Bounding arterial pulses, Widened pulse pressure
• Enlarged heart, prominent apical impulse.
•Classic continuous machinery systolic murmur
• Mild-d­ias­tolic murmur at the apex.
Trea­tment
• Indome­thacin, inhibitor of prosta­glandin synthesis
• Surgical or catheter closure.
Same compli­cations

Coarction of the Aorta (Acyan­otic)

Narrowing of aorta due to a constr­icting band
Signs & Symptoms
•Dimin­ution or absence of femoral pulses
•Higher BP in upper extrem­ities, headache, vertigo
•Weak lower extremity pulses. decrease cardiac output
• Epistaxis & CVA not in children due to elevated BP
•Leg pain due to diminished blood supply
Trea­tme­nts
•Surgical interv­ention, prevent left vent dysfun­ction
•Angop­lasty is used by some centers
•Balloon angiop­lasty is the procedure of choice
•Antih­ype­rte­nsive - High BP post-op
•Antib­iotic as prophy­lactic
                                   
 

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