CONGENITAL HEART DISEASES PPT

CYANOTIC AND ACYNOTIC HEART DISEASES

1. CONGENITAL HEART DISEASES P.THIRUNAGALINGA PANDIYAN M.Sc.,(Child Health Nursing) Madurai Medical College Madurai

2. CONGENITAL HEART DEFECT (CHD) Definition A congenital heart defect (CHD) is defined as a defect in the structure of the heart and great vessels which is present at birth.

3. CAUSES Genetics Genetic changes, either focal mutations or deletion or addition of segments of DNA Environmental Known antenatal environmental factors include maternal infections (Rubella), drugs (alcohol, hydantoin , lithium and thalidomide) and maternal illness (diabetes mellitus, phenylketonuria, and systemic lupus erythematosus ). Maternal obesity

4. CLASSIFICATION OF CONGENITAL HEART DISEASES Cyanotic heart disease , is a condition that deoxygenated blood moves from the right side of the heart to the left side through abnormal openings or defects.

5. CLASSIFICATION OF CONGENITAL HEART DISEASES Acyanotic heart disease is a condition that oxygenated blood moves from the left side of the heart to the right side and then to the lungs.

6. CLASSIFICATION OF CONGENITAL HEART DISEASES

7. ACYANOTIC HEART DISEASE Blood is shunted (flows) from the left side of the heart to the right side of the heart Child retain normal levels of oxyhemoglobin saturation in systemic circulation. Common Acyanotic heart diseases are Atrial septal defect, or ASD Ventricular septal defect, or VSD Patent ductus arteriosus Co arctation of the aorta Aortic valve stenosis Pulmonary valve stenosis

8. ATRIAL SEPTAL DEFECT Atrial septal defect (ASD) is a form of congenital heart defect that enables blood flow between the left and right atria via the interatrial septum. The interatrial septum is the tissue that divides the right and left atrium.

9. ATRIAL SEPTAL DEFECT

10. Types of Atrial Septal Defects 1.Ostium Secundum – defect located in the center of the atrial septum (most common type ) 2.Ostium Primum – defect located near the lower portion of the atrial septum, may be associated with defects in the mitral and tricuspid valve (second most common type) 3.Sinus Venosus – defect located near the top of the atrial septum and frequently associated with abnormal connection of the right pulmonary vein(s) to the right atrium instead to the left atrium (least common type)

11. ASD TYPES

12. Clinical manifestations of ASD Asymptomatic Systolic murmur with fixed split second heart sound May also be a diastolic murmur Risk for developing dysrhythmias

13. DIAGNOSIS OF ASD Ultrasonography Auscultation: Echocardiography Transesophageal Doppler (TCD) Bubble study Electrocardiogram

14. TREATMENT FOR ASD Surgical Patch Closure-open repair Percutaneous ASD closure is currently only indicated for the closure of secundum ASD

15. VENTRICULAR SEPTAL DEFECT A ventricular septal defect (VSD) is a defect in the ventricular septum, the wall dividing the left and right ventricles of the heart.

16. VSD

17. Signs and symptoms of VSD Pansystolic ( Holosystolic ) murmur Fail to thrive Sweaty Tachypnoeic ( breathe faster) .

18. TREATMENT Medical Treatment Cardiac glycosides (e.g., Digoxin 10-20mcg/kg per day) Loop diuretics (e.g., Furosemide 1–3  mg/kg per day) ACE inhibitors (e.g., Captopril 0.5–2  mg/kg per day).

19. Surgical Treatment for VSD Surgical treatment: -Surgical patch closure.

20. PATENT DUCTUS ARTERIOSUS Patent ductus arteriosus (PDA) is a congenital disorder in the heart wherein a neonate's ductus arteriosus(connection between Pulmonary artery and Descending aorta ) fails to close after birth.

21. PDA

22. Signs and symptoms of PDA Tachycardia Respiratory problems Dyspnea - shortness of breath Continuous machine-like heart murmur Cardiomegaly - enlarged heart Left subclavicular thrill Bounding pulse

23. Diagnosis of PDA Echocardiography Electrocardiography (ECG) A chest X-ray

24. Treatment of PDA Medical treatment : Indomethacin 0.1 to 0.25 mg /kg Surgical treatment : Surgical division or ligation of the patent vessel is performed.

25. COARCTATION OF THE AORTA Coarctation of the aorta is a congenital condition whereby the aorta narrows in the area where the ductus arteriosus This results in increased pressure proximal to the defect and decreased pressure distal to the obstruction.

26. COARCTATION OF THE AORTA

27. Signs and symptoms of Coarctation of aorta Difficulty breathing, Poor appetite Trouble feeding, Failure to thrive. Dizziness or shortness of breath, Faint or near-fainting episodes Chest pain, Fatigue, Headaches, or nosebleeds

28. Imaging and diagnosis A classic 'figure E sign' on x-ray Magnetic resonance Angiography. Echocardiograms MR, CT Angiography

29. Treatment Surgical treatment : Surgical repair is by resection of the coarcted portion with an end-to-end anastomosis of the aorta Enlargement of the constricted section using a graft of prosthetic material or a portion of the lift subclavian artery. Non surgical treatment: Baloon angioplasty

30. AORTIC VALVE STENOSIS Aortic valve stenosis (AS) is a disease of the heart valves in which the opening of the aortic valve is narrowed.

31. Signs and symptoms Mild to moderate aortic stenosis do not have symptoms. Shortness of breath on exertion Syncope Chest Pain

32. Diagnosis Electrocardiogram Heart catheterization Echocardiogram. Chest X-ray

33. Management Aortic valve replacement Percutaneous ( Transcatheter )Aortic Valve Replacement Balloon valvuloplasty

34. PULMONIC STENOSIS Pulmonic stenosis is a condition of narrowing of Pulmonary valve

35. PULMONIC STENOSIS

36. Symptoms Jugular vein distension Cyanosis Right ventricular hypertrophy Sudden fainting. An enlarged liver (hepatomegaly) Swelling in the legs (edema)

37. Treatment Valve replacement Balloon Valvuloplasty

38. CYANOTIC HEART DISEASE Tetralogy of Fallot Transposition of the great vessels Tricuspid atresia Hypoplastic left heart syndrome

39. TETRALOGY OF FALLOT Tetralogy of Fallot (TOF) is a congenital heart defect which has four anatomical abnormalities Four defects are Pulmonary Stenosis Overriding aorta Ventricular Septal Defect (VSD) Right ventricular hypertrophy

40. TETRALOGY OF FALLOT

41. Signs and symptoms Low blood oxygen saturation causes cyanosis Heart murmur Difficulty in feeding, Failure to gain weight, Retarded growth and physical development, Dyspnea on exertion, Clubbing of the fingers and toes, and Polycythemia .

42. Diagnosis Chest X ray- The abnormal " (Boot-like) appearance of a heart Echocardiogram

43. Management There are also simple procedures such as Squatting and the Knee Chest Position

44. Management Beta-blockers such as propranolol, Morphine to reduce ventilatory drive Vasopressor such as epinephrine, phenylephrine, or norepinephrine to increase blood pressure. Oxygen (100%)

45. Surgical procedures Palliative surgery Blalock-Thomas- Taussig shunts The Potts shunt and the Waterston-Cooley shunt Total surgical repair

46. TRANSPOSITION OF THE GREAT VESSEL The aorta is present at Right ventricle ( usually Left Ventrilcle ) and Pulmonary artery is present at Left ventricle ( usually right Ventrilcle ) The condition is also called dextro -transposition of the great arteries.

47. TRANSPOSITION OF THE GREAT VESSEL

48. TRANSPOSITION OF THE GREAT VESSEL Clinical manifestations Cyanotic Growth failure Abnormal Heart sounds Cardiomegaly

49. TRANSPOSITION OF THE GREAT VESSEL Management : Prostaglandin E1, digoxin,Lasix Surgical treatment An Arterial switch procedure. Intra Artial baffle repairs, Rastelli procedure also performed.

50. TRICUSPID ATRESIA Tricuspid atresia is a form of congenital heart disease whereby there is a complete narrowing of the tricuspid valve.

51. TRICUSPID ATRESIA

52. Clinical manifestations Progressive cyanosis Poor feeding Tachypnea over the first 2 weeks of life Holosystolic murmur due to the VSD Left ventricular hypertrophy

53. Treatment Prostoglandins to maintain Patent Ductus Arteriosus Modified Blalock- Taussig shunt to maintain pulmonary blood flow Cavopulmonary anastomosis to provide stable pulmonary flow Fontan procedure to redirect inferior vena cava and hepatic vein flow into the pulmonary circulation

54. HYPOPLASTIC LEFT HEART SYNDROME Hypoplastic left heart syndrome (HLHS) is a birth defect that affects normal blood flow through the heart. The left side of the heart does not form correctly.

55. HYPOPLASTIC LEFT HEART SYNDROME

56. Signs and symptoms Cyanosis Heart failure Decreased cardiac output

57. Treatment Multiple stage approach surgery - Norwood procedure Anastamosis of the main pulmonary artery to the aorta Heart transplantation

58. Nursing Interventions A. Provide adequate nutritional and fluid intake to maintain the growth and developmental needs of the child Feed in semi-erect position Provide small frequent feedings Provide foods with high nutritional value Determine child’s likes and dislikes Strict input and output Daily weight

59. Nursing Interventions B. Prevent infection Prevent exposure to communicable diseases Immunizations should be up-to-date Handwashing should be observed Be certain that the child receives prophylactic medication for infective endocarditis

60. Nursing Interventions Reduce the workload of the heart since decreased activity and expenditure of energy will decrease oxygen requirements Adequate rest Avoid unnecessary activities Prevent excessive crying Provide diversional activities Relieve the respiratory distress associated with increased pulmonary blood flow or oxygen deprivation

61. NURSING MANAGEMENT OF THE CHILD WITH A CONGENITAL HEART DEFECT Nursing Diagnoses Impaired gas exchange related to altered pulmonary blood flow or oxygen deprivation Altered cardiac output related to specific anatomic defect Activity intolerance related to decreased oxygenation in blood and tissues Altered Nutrition: less than body requirements related to the excessive energy demands required by increased cardiac workload

62. NURSING MANAGEMENT OF THE CHILD WITH A CONGENITAL HEART DEFECT Increased potential for infection related to poor nutritional status Anxiety related to diagnostic procedures and hospitalization Developmental delay related to decreased energy, inadequate nutrition, physical limitations and social isolation Alteration in parenting related to parental perception of the child as vulnerable