‘ The Pedi-Cardiac Lecture ’
Part 3
Pediatric Cardiovascular Disorders
Jerry Carley MSN, MA, RN, CNE
Concept Map:
Pediatric Cardiac Conditions
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AS
Aortic Stenosis
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6% of CHD defects
Aortic valve: has two rather than three
leaflets. Leaflets are thickened or fused.
Obstruction of blood flow from left ventricle
Mild symptoms: dizziness, syncope, angina,
fatigue
30% incidence of sudden death
Pathophysiology
Partially fused
Aortic Valve Leaflets
Frequently found in
Association with:
Mitral valve
Stenosis
Coarctation of
The Aorta
Decreased
Exercise
Tolerance
Effects / Symptoms
Possibly
Asymptomatic
Possible (L)
Ventricular
Hypertrophy
Treatments
Surgery
Heart Failure
Heart
Catheterization
Balloon
Dilation
Stenting
Closed Heart
Surgery
Nursing Care
Aortic Stenosis
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Causes obstruction to blood flow between the
left ventricle and aorta.
Most common form is obstruction of the valve
itself
When the aortic valve does not open properly
the left ventricle must work harder to eject
blood into the aorta.
Left ventricular muscle becomes
hypertrophied.
Diagnosis
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Heart murmur or AS is a turbulent noise
caused by ejection of blood through the
obstructed valve.
Electrocardiogram is usually normal
Echocardiogram will show the obstruction
and rule out other heart anomalies
Exercise stress test – provides information on
impact of the stenosis on heart function
Treatment
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Cardiac catheterization – balloon dilation of the
narrowed valve.
Surgical valvotomy if the closed procedure does not
work – often done when patient is older when
severe calcium deposits further obstruct the valve.
Recurrent valve obstruction is a complication and if
valve replacement is done too early the child may
outgrow the valve.
Antibiotic prophylaxis especially if valve replacement
HLH
Hypoplastic Left Heart (HLH)
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One of the most complex defects seen in the
newborn and the most challenging of all the
congenital defects
All the structures on the left side of the heart
are severely underdeveloped.
Mitral and aortic valves are either completely
closed or are very small – left ventricle is tiny
– aorta is small and often only a few
millimeters in diameter
(HLH)
HLH
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Life threatening shock develops when the
ductus arteriosis closes
Low oxygen saturations – will not increase
with oxygen administration
Pulses will be weak in all extremities
Plan to deliver infant in a hospital capable of
providing the aggressive treatment needed
Treatment HLH
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Three staged procedure to reconfigure the
cardiovascular system
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Norwood Procedure – right ventricle becomes the
systemic ventricle pumping blood to the body
Glenn Procedure-- done at 3-6 months
Fontan Procedure-- done at 2 -3 years of age
Long Term Complications
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Easily tiring when participating in sports or
other exercises
Formation of blood clots – heparin or
Coumadin use
Heart arrhythmias – pace maker
Cardiac failure
‘Acquired’ Pediatric Cardiac Conditions
Concept Map:
Pediatric Cardiac Conditions ( Acquired )
Frequent CHD Complication:
Bacterial Endocarditis
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Infection of endocardial surface of the heart
History of CHD, Kawasaki Disease,
Rheumatic Fever, or prosthetic valves are
more susceptible to infection
Prophylactic antibiotics with dental care,
throat, intestinal, urinary or vaginal infections
or surgery.
Rheumatic Fever
an inflammatory disease that occurs as a reaction to Group A
β-hemolytic streptococcus (GABHS) infection of the throat.
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Assessment
Risk Factors
◯◯ usually occurs within 2 to 6 weeks following an untreated or partially
treated upper respiratory infection (strep throat) with GABHS.
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Subjective and Objective Data
◯◯ History of recent upper respiratory infection
◯◯ Fever
◯◯ Fatigue
◯◯ Sore throat
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Rheumatic Fever…
S/S Continued
◯◯ Activity intolerance
◯◯ Poor appetite
◯◯ Tachycardia, cardiomegaly, prolonged PR interval, new or changed heart
murmur, muffled heart sounds, pericardial friction rub, and reports of chest pain,
which may indicate carditis
◯◯ Nontender, subcutaneous nodules over bony prominence
◯◯ Large joints (knees, elbows, ankles, wrists, shoulders) that have painful
swelling indicating polyarthritis
■■ Symptoms last a few days and then disappear without treatment,
frequently returning in another joint.
Rheumatic Fever……
◯◯ Pink, nonpruritic macular rash on the trunk and inner surfaces of
extremities that appears and disappears rapidly, indicating erythema
marginatum.
◯◯ CNS involvement (chorea) including involuntary, purposeless
muscle movements; muscle weakness; involuntary facial movements;
difficulty performing fine motor activities; labile emotions; and
random, uncoordinated movements of the extremities
◯◯ Irritability, poor concentration, and behavioral problems
Kawasaki Disease
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Acute-self limiting disease
Generalized vasculitis
Peak incidence 6 months to 2 years
More common in males and Japanese
http://www.aafp.org/afp/990600ap/3093.html
Clinical Manifestations
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High fever
Conjunctivitis – no drainage
Strawberry tongue
Edema of hands and feed
Reddening of palms and soles
Lymph node swelling
Child with Kawasaki Disease:
Red eyes, dry cracked lips, beefy red tongue
Edema – Hands and Feet
Peeling Finger Tips
Blood Values
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Elevated WBC
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Elevated ESR
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Elevated platelets
Interdisciplinary Interventions
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Intravenous gamma globulin
High dose of ASA while in hospital
Low dose ASA upon discharge
Base-line echocardiogram to assess
coronary artery status
Pye, S. & Green, A. (2011) Parent
Education After Newborn Congenital Heart
Surgery. Retrieved from
http://www.medscape.com/viewarticle/4582
06
Cyanosis Prior to Surgery…
18
Hours
Post-op
TOF: The Tatoo !
Cardiac
24 Hours Post-Op
http://www.youtube.com/watch?v=KFfCKy0nKr0