NCM 107
WEEK 14
CHILD WITH CARDIOVASCULAR
DISORDERS
_______________________________________
Prepared by Giovanni Clyde E. Rebadulla
INTRODUCTION
_________________________________
This lesson module will serve as the basis for the students
understanding on the Cardiovascular disorders of Pediatric clients.
This will focus on assessment , common laboratory tests, new
classification of cardiac pathologic conditions , the specific
disorders and the medical and Nursing managements.
CHILD WITH CARDIOVASCULAR
DISORDER
DEFINITION OF TERMS
• Systole
– Contraction of the chambers of the heart.
• Diastole
– Relaxation of the chambers of the heart.
DEFINITION OF TERMS
• CARDIAC OUTPUT (CO)
– The volume of blood pumped by the
ventricles per minute.
– Calculated by multiplying stroke volume
(the volume of blood a ventricle ejects
during systole) by the heart rate (beats per
minute).
– CO = SV x HR
DEFINITION OF TERMS
• CARDIAC OUTPUT (CO)
– Affected by 3 main factors:
• PRELOAD
– Volume of blood in the ventricles at the end of
diastole.
• AFTERLOAD
– Resistance against which the ventricles must pump.
• CONTRACTILITY
– Ability of the ventricles to stretch.
– Refers to the force of contraction generated by the
myocardial muscle.
ASSESMENT OF HEART
DISORDERS IN CHILDREN
HISTORY TAKING
HISTORY
• Should include:
– Thorough pregnancy history.
– Ask about the frequency of infections.
– Ask the ff:
• “ How much activity does it take before the child
becomes tired?” “An hour of strenuous play?” “ A
short walk?”
– Ask about the child’s usual position when
resting. ( Some infants with CHD often prefer
the knee-chest position, whereas older
children often voluntarily squat.
PHYSICAL ASSESSMENT
PHYSICAL ASSESSMENT
• General Appearance
– Inspect the toes & fingers. Check for
cyanosis & capillary refill time.
– Inspect mucous membranes.
– Cyanosis can be best recognized in the
tongue & mucous membrane of the newborn.
– Cyanosis persisting for over 20 minutes after
birth suggests serious cardiopulmonary
dysfunction.
PHYSICAL ASSESSMENT
• General Appearance
– If the cyanosis increases with crying, cardiac
dysfunction is suggested because the child is
unable to meet increased circulatory
demands.
PHYSICAL ASSESSMENT
• Pulse, Blood Pressure, & Respirations
– Tachycardia
• Pulse rate of more than 160 bpm in an infant.
• More than 100 bpm at 3 years of age.
– Tachycardia is particularly significant if
present during sleep.
PHYSICAL ASSESSMENT
• Pulse, Blood Pressure, & Respirations
– Murmurs
• Innocent heart murmur
– Murmurs of no significance.
• Organic heart murmur
– As a result of a congenital heart disease or defect.
DIAGNOSTIC TESTS
• ELECTROCARDIOGRAM
DIAGNOSTIC TESTS
• ELECTROCARDIOGRAM
– Rate
– Rhythm
– Hypertrophy
– Ischemia
– Infarction
DIAGNOSTIC TESTS
• RADIOGRAPHY
– Determines heart size.
– Can reveal fluid
collecting in the lungs
(pleural effusion) in
cardiac failure.
DIAGNOSTIC TESTS
• ECHOCARDIOGRAPHY
– Assesses movement & dimension of cardiac
chambers, thickness of walls & motion of
valves.
DIAGNOSTIC TESTS
• Complete blood count
DIAGNOSTIC TESTS
• Arterial Blood Gas
DIAGNOSTIC TESTS
• Cardiac catheterization
DIAGNOSTIC TESTS
• Cardiac catheterization
–Helps evaluate cardiac function.
• Diagnostic
–Helps diagnose heart defects.
• Interventional
–Corrects an abnormality by dilating a
narrowed valve with the use of a ballon
catheter.
MONITORING
• Central Venous Pressure (CVP)
monitoring.
CARDIOVASCULAR
DISORDERS
CONGENITAL HEART DISEASES
Common in girls – PDA, ASD
Common in boys – TOGA ( transportation
of
great arteries)
TA – truncus arteriosus
TOF – tetralogy of Fallot
Causes: genetic predisposition
teratogens: exposure to rubella – 1st month
CONGENITAL HEART DISEASE
• The usual cause is failure of heart structure to
progress beyond an early stage of embryonic
development.
CONGENITAL HEART DISEASE
• CLASSIFICATION (Old)
– Acyanotic heart defects
• Involves either a stricture to the flow of blood or a
shunt that moves blood from arterial to the venous
system (oxygenated to unoxygenated blood, or
left-to-right shunt).
– Cyanotic heart defects
• Blood is shunted from the venous to the arterial
system as a result of abnormal communication
between the two (deoxygenated blood to
oxygenated blood; right-to-left shunt) .
CONGENITAL HEART DISEASE
I. DEFECTS WITH INCREASED PULMONARY BLOOD FLOW
1.
2.
3.
4.
Ventricular Septal Defect (VSD)
Atrial Septal Defect (ASD)
Atrioventricular Canal Defect (AVC)
Patent Ductus Arteriosus (PDA)
II. OBSTRUCTIVE DEFECTS
1.
Pulmonic Stenosis
2.
Aortic Stenosis
3. Coarctation of the Aorta
III. MIXED DEFECTS
1.
Transposition of the Great Arteries
2.
Total Anomalous Pulmonary Venous Return
3.
Truncus Arteriosus
4.
Hypoplastic Left Heart Syndrome
IV. DEFECTS WITH DECREASED PULMONARY BLOOD FLOW
1.
2.
Tricuspid Atresia
Tetralogy of Fallot
CONGENITAL HEART DISEASE
•
CLASSIFICATION (New)
–
Include defects with:
I. Increased pulmonary blood flow.
II. Obstruction to blood flow (out of the
heart).
III. Mixed blood flow (oxygenated &
deoxygenated blood mixing in the
heart or great vessels).
IV. Decreased pulmonary blood flow.
DEFECTS w/ INCREASED
PULMONARY BLOOD FLOW
Acyanotic Heart defects
•
•
•
Increased pressure in the
left
side of the heart
Left to Right shunting of
blood
CONGENITAL HEART DISEASE
I.
DEFECTS WITH INCREASED
PULMONARY BLOOD FLOW
1. Ventricular Septal Defect (VSD)
2. Atrial Septal Defect (ASD)
3. Atrioventricular Canal Defect
(AVC)
4. Patent Ductus Arteriosus (PDA)
CONGENITAL HEART DISEASE
• VENTRICULAR SEPTAL DEFECT (VSD)
CONGENITAL HEART DISEASE
• VENTRICULAR SEPTAL DEFECT
(VSD)
– The most common of all congenital cardiac
defects.
– Assessment:
• At 4-8 wks: Loud, harsh systolic murmur, 3rd-4th
ICS, Left sternal border.
– Therapeutic management:
• About 60 % of small VSDs close spontaneously. A
number may be closed by interventional cardiac
catheterization. The remainder may require open
heart surgery.
I. VSD or Ventricular Septal
Defect :
opening between 2
ventricles
Most common isolated congenital
heart defect
Sx: systolic murmurs at lower
border of sternum; 3-4th LICS
cardiac catheterization : increased
O2 saturation
ECG : hypertrophy of R side of heart
Nsg Care:
Cardiac catheterization: site Right femoral
vein
1.NPO 6 hrs before procedure.
2.Assess for complications – infection,
thrombus formation
3.Check pedal pulses (dorsalis pedis)
Mgt.1. long term antibiotic – to prevent
subacute bacterial endocarditis (SBE)
2. open heart surgery- if > 2 mm defect
CONGENITAL HEART DISEASE
• ATRIAL SEPTAL DEFECT (ASD)
CONGENITAL HEART DISEASE
• ATRIAL SEPTAL DEFECT (ASD)
– Abnormal communication between the two atria.
– More frequent in girls.
– Blood flow is from left to right (oxygenated ot
unoxygenated).
– Assessment:
• Harsh Systolic murmur at the 2nd -3rd ICS,
pulmonic area.
– Therapeutic Management:
• Without surgery, the child is at risk for infectious
endocarditis & eventual heart failure.
II. ASD or Atrial Septal Defect :
failure of foramen ovale to close
Ostium
ASD Primum
1
opening is at the lower
end of the septum
ASD Ostium
Opening is near the
2
secundum center of the septum
ASD Sinus
3
venosus
Opening is near the
junction of SVC and right
Sx :systolic murmur @
upper
border of sternum;
2-3th LICS
result of cardiac catheterization &
ECG same with VSD
Mgt: open heart surgery
; Increase in Pressure in the left ventricle
+ Back flow
+ Pulmonary congestion and edema
RESULT : Dsypnea
Cracles
Frothy secretions
Blood tinge sputum ( pink)
**** Failure of the Foramen Ovale to close
CONGENITAL HEART DISEASE
• ATRIOVENTRICULAR CANAL DEFECT
(AVC)
CONGENITAL HEART DISEASE
• ATRIOVENTRICULAR CANAL DEFECT
(AVC)
– Also known as an endocardial cushion
defect.
– Results from the incomplete fusion of the
endocardial cushion or in the septum of the
heart at the junction of the atria & ventricles.
– 1 in 9 children with trisomy 21 (Down
Syndrome) has this type of congenital heart
defect.
CONGENITAL HEART DISEASE
• PATENT DUCTUS ARTERIOSUS (PDA)
CONGENITAL HEART DISEASE
• PATENT DUCTUS ARTERIOSUS (PDA)
– The ductus arteriosus is an accessory fetal
structure that connects the pulmonary artery
to the aorta. If it fails to close at birth, blood
will be shunted from the aorta (oxygenated
blood) to the pulmonary artery (deoxygenated
blood).
– Assesment:
• Wide pulse pressure
• Typical continuous “machinery”
murmur, upper left sternal border.
CONGENITAL HEART DISEASE
• PATENT DUCTUS ARTERIOSUS (PDA)
– Therapeutic management:
• Prostaglandins particularly PGE1
stimulates the ductus arteriosus to remain open
during fetal life.
• Indomethacin, a prostaglandin inhibitor
may be used for ductus closure.
• If medical management fails, surgical ligation of
the ductus arteriosus is done.
I.PDA=Pulsus Ductus Arteriosus
failure of the ductus arteriosus to close
- should close within 24 h-complete
month
close – 1
= + Persistent connection
= + congestion as more blood goes to
lungs
Sx :
machinery-like murmur
wide pulse pressure (>40
mmHg)
prominent radial pulse
ECG :
hypertrophy Left ventricle
Drug:
Indomethacin
–Pg
inhibitor
facilitate closure of PDA
ligation of PDA by 3-4 yo
thoracotomy procedure
CONGENITAL HEART DISEASE
II. OBSTRUCTIVE DEFECTS
1. Pulmonic Stenosis
2. Aortic Stenosis
3. Coarctation of the Aorta
CONGENITAL HEART DISEASE
• PULMONIC STENOSIS
CONGENITAL HEART DISEASE
• PULMONIC STENOSIS
– Narrowing of the pulmonary valve or the
pulmonary artery just distal to the valve.
– Assessment:
• asymptomatic or have signs of heart failure.
• Cyanosis may be present if narrowing is severe.
– Therapeutic Management:
• Depends
OBSTRUCTIVE LESIONS
1.PULMONIC Stenosis:narrowing of
pulmonic valve
Sx: typical systolic ejection murmur :
upper left border of sternum
S2 sound widely split
ECG : RIGHT ventricular
hypertrophy
Mgt.: Balloon angioplasty
CONGENITAL HEART DISEASE
• AORTIC STENOSIS
CONGENITAL HEART DISEASE
• AORTIC STENOSIS
– Stenosis or stricture of the aortic valve
preventing blood from passing freely from the
LV to the aorta.
– Assessment:
• The child may be free of symptoms
if severe, there is decreased cardiac output
as evidenced by faint pulses, hypotension,
tachycardia.
– Therapeutic Management
• Balloon angioplasty or surgical repair.
2. Aortic Stenosis=:narrowing of
the Aortic valve
Sx:
angina typical murmur
rough systolic sound and thrill
ECG: Left ventricular hypertrophy
Mgt: Balloon valvuloplasty
Open heart surgery : if >2 mm defect
CONGENITAL HEART DISEASE
• COARCTATION OF THE AORTA
CONGENITAL HEART DISEASE
• COARCTATION OF THE AORTA
– Narrowing of the lumen of the aorta due to a
constricting band.
– Results in increased blood pressure in the
upper portions of the body therefore
producing headache & vertigo.
– Epistaxis may occur.
CONGENITAL HEART DISEASE
• COARCTATION OF THE AORTA
– Assessment:
• Absence of femoral pulses
• Enlarged collateral vessels seen as nodules on the
ribs.
• (+) leg pain due to diminished blood supply to the
lower extremities.
• Blood pressure on the arms will be at least 20
mmHg higher than the legs.
– Therapeutic Management:
• Balloon catheter, surgery.
• Surgical repair is usually scheduled by 2 years of age.
3. Coarctation
of Aorta :
narrowing of
the segment in aortic arch
Sx: absent femoral pulse
-increased BP in upper extremities;
-decreased in lower extremities
- PR in upper extremities; higher than
he PR in lower extremities
ECG: left ventricle hypertrophy
Mgt: close heart surgery;Balloon
angioplasty
again:::Different BP in lower and upper
Extremities
•
•
•
•
•
A young child has Coarctation of the
Aorta. When taking the child’s vital signs,
the nurse can expect to observe:
a. Nothing of the clavicle
b. Bounding femoral pulses
c. Weak, thread and radial pulses
d. High BP in upper extremities
•
•
•
A child undergoes heart surgery to repair
the defects associated with COA
Postoperatively it is essential that the
nurse prevent:
a. Crying
c. Constipation
b. Coughing
d.Unnecessary
movement
CONGENITAL HEART DISEASE
III. MIXED DEFECTS
1. Transposition of the Great Arteries
2. Total Anomalous Pulmonary
Venous Return
3. Truncus Arteriosus
4. Hypoplastic Left Heart Syndrome
CONGENITAL HEART DISEASE
• TRANSPOSITION OF THE GREAT
ARTERIES
CONGENITAL HEART DISEASE
• TRANSPOSITION OF THE GREAT
ARTERIES
– Incompatible with life.
– Assessment:
• Cyanotic at birth.
– Therapeutic Management:
• PGE1 Administration to keep Ductus Arteriosus open.
• Surgical repair.
Transposition of Great Arteries (TOGA)
- aorta originates from Right ventricle (normally from Left
ventricle)
- pulmonary artery arising form Leftt ventricle (normally –
Right ventricle)
Sx: cyanosis or signs of CHF
polycythemia: compensatory due to
chronic hypoxia
ECG : cardiomegaly
Cardiac cath
Mgt :Pg E1
:
decreased O2 saturation
Palliative repair – Rashkind
procedure
Complete repair – Mustard repair
CONGENITAL HEART DISEASE
• TOTAL ANOMALOUS PULMONARY
VENOUS RETURN
– The pulmonary veins return to the right atrium
or the superior vena cava instead of to the left
atrium.
– Infants are mildly cyanotic & tire easily.
• right side of the heart hypertrophies& the left side
remain small
• - CHF & cyanosis may occur
•
Mgt : Corrective repair in early infancy
CONGENITAL HEART DISEASE
•
TRUNCUS ARTERIOSUS
– One major artery or “trunk” arises from
the left & right ventricles in place of a
separate aorta & pulmonary artery.
– The child is cyanotic & may have a typical
VSD murmur.
3. TRUNCUS ARTERIOSUS:
aorta & pulmonary artery arise
from
1 single vessel or common trunk
that originates from both
ventricles
Sx:
cyanosis,
polycythemia,
poor growth ,CHF signs murmur
Mgt: Corrective repair in early
infancy
CONGENITAL HEART DISEASE
• HYPOPLASTIC LEFT HEART SYNDROME
CONGENITAL HEART DISEASE
• HYPOPLASTIC LEFT HEART SYNDROME
– The LV is non-functional & is unable to
effectively pump blood into the systemic
circulation.
– Attempts at surgery are of limited success.
– Infants rarely live longer than 1 month.
CONGENITAL HEART DISEASE
IV. DEFECTS WITH DECREASED
PULMONARY BLOOD FLOW
1. Tricuspid Atresia
2. Tetralogy of Fallot
DEFECTS w/ DECREASED
PULMONARY BLOOD FLOW
Cyanotic Heart Defects: Right to Left
heart
shunting of
blood
: increased pressure in the right side of
the
heart. Common sign is
Cyanosis
CONGENITAL HEART DISEASE
• TRICUSPID ATRESIA
– An extremely serious disorder since the
tricuspid valve is completely closed allowing no
blood to flow from the right atrium to the right
ventricle.
– Instead, blood crosses through the patent
foramen ovale into the left atrium.
4. Tricuspid
atresia: failure of
tricuspid valve to open
Sx: cyanosis, tachycardia, dyspnea
polycythemia, clubbing of fingers
Mgt: Pg E1: to keep patency of
ductus arteriosus
Fontan procedure:
to open
valve
tricuspid
•
•
•
A 2-year old has a congenital right to left
shunt defect of the heart, the nurse
would expect to observe:
a. Orthopnea
c. Absense of
pedal pulses
b. An elevated hematocrit d. Edema in
the extremities
CONGENITAL HEART DISEASE
• TETRALOGY OF FALLOT
CONGENITAL HEART DISEASE
•
TETRALOGY OF FALLOT
– Four anomalies are present:
1.
2.
3.
4.
Pulmonic stenosis
VSD
Overriding aorta
Hypertophy of the right ventricle
CONGENITAL HEART DISEASE
•
TETRALOGY OF FALLOT
– Assessment:
•
•
•
•
•
Newborns may not exhibit a high degree of
cyanosis but as they become more active, they will
begin to appear cyanotic.
Polycythemia will occur.
Sever dyspnea, growth retardation & clubbing of
fingers.
Tend to assume a squatting or knee chest
position.
May develop syncope or fainting episodes (“tet”
spells) caused by decreased blood supply to the
brain.
CONGENITAL HEART DISEASE
•
TETRALOGY OF FALLOT
– Therapeutic management
•
Surgery done at 1 – 2 years of age.
– Temporary repair:
– Full repair:
•
Blalock –Taussig procedure.
Brock procedure.
If a baby begins to have a hypoxic episode, placing
the baby in a knee-chest position &
administering morphine
effective.
sulfate is generally
5.
Tetralogy of Fallot
= Persistent cyanosis with vigorous
crying
= Hypoxia inspite of O2 therapy
P – pulmonary stenosis
R – right ventricular Hypertrophy
O – overriding or dextroposition of aorta
V – ventricular septal defect
1.
2.
3.
4.
5.
6.
Sx:
ECG : right ventricular hypertrophy
Cyanosis; polycythemia;
syncope
severe dyspnea –> squatting position :
to decrease venous Return
growth retardation: d/t decreased
tissue perfusion
Exertional Dyspnea with cyanosis
6. tet spell or cyanotic spell
:
short episodes of hypoxia,
relieved by squatting
Knee chest position
7. clubbing of fingers:
compensatory enlargement of
due to chronic hypoxia
8. mental retardation:bd/t
oxygenation in the brain
9. CXR: boot-shaped heart
10. Stunted growth
capillaries
decreased
Mgt:
1.O2 and decrease o2 demand
2.Avoid Valsalva maneuver/ administer
laxative/ increase roughage
3.Beta-blockers : Propranolol
4. Palliative repair –
Blalocktaussig procedure
5. Brock procedure – complete repair of
associated defects
6.Prophylactic antibiotics
7. Monitor hemoglobin hct,consciousness
8. POSITION during attacks : SQUAT or
Knee Chest Position
•
•
•
•
•
A common finding in most children with
cardiac anomalies is:
a. Mental retardation.
b. Delayed physical growth.
c. Cyanosis and clubbing of fingertips.
d. A family history of cardiac anomalies.
ACQUIRED HEART DISEASE
•
•
•
•
•
•
•
Heart Failure
Rheumatic Fever
Kawasaki Disease
Endocarditis
Hypertension
Hyperlipidemia
Cardiomyopathy
ACQUIRED HEART DISEASE
• HEART FAILURE
– Results when the myocardium of the heart
cannot circulate & pump enough blood to supply
oxygen & nutrients to body cells.
– Blood pools in the heart or in the pulmonary or
venous system.
ACQUIRED HEART DISEASE
• HEART FAILURE
– Assessment:
• First sign is tachycardia then followed by
tachypnea.
• Infants are usually breathless, tire easily & have
feeding difficulties.
• Right sided HF:
– Increased venous pressure.
– Hepatomegaly.
– Edema (late sign).
• Left Sided HF:
– Pulmonary congestion (blood accumulates in the lungs).
– Dyspnea.
ACQUIRED HEART DISEASE
• HEART FAILURE
– Therapeutic Management:
• Evacuation of excess fluid:
– Diuretics: Furosemide
(Lasix)
• Improve contractility of the heart:
– Inotropics:
Digoxin (Lanoxin)
• Signs of Digoxin toxicity: Anorexia, nausea & vomiting,
dizziness, diarrhea & headache.
• Reduce afterload:
– Vasodilators:
Hydralazine
•
•
•
Among the last signs of heart failure in
the infant and child is:
a. Orthopnea
c. Tachycardia
b. Tachypnea
d. Peripheral
edema
ACQUIRED HEART DISEASE
• RHEUMATIC FEVER
• - inflammatory ,Autoimmune dise.ase due to an
infection w/ Group A Beta
Hemolytic
streptococcus
(GABHS)
• -pharyngitis, tonsillitis, scarlet fever, “strep
throat” or impetigo.
– Occurs most often in children 6 – 25 years old.
ACQUIRED HEART DISEASE
• RHEUMATIC FEVER
– Therapeutic Management:
• Penicillin (IM) therapy to be maintained for 10 – 14
days then the child is maintained on prophylactic
penicillin therapy for at least 5 years after the initial
attack or until they are 18 years of age.
Rheumatic Heart
Disease
-complication of untreated
Rheumatic
fever;
-presence of Aschoff’s bodies
that
affect the mitral valve
; MVP or mitral regurgitation
Jones Criteria
Major
1. polyarthritis – multi joint pain;
asymmetrical, migratory
2. chorea – st. vitus dance purposeless involuntary hand and
shoulder with grimace
3. pancarditis – tachycardia
erythema marginatum - macular
rashes
4. SQ nodules
5. erythema marginatum – reddish
macular lesions on extensor
surfaces (elbow, knee)
Minor
1. arthralgia –
joint pain
2. low grade
fever
3. Inc. C
reactive protein
4. Inc. ESR
5. Inc. ASO titer
6. ECG :
prolonged PR
interval
Criteria: 2 major manifestations
1 major + 2 minor signs
OR
Nsg Care: CBR
throat swab – culture and sensitivity
DOC – penicillin G
NSAIDS for arthritis
A/E of aspirin w/ viral infection :
Reye’s syndrome– form of encephalopathy
- fatty infiltration of organs such as liver
and
brain
Penadur
; IM once amonth .3-5 years
ACYANOTIC Heart Disease
Ventricular Septal Defect
Atrial Septal Defect
Coartation of the Aorta
Atrial Septal Defect
Aortic stenosis
Pulmonary stenosis
Cyanotic Heart Disease (3 T’s)
TOGV
Tetralogy of Fallot
Truncus Arteriosus
•
•
•
The pathology of rheumatic fever chiefly
involves changes in which basic type of
tissue?
a. Muscular
c. Connective
b. Endocrine
d. Epithelial
•
•
In obtaining health history the nurse
should be alert to the mention of which of
the following as evidence of previous
episodes of rheumatic fever?
1. Watery diarrhea
3. Frequent
•
•
•
epistaxis
2. Growing pains
4. Episodic vertigo
a. 1 and 2
c. 3 and 4
b. 2 and 3
d. All of the above
ACQUIRED HEART DISEASE
• KAWASAKI DISEASE
ACQUIRED HEART DISEASE
• KAWASAKI DISEASE
– A febrile, multi-systemic disorder that occurs
almost exclusively in children before the age of
puberty.
– Vasculitis is the principle (& life threatening)
finding.
– Therapeutic management:
• Salicyclic acid (Aspirin): decreases inflammation &
platelet aggregation.
ACQUIRED HEART DISEASE
• ENDOCARDITIS
ACQUIRED HEART DISEASE
• ENDOCARDITIS
– Inflammation & infection of the endocardium or
heart valves of the heart.
– Vegetation is composed of bacteria, fibrin &
blood.
– Commonly occurs as a complication of congenital
heart disease such as VSD, TOF, COA.
– Streptococcal infection tends to invade the body
during dental surgery.
– Over a period of time the invading process
destroys the valves & endocardium.
ACQUIRED HEART DISEASE
• HYPERTENSION
– Primary Hypertension
• Occurs as a secondary manifestation of another disease such as
kidney disease, COA.
– Essential Hypertension
• No identifiable cause
• HYPERLIPEDEMIA
– Increased fatty acid in the blood.
• CARDIOMYOPATHY
– Refers to a structural or functional abnormality of the
ventricular myocardium.
– Impairs systolic function & may lead to heart failure.
CARDIOPULMONARY ARREST
• Assessment:
– Respiratory failure is the most frequent
cause of cardiac arrest because anoxia in the
heart muscle quickly leads to cardiac arrest.
CARDIOPULMONARY ARREST
• STEPS FOR RESUSCITATION (ABC’s)
– AIRWAY
– BREATHING
– CIRCULATION
CARDIOPULMONARY
RESUSCITATION
• AIRWAY
– Assess the patient’s airway for patency and look
for signs of airway obstruction.
– Open the airway using head tilt/chin lift if no
spinal trauma is suspected, or modified jaw
thrust if spinal trauma is suspected
CARDIOPULMONARY
RESUSCITATION
• BREATHING
CARDIOPULMONARY
RESUSCITATION
• CIRCULATION
– Feel for the carotid pulse (in an infant, the
brachial pulse).
CARDIOPULMONARY
RESUSCITATION
• CIRCULATION
– If you feel no pulse, proceed with chest
compressions.