NCM 109 M CARDIO

• Cardiovascular system


  The body system on which all other systems depend, consisting of the heart, blood, and blood vessels
• Heart


  • Acts as a pump
• Blood


  • Provides the fluid and cells for transport of oxygen and nutrients
• Blood vessels


  • Provide the means and routes for transport throughout the body
• Cardiovascular disorders


  Occur as a result of a congenital anomaly or acquired disease
• How blood circulates through the heart and body

  Not provided
• Cardiovascular disorder assessment


  • Through history taking (family history, pregnancy history, child's history) and physical assessment (general appearance, pulse, blood pressure, respirations)

  
• Cardiovascular disorder diagnostics


  • Electrocardiogram (ECG)
  • Radiography (fluoroscopy, radio angiocardiography)
  • Echocardiography
  • Exercise training
  • Cardiac catheterization
  • Laboratory tests (CBC, arterial blood gas, oxygen saturation, prothrombin and partial thromboplastin times, electrolytes)
• Cardiac catheterization


  A procedure where a small radiopaque catheter is passed through a major vein into the heart to secure blood samples or inject dye, helping to evaluate cardiac function
• Pre-cardiac catheterization preparation


  1. Watch for signs of toxicity to dye

  2. Ensure recent chest radiograph, ECG, and electrolyte levels

  3. Hold digoxin

  4. Take and record pedal pulses, height and weight

  5. Do not draw blood from catheterization site

  6. Keep NPO for 2-4 hours
• Post-cardiac catheterization care


  1. Take vital signs every 15 minutes for first hour

  2. Check apical pulse for bradycardia or dysrhythmias

  3. Assess pulses, temperature, and color of affected extremity

  4. Check dressing for bleeding or hematoma
• Post-cardiac catheterization home care

  1. Keep dressing in place for 24 hours

  2. Observe site for redness, swelling, drainage, or bleeding

  3. Check temperature

  4. Avoid strenuous exercise

  5. Take acetaminophen for pain

  6. Keep follow-up appointment
• Congenital heart disorders


  Abnormalities in cardiovascular structures that occur before birth, affecting approximately 1 in 100 children

  
• Classifications of congenital heart disorders

  • Left-to-right shunts
  • Right-to-left shunts

  
• Left-to-right shunts


  Acyanotic heart disease involving abnormal openings or shunts that move oxygenated blood to the unoxygenated side

  
• Left-to-right shunt clinical manifestations

  • Infant is not cyanotic
  • Tachycardia
  • Cardiomegaly
  • Dyspnea and pulmonary edema
  • Increased respiratory infections
• Right-to-left shunts


  Cyanotic heart disease where deoxygenated blood is shunted to the oxygenated side

  
• Right-to-left shunt clinical manifestations

  • Hypoxemia
  • Polycythemia
  • Increased blood viscosity

  
• Classifications of congenital heart disorders by hemodynamics

  • Increased pulmonary blood flow
  • Obstruction to blood flow leaving the heart
  • Mixed blood flow
  • Decreased pulmonary blood flow

  
• Increased pulmonary blood flow disorders

  Involve abnormal openings or connections between the left and right sides of the heart or great arteries, allowing blood flow from the high pressure left side to the lower pressure right side

  
• Disorders with increased pulmonary blood flow

  • Ventricular septal defect
  • Atrial septal defect
  • Atrioventricular canal defect
  • Patent ductus arteriosus

  
• Ventricular septal defect


  Most common congenital cardiac disorder, involving an opening in the septum between the two ventricles

  
• Ventricular septal defect assessment

  • Heart murmur
  • Echocardiography showing right ventricular hypertrophy
  • ECG showing right ventricular hypertrophy
  • Chest X-ray showing heart size

  
• Ventricular septal defect management

  1. Small VSDs close spontaneously

  2. Moderate VSDs may be closed during cardiac catheterization

  3. Larger VSDs require open-heart surgery before age 2

  4. Treat heart failure

  
• Ventricular septal defect postoperative management

  1. Alert for arrhythmias

  2. Provide prophylactic antibiotics for 6 months

  3. Allow normal activities after repair
• Atrial septal defect


  Abnormal communication between the two atria, allowing blood to shift from left to right atrium

  
• Types of atrial septal defects

  • Ostium premium (ASD1)
  • Ostium secundum (ASD2)
• Atrial septal defect risk factors

  • Rubella infection
  • Drug, tobacco, alcohol use, or exposure to certain substances
  • Diabetes or lupus
  • Obesity
  • Phenylketonuria (PKU)
• Atrial septal defect assessment

  • Auscultation of systolic murmur and fixed S2 splitting
  • Echocardiography showing enlarged right side of heart and increased pulmonary blood flow

  
• Right atrium


  An acyanotic defect with increase in volume in the right side of the heart and generally results in ventricular hypertrophy and increased pulmonary artery blood flow

  
• ATRIAL SEPTAL DEFECT: TYPES

  • Ostium premium (ASD1)
  • Ostium secundum (ASD2)
• Ostium secundum (ASD2)


  May be asymptomatic and not discovered until infection from recirculating blood occurs
• ATRIAL SEPTAL DEFECT: RISK FACTORS

  • Rubella infection
  • Drug, tobacco or alcohol use, or exposure to certain substances
  • Diabetes or lupus
  • Obesity
  • Phenylketonuria (PKU)
• ATRIAL SEPTAL DEFECT: ASSESSMENT

  • Auscultation
  • Echocardiography with color flow Doppler
  • Cardiac catheterization
• ATRIAL SEPTAL DEFECT: SIGNS & SYMPTOMS

  • Shortness of breath, especially when exercising
  • Fatigue
  • Swelling of legs, feet, or abdomen
  • Heart palpitations or skipped beats
  • Heart murmur, a whooshing sound that can be heard through a stethoscope

  
• ATRIAL SEPTAL DEFECT: MANAGEMENT

  • Some ASD close spontaneously and some not requiring surgery
  • Medications: beta-blockers and anticoagulants
  • Surgery to close the defect is done electively between 1 and 3 years of age
• CATHETER-BASED REPAIR: CARDIAC CATHETERIZATION


  1. A mesh patch or plug is passed through the catheter and used to close the hole. Heart tissue grows around the seal, permanently closing the hole

  2. Secundum type of atrial septal defect
• OPEN HEART SURGERY


  1. The surgeons use patches to close the hole

  2. It is the only way to fix primum, sinus venosus, and coronary sinus atrial defects

  
• ATRIAL SEPTAL DEFECT: COMPLICATIONS

  • Right-sided heart failure
  • Heart rhythm abnormalities (arrhythmias)
  • Increased risk of a stroke
  • Shortened life span
  • Eisenmenger syndrome - pulmonary hypertension

  
• Patent ductus arteriosus (PDA)

  • Before Delivery: Ductus arteriosus (DA) is essential to maintaining fetal systemic perfusion
  • After Delivery: Closure begins with the first breath, Anatomic closure of DA with intimal remodeling and loss of smooth muscle occurs over next several days (7 to 14 days of age)