FINALS-NCMMCA

• Cardiac disorders are a major focus of health promotion and disease prevention measures in both adults and children
• Congenital heart diseases


  Disorders that occur as a result of a congenital anomaly where the heart developed inadequately in utero or cannot adapt to extrauterine life for some reason
• Congenital heart diseases are higher in preterm infants
• Congenital heart diseases affect equal numbers of male and female infants, but specific defects show a tendency toward sex differences
• Usual causes of congenital heart disorders


  • Failure of a heart structure to progress beyond an early stage of embryonic development
  • Maternal rubella infection
• Disorders caused by maternal rubella infection


  • Patent ductus arteriosus
  • Pulmonary or aortic stenosis
  • Atrial or ventricular septal defects
  • Pulmonary stenosis
• Atrial and ventricular septal defects can also be familial
• If a parent has an aortic stenosis, atrial septal defect, ventricular septal defect, or pulmonic stenosis, the incidence of this occurring also in the child is about 10% to 15%
• Cyanotic and acyanotic congenital heart disorders


  Previously classified based on the physical sign of cyanosis, now classified based on hemodynamic and blood flow patterns
• Disorders with increased pulmonary blood flow


  • Ventricular septal defect (VSD)
  • Atrial septal defect (ASD)
  • Patent ductus arteriosus (PDA)
• Ventricular septal defect (VSD)


  An opening is present in the septum between the two ventricles, causing blood to shunt from left to right across the septum, resulting in right ventricular hypertrophy and increased pressure in the pulmonary artery
• Ventricular septal defect (VSD)


  • It is an acyanotic disorder
  • It impairs the effort of the heart because blood that should go into the aorta and out to the body is shunted back into the pulmonary circulation
• Up to 85% of VSDs are so small they close spontaneously
• Moderate size VSDs may be closed during cardiac catheterization, while larger ones (over 3 mm) require open heart surgery
• VSD closure is usually scheduled before 2 years of age to prevent pulmonary artery hypertension
• If a VSD is left open, cardiac failure from the artery hypertension can result, and the heart can become infected (endocarditis) because of the recirculating blood flow
• Atrial septal defect (ASD)


  Abnormal communication between the two atria, allowing blood to shift from the left to the right atrium
• Atrial septal defects (ASDs) are more common in girls than boys
• Atrial septal defect (ASD)


  • It is an acyanotic defect
  • Blood flow is from left to right (oxygenated to deoxygenated) because of the stronger contraction of the left side of the heart
  • It causes an increase in the ventricular hypertrophy and increased pulmonary artery blood flow, the same as with a VSD
• Types of atrial septal defects


  • Ostium primum (ASD1) - opening at the lower end of the septum
  • Ostium secundum (ASD2) - opening near the center of the septum
• ASD2 defects may be asymptomatic and not discovered until infection from recirculating blood occurs
• Surgery to close an ASD is done electively between 1 and 3 years of age
• ASD closure is important because without it, a child is at risk for infectious endocarditis and eventual heart failure, and in girls it can cause emboli during pregnancy
• Patent ductus arteriosus (PDA)


  Accessory fetal structure that connects the pulmonary artery to the aorta, which fails to close at birth
• Patent ductus arteriosus (PDA) is twice as common in girls as boys and occurs at a higher incidence at higher altitudes
• In preterm infants, the incidence of PDA may be as high as 20% to 60% and accounts for about 10% of all heart disease
• Reason the ductus arteriosus remains open in fetal life


  Stimulation by prostaglandins, particularly PGE1, from the placenta and the low oxygen level of fetal blood
• Reason the ductus arteriosus closes after birth

  When the PGE1 level falls and the oxygen level increases
• If the ductus arteriosus does not close spontaneously, an infant may be prescribed IV indomethacin or ibuprofen, prostaglandin inhibitors, to encourage closure
• If medical management fails to bring about closure of the ductus arteriosus, the disorder is closed by cardiac catheterization when the child is 6 months to 1 year of age, or exceptionally large defects are closed surgically by ductal ligation
• Disorders with obstruction to blood flow

  Congenital anomalies that cause a vessel or valve to be narrower than usual, increasing pressure before the narrowing and decreasing pressure after the narrowing, prohibiting enough blood from reaching its intended site
• Pulmonary stenosis

  Narrowing of the pulmonary valve or the pulmonary artery just distal to the valve, leading to right ventricular hypertrophy
• Aortic stenosis

  Prevents blood from passing freely from the left ventricle of the heart into the aorta, leading to increased pressure and hypertrophy of the left ventricle
• Coarctation of the aorta

  Narrowing of the lumen of the aorta due to a constricting band, more common in boys than girls and the leading cause of congestive heart failure in the first few months of life
• Coarctation of the aorta can occur in two locations: preductal (between the subclavian artery and the ductus arteriosus) or postductal (distal to the ductus arteriosus)
• As pressure in the subclavian artery increases

  There is increased pressure in the heart and upper portions of the body
• Elevated upper body blood pressure

  Produces headache and vertigo
• Exceptional irritability

  May be the main clue that symptoms are present in a child under 3 years of age who has difficulty describing sensations
• Coarctation is slight

  Absence of palpable femoral pulses may be the only symptom
• Always include evaluation of femoral pulses in all initial newborn assessments and admission inspections to newborn nurseries