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Cardiovascular

Cardiovascular . Islamic University – Nursing College . Fetal Circulation. Foramen ovale : I s anatomical opening between the right atrium and left atrium which closes shortly after birth.

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Cardiovascular

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  1. Cardiovascular Islamic University – Nursing College

  2. Fetal Circulation • Foramen ovale: • Is anatomical opening between the right atrium and left atrium which closes shortly after birth. • Higher pressure in the left atrium due to increased pulmonary blood flow cause the foramanovale to close. • Ductus arteriosus: • A vessel that connects the main pulmonary artery to the aorta • The ductus arteriosus should functionally close within 15 hours and structurally within a few weeks (in mature infants) • Higher concentrations of oxygen in the blood, decreased prostaglandin levels and decreased pulmonary vascular resistance closes the ductus arteriosus.

  3. Functions of Cardiovascular System • The cardiovascular system is responsible for circulating blood throughout the body • A healthy cardiovascular system is vital to supplying the body with oxygen and nutrients

  4. Assessment of Cardiac Function • History: parents usually report • Poor weight gain, poor feeding habits, fatigue during feeding, sweating with feeding. • Frequent respiratory infections and difficulties (tachypnea, dyspnea, shortness of breath, persistent cough). • Cyanosis • Evidence of exercise intolerance

  5. Assessment of Cardiac Function • History • A previous cardiac defects in a sibling • Maternal rubella infection during pregnancy, • The use of medications or chemicals during pregnancy • Chronic illness • Children with chromosomal abnormalities are likely to have associated congenital heart defects. • A history of viral infection or toxic exposure (myocardities) • A history of streptococcal infection (Rheumatic fever)

  6. Assessment of Cardiac Function • Physical Examination; Vital signs • Tachycardia or bradycardia may indicate cardiac disease. • Tachypnea may indicate congestive heart failure. • Hypertension; Differences in BP between the upper and lower extremities may indicate coarctation of the aorta.

  7. Assessment of Cardiac Function • Physical Exam; Inspection • Skin color ( cyanosis, flushed skin) • Position of comfort • Presence of clubbing • Lethargy and overall • Nutritional status

  8. Assessment of Cardiac Function • Physical Exam; Palpation • The point of maximum intensity and the apical impulse • The presence of a thrill/murmur should be noted. • The quality and symmetry of all pulses. • Warmth of extremities, capillary refill, and presence or absence of edema. • Locating the hepatic and splenic borders

  9. Assessment of Cardiac Function • Physical Exam; Auscultation • Heart sounds, heart rate and rhythm. • The presence of additional heart sounds, such as a murmur, is noted. • Lung sounds

  10. Murmurs • Innocent murmurs vs. Organicmurmurs • An innocent or functional heart murmur • Not resulting from heart disease • This is the most common type of heart murmur • May be caused by fever, anemia, or a thin chest • Organic murmur • Indicates abnormality in the heart or a major artery • May be caused by a narrow valve, a leaking valve, or a hole in the heart

  11. Murmurs • How to assess murmurs • Position in cardiac cycle • Duration & location • Quality; pitch, intensity • Whether there is a thrill • Whether the murmur changes with position change • Organic murmurs are • Either systolic or diastolic • Long, harsh or blowing, loud • constant • heard not matter what position the child is in.

  12. Diagnostic procedures to Evaluate the Cardiovascular Function • CBC • Electrolytes • PT (Prothrombin Time)& PPT (Partial Thromboplastin Time) • Total protein and Albumin. • Blood gases (pulse oximetry) • Radiography; MRI • Treadmill Test (physical test) • ECG/ EKG provides information about: • Electrical activity of the heart • HR, rhythm, presence or absence of hypertrophy, ischemia or necrosis, • Abnormalities in the conduction system • Presence of electrolyte imbalances

  13. Cardiac Catheterization • A diagnostic invasive procedure • Catheter is inserted through a peripheral blood vessel into the heart, to visualize the structures inside & function • Other purpose • To obtain cardiac tissue samples for biopsy. • Close small holes inside the heart • Place wire devices, called stents, in narrowed arteries to keep them open • Heart X-ray film

  14. Cardiac Catheterization • Nursing care; Pre- catheterization education • Explain about catheterization • What to expect during and after the test (child will have to lie flat and will have a bulky dressing over the catheter insertion site) • Post-Procedure • Lie flat 3-4 hours • V/S every 15 minutes for the first several hours • Check site every 15 minutes for integrity of dressing • Check pulses distal to site & extremity for capillary refill and warmth • Avoid dehydration & hypothermia • Check for signs of infection • Avoid tub baths and strenuous exercise for 2-3 days

  15. Congenital heart disease: Increased pulmonary blood flow • Atrial Septal Defect (ASD) • Ostiumprimum • Lower end of septum • 5% • Ostiumsecundum (most common) • In the center of septum • 90% • Sinus venosus • Higher end of the septum near junction of superior vena cava and right atrium

  16. Congenital heart disease: Increased pulmonary blood flow:ASD • CM • Many children have no symptoms and seem healthy • If the opening is large S& S of CHF may develop and increased the risk of endocarditis. • Harsh systolic Murmur over 2nd or 3rd ICS. • A Widely split in S2. • Atrial dysrhythmias • Pulmonary vascular obstructive diseases and emboli formation later in life from chronic • Enlarged right side and increased pulmonary circulation

  17. Congenital heart disease: Increased pulmonary blood flow: ASD • Treatment of ASD • ASD may close spontaneously as the child grows • Some children may need medication such as digoxin and diuretics • Control infection • Catheterization may be needed to close the septum

  18. Congenital heart disease: Increased pulmonary blood flow • Ventricular Septal Defect (VSD) • Most common congenital heart defect • Can be classified as • Membranous VSD (located in the upper section; 80% of all VSD cases • Muscular VSD (located in the lower section; 20% of all cases)

  19. Congenital heart disease: Increased pulmonary blood flow: VSD • CM • Fatigue • Sweating • Rapid, heavy, congested breathing • Disinterest in feeding • Poor weight gain • Murmurs • May lead to hypertrophy and enlargement of the right atrium • CHF is common • Treatment: Surgical repair

  20. Congenital heart disease: Increased pulmonary blood flow • Patent Ductus Arteriosus (PDA) • CM • Asymptomatic or signs of CHF • Murmurs • A widened pulse pressure & bounding pulses • At risk for endocarditis & pulmonary vascular obstructive disease • Treatment • Prostaglandin inhibitor • Surgical repair

  21. Congenital heart disease: Obstructive Defects • Coarctation of the Aorta (COA) • Narrowing anywhere in the aorta • Increased pressure proximal to the defect • Restricts the amount of oxygenated blood to lower part • LT ventricle has to work harder • Risk for endocarditis • Coronary arteries may narrow due to high pressure

  22. Congenital heart disease: Obstructive Defects: COA • CM • High BP and bounding pulse in arms • Low BP & Absent femoral pulse and cool extremities • Headaches, dizziness , fainting & epistaxis • Cramps in the legs • Pt at high risk for hypertension, ruptured aorta and stroke • Kidneys’ function may be altered ( decrease urine ) • Treatment • Enlargement of constricted section (surgical or nonsurgical (Balloon angiplasty))

  23. Congenital heart disease: Obstructive Defects • Aortic Stenosis (AS) • Narrowing or stricture of the aortic valve • Types of AS: • Valvular stenosis • The most common • caused by malformed cusps • Resulting in a bicuspid rather than tricuspid valve or fusion of the cusps. • Subvalvular stenosis • Is a stricture caused by a fibrous ring below a normal valve. • Supravalvular stenosis

  24. Congenital heart disease: Obstructive Defects: Aortic Stenosis(AS) • Aortic Stenosis(AS) • Extra workload on the left ventricle causes hypertrophy which causes an increase in the left atrium pressure in turn increases the pressure in the pulmonary veins • AS is progressive, associated with sudden episodes of myocardial ischemia • Sudden death is possible • CM • Faint pulses, hypotension , tachycardia & poor feeding • Chest pain , Dizziness when standing • Murmurs • Treatment • Balloon dilatation (via cardiac catheterization) • Valvotomy involves a surgical removal of adhesion that preventing valve leaflets from opening • Aortic valve replacement

  25. Congenital heart disease: Obstructive Defects Pulmonary Stenosis • Pulmonary Stenosis (PS) • Narrowing at the entrance of the pulmonary artery • When RT ventricular failure develops this causes an increase in the RT atrial pressure • The accelerating pressure reopen the foramen ovale causing systemic cyanosis • In severe cases CHF occurs

  26. Congenital heart disease: Obstructive Defects: PS • CM • Mild cases are asymptomatic • Cyanosis in severe cases • Murmurs • Cardiomegaly (chest X-ray) • Treatment • Depends on the degree of the stenosis may wait for a few years • Relieve stenosis or valve adhesion by balloon angioplasty

  27. Congenital heart diseaseDecreased Pulmonary Blood Flow • Tetralogy of Fallot (TOF) • The classic form includes four defects: • Ventricular septal defect • Pulmonic stenosis • Overriding aorta: the aorta is shifted towards the right side of the heart so that it sits over the ventricular septal defect • Right ventricular hypertrophy

  28. Congenital heart diseaseDecreased Pulmonary Blood Flow: TOF • In mild right ventricle obstruction, the pressure in the right ventricle can be slightly higher than the left, thus some of the deoxygenated blood in the right ventricle will pass through the VSD to the left ventricle thus a child may not appear blue • In severe obstruction in the RT ventricle the large amount of de-oxygenated blood passes via VSD into the LT ventricle thus these children appear blue • Tetralogy of Fallot occurs in about two out of every 10,000 live births. • It makes up about 8 percent of all cases of congenital heart disease.

  29. Congenital heart diseaseDecreased Pulmonary Blood Flow: TOF • CM • Infants may be acutely cyanotic at birth; others have mild cyanosis • CM progresses over the first year of life as the pulmonic s tenosis worsens • Murmur • Acute episodes of cyanosis and hypoxia, called blue spells "". Anoxic spells occur when the infant's oxygen requirements exceed the blood supply (crying, tighter pulmonary artery ) • Children with cyanosis may have clubbing nail, squatting position, poor growth • TOF children at risk for cerebrovascular disease and sudden death • Polycythemia • Treatment: primarily palliative shunt then complete repair (such as closure of VSD)

  30. Congenital heart diseaseDecreased Pulmonary Blood Flow • Tricuspid Atresia (TA) • Failure of the tricuspid valve to develop so there is no communication from the right atrium to the right ventricle • Blood flows through an atrial septal defect or a patent foramen ovale to the left side of the heart and through a VSD to the right ventricle • associated with pulmonic stenosis and transposition of great arteries. • complete mixing of deoxygenated and oxygenated blood in the left side of the heart, resulting in systemic cyanosis

  31. Congenital heart diseaseDecreased Pulmonary Blood Flow: TA • CM • Cyanosis • Tachycardia & dyspnea • Clubbing nail • Children with TA at risk for stroke • Treatment • Prostaglandin • Palliative treatment; shunt to increase blood flow to the lungs • Surgical treatment

  32. Congenital heart diseaseMixed Defects • Transposition of Great Arteries/Vessels (TGA/V) • The pulmonary artery leaves the left ventricle, and the aorta exits from the right ventricle, with no communication between the systemic and pulmonary circulation • Deoxygenated blood returns via misconnected aorta to the body • Oxygenated blood goes back to lungs

  33. Congenital heart diseaseMixed Defects (TGV/A) • Often associated with • Septaldefects • PDA, VSD, • Patent foramen ovale • CM • Severe cyanosis • May have signs of CHF • Cardiomegaly a few weeks after birth • Treatment • Surgical (arterial switch procedure)

  34. Congenital heart diseaseMixed Defects • Truncusarteriosus (TA) • A single vessel arising from the heart that forms the aorta and pulmonary arteries. • Large Ventricular septal defect accompanies TA • Oxygenated and deoxygenated blood mixed inside the heart, some leaves to the lungs others to the systemic circulation • TA causes severe cyanosis

  35. Congenital heart diseaseMixed Defects: TA • CM • Cyanosis • Murmur • Fatigue, sweating, cool skin • Increased RR & HR, heavy & congested breathing • Disinterest in feeding and poor Wt gain • Treatment is by surgical repair

  36. Congenital heart diseaseMixed Defects • Hypoplastic left heart syndrome (HLHS) • Is a combination of abnormalities of the heart and the great vessels • In HLHS most structures on the left side of the heart are small & underdeveloped • Mitral valve, left ventricle, aortic valve & aorta are involved. • The newborn develops symptoms shortly after delivery

  37. Congenital heart diseaseMixed Defects: HLHS • CM • Cyanosis • Sweating, cool skin • Increased RR & HR, heavy breathing • Treatment is by series of surgical repair

  38. Acquired Cardiovascular Disorders • Rheumatic Heart Disease (RHD) • Congestive Heart Failure (CHF)

  39. Acquired Cardiovascular Disorders :RHD • Permanent damage to the heart valves is caused by Rheumatic Fever (RF) • It develops after an infection of the upper RT with group A β-hemolytic streptococci • The antigens of group A Streptococci bind to receptors in the heart, muscle, brain & synovial joints, causing an autoimmune response • The antigens produced by Streptococci are similar to the body’s own antigens thus antibodies may attack healthy body cells • RF forms Aschoff bodies(inflammatory lesions) that causes swelling and alterations in the connective tissue

  40. Acquired Cardiovascular Disorders :RHD • RF major criteria • Rheumatic Carditis • Polyarthritis • Erythemamarginatum • Subcutaneous nodules • chorea

  41. Acquired Cardiovascular Disorders :RHD • Rheumatic Carditis • Involves endocardium, pericardium & myocardium • CM: • valvulitis • Myocardities • Pericarditis: muffled heart sound due to pericardial effusion, chest pain, pericardial friction rub • Murmur • Tachycardia especially during sleep • Polyarthritis • Joints such as knees, elbows, hips, shoulders & wrists • Joints are swollen, hot, red & painful

  42. Acquired Cardiovascular Disorders :RHD • Erythemamarginatum • Erythematousmacule mostly found on the trunk & extremities • Subcutaneous nodules • Nontender swellings mostly found on the bony prominences areas such as feet, hands vertebrae • Chorea • Sudden & aimless irregular movements of the extremities • Involuntary facial, grimaces • Speech disturbances • Emotional liability • Muscle weakness • Other minor criteria: arthralgia (joint pain), fever, fatigue and elevated ESR

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