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Congenital Heart Defects Teaching Presentation

Congenital Heart Defects Summary - Cyanotic, Acyanotic
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Adult Health II (NUR 2211)

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Academic year: 2021/2022
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Congenital Heart Defects (CHD) Information Sheet

ACYANOTIC DISORDERS: Have adequate O2, listen for “area” and “type of sound” to determine CHD as well as s/s Aortic Stenosis (Obstructive Blood Flow)  Patho: “Narrowing” of the aortic valve or a narrowing of the aorta (to “stenose” is to thicken or make narrow) o Normally, oxygen-rich blood is pumped from left ventricle, through the aortic valve, into aorta and then out to the body o AS makes it hard for the heart to pump blood to the body  Tx: Open-heart surgery may be needed to correct this defect (depending on the severity of the stenosis) o Another option is balloon valvuloplastyIncidence: Congenital AS occurs in 3-6% of all children with CHD o Relatively few are symptomatic in infancy, incidence of problems increases sharply in adulthood o Occurs 4x more often in boys than in girls  *Sound: Thrill at base of heart, systolic murmur best hear along left sternal border with radiation to right upper sternal border Atrial Septal Defect (ASD) (Increased Pulmonary Blood Flow.. to Right)  Patho: A hole in the wall between the two upper chambers is called an atrial septal defect, or ASD o “Septum”: Wall that separates the right and left sides of the heart o Normally, low-oxygen blood entering the right side of the heart stays on the right side, and oxygen-rich blood stays on the left side of the heart, where it is then pumped to the body. When a defect or "hole" is present between the atria (or upper chambers), some oxygen-rich blood leaks back to the right side of the heart. It then goes back to the lungs even though it is already rich in oxygen. Because of this, there is significant increase in the blood that goes to the lungs.  Tx: Some ASDs will close on their own and no surgery is needed. o Atrial septal defects can vary greatly in size.  Some ASDs are closed in the catheterization lab and do not require open-heart surgery.  Some ASDs will need to be corrected with open-heart surgery to restore normal blood circulation and/or to repair subsequent damage, which has occurred in the heart.  Many ASDs are not detected until adulthood. Left untreated for decades, potential problems include lung disease, exercise intolerance, heart rhythm abnormalities, shortened life expectancy and the increased risk of a stroke.  Incidence: Atrial septal defects occur in 5-10% of all children with CHD. o Girls 2x as often as boys.  *Sound: Right ventricular heave, fixed second heart sound split, & systolic ejection murmur.

Ventricular Septal Defect VSD (Increased Pulmonary Blood Flow.. to Right)  Patho : A hole in the wall between the two lower chambers is called an ventricular septal defect, or VSD o “Septum”: Wall that separates the right and left sides of the heart  Normally, blood entering the right side of the heart stays on the right side (this is low-oxygen blood), and blood on the left side of the heart stays on the left side (this is oxygen-rich blood) which is then pumped to the rest of the body o When a defect or "hole" is present between the ventricles (or lower chambers), blood from the left side of the heart is forced through the defect to the right side every time the heart beats o It then goes back to the lungs even though it is rich in oxygen o Blood that is not yet oxygen-rich cannot get to the lungs as a result  Common signs and symptoms: are trouble eating and gaining weight, breathlessness and easy fatigability o Infants with a large VSD tire quickly after not eating very much, fall asleep, wake up in a short while quite hungry, try to eat again, tire easily, and the cycle is repeated  Because the heart has to pump extra blood, it may enlarge. o High pressure may occur in the blood vessels there, because there's more blood going to the lungs  This may cause permanent damage to the walls of the blood vessels over time  Tx: Most VSDs will close on their own. Those that close on their own are usually small and do so in the first year of life o Large VSDs, especially those that do not close in the first year of life, will usually need to be closed surgically  VSD closure is one of the most commonly performed CHD operations  Following repair, there is virtually normal growth, development, and life expectancy  Incidence: Most common CHD, found in 30-60% of all newborns with a CHD, or about 2-6 per 1000 births  *Sound: Holosystolic harsh murmur along left sternal border

Coarctation of the Aorta COA (Obstructive Blood Flow)  Patho: Aorta is the main artery that sends oxygen-rich blood from the heart to the body o COA is a constricted segment of the aorta that obstructs blood flow to the body (co arc tation is a narrowing at the arch of the aorta versus narrowing at the root of the aorta as in aortic stenosis) o Left ventricle has to pump harder because the pressure is high. Because of this, the heart may enlarge

c) Valve that has thick leaflets that do not open all the way  Tx: Open-heart surgery may be needed to correct the defect (depending on the severity of the pulmonary stenosis) o Another option may be a balloon valvuloplasty , done in the cardiac catheterization lab  Incidence: 2 nd most common CHD, comprising 5-10% of all cases of CHD. It is a component of half of all complex CHD  *Sound: High pitched click following 2nd heart sound & a systolic ejection murmur loudest at upper left sternal border

CYANOTIC DISORDERS (Four Ts): These lack O2, look for low O2 s/s, not “sounds,” implement interventions to increase O Tetralogy of Fallot (TOF) (Decreased Pulmonary Blood Flow... Right to Left) TOF is one of the most common forms of complex CHD that causes cyanosis, or a blue baby. Comprised of 4 separate components: 1. Ventricular septal defect (VSD) 2. Pulmonary stenosis (PS) 3. Right ventricular hypertrophy (RVH), an increase in the size of the right ventricle 4. Overriding aorta (OA), aorta lies directly over the ventricular septal defect  Patho: The VSD is usually large and blood flows from the right ventricle through this VSD into the left ventricle  This occurs because of the resistance of blood flow through the pulmonary valve  Once the blood flows into the left ventricle it is ejected into the aorta and delivers de-oxygenated blood into the body  Because there is de-oxygenated blood being delivered to the body, these babies may appear cyanotic, or "blue"  Tx: Open-heart surgery is needed  Incidence: Occurs in about 2 out of every 10,000 live births, occurs equally in boys and in girls.

Transposition of the Great Arteries (or Vessels) (TGA/TGV) (Mixed Pulmonary Blood Flow)  Patho: Aorta (the main artery that carries blood to the body) originates from the right ventricle and the pulmonary artery (the artery that carries low-oxygen blood to the lungs) from the left ventricle. Babies with transposition are extremely blue at birth. o Because of this reversal, the aorta carries low-oxygen blood from the right ventricle to the body  The pulmonary artery carries oxygen-rich blood back to the lungs  Tx: Arterial switch operation (the major arteries are "switched") aorta is connected to left ventricle and pulmonary artery is connected to right ventricle (the ASD, VSD and/or PDA may also need to be corrected to restore normal blood flow)

o In order for infants with TGA to survive, they must have some communication between the right and left sides of the heart to allow-oxygen-rich blood to reach the body o This mixing of blood is possible through an ASD, VSD or PDA (even though there is mixing of oxygenated and de-oxygenated blood, it is often not adequate to sustain life for an extended period)  Incidence: Occurs in 5-7% of all CHD, 60-70% are boys

Truncus Arteriosus (Mixed Pulmonary Blood Flow o Patho: Only one artery originates from the heart and forms both the aorta and the pulmonary artery o The truncus arises above a VSD that is almost always associated with this defect o The truncus receives low-oxygen blood from the right ventricle and oxygen-rich blood from the left ventricle o This mix of high and low-oxygen blood is sent out to the body and to the lungs  Tx: Open-heart surgery in infancy (involves closure of the VSD and removal of the pulmonary arteries from the truncus) o Pulmonary arteries are then connected to the right ventricle with a prosthetic tube, which is replaced as the infant grows  Incidence: Occurs in <1 out of every 10,000 live births, making up 1 % of all CHD cases

Tricuspid Atresia (Decreased Pulmonary Blood Flow Right to Left)  Patho: In tricuspid atresia, there is no tricuspid valve so no blood can flow from the right atrium to the right ventricle o As a result, the right ventricle is small and not fully developed  Survival depends on an opening in the wall between atria (ASD) and usually an opening between the two ventricles (VSD)  As a result, the venous (bluish) blood that returns to the right atrium flows through the ASD and into the left atrium o There it mixes with oxygen-rich (red) blood from the lungs o Most of this poorly oxygenated mixture goes from the left ventricle into the aorta and on to the body o The rest flows through the VSD into the small right ventricle, through the pulmonary artery and back to the lungs  Tx: A surgical shunting procedure is often used to increase blood flow to the lungs o A pulmonary artery banding procedure to decrease blood flow to the lungs may be needed for some children who have too much blood flowing to the lungs o A Fontan procedure may also be used to restore blood flow

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Congenital Heart Defects Teaching Presentation

Course: Adult Health II (NUR 2211)

203 Documents
Students shared 203 documents in this course

University: Hillsborough Community College

Was this document helpful?
Congenital Heart Defects (CHD) Information Sheet
ACYANOTIC DISORDERS: Have adequate O2, listen for “area” and “type of sound” to determine CHD
as well as s/s
Aortic Stenosis (Obstructive Blood Flow)
Patho: “Narrowing” of the aortic valve or a narrowing of the aorta (to “stenose” is to thicken or make
narrow)
oNormally, oxygen-rich blood is pumped from left ventricle, through the aortic valve, into aorta
and then out to the body
oAS makes it hard for the heart to pump blood to the body
Tx: Open-heart surgery may be needed to correct this defect (depending on the severity of the stenosis)
oAnother option is balloon valvuloplasty
Incidence: Congenital AS occurs in 3-6% of all children with CHD
oRelatively few are symptomatic in infancy, incidence of problems increases sharply in adulthood
oOccurs 4x more often in boys than in girls
*Sound: Thrill at base of heart, systolic murmur best hear along left sternal border with radiation to
right upper sternal border
Atrial Septal Defect (ASD) (Increased Pulmonary Blood Flow…Left to Right)
Patho: A hole in the wall between the two upper chambers is called an atrial septal defect, or ASD
o“Septum”: Wall that separates the right and left sides of the heart
oNormally, low-oxygen blood entering the right side of the heart stays on the right side, and
oxygen-rich blood stays on the left side of the heart, where it is then pumped to the body. When a
defect or "hole" is present between the atria (or upper chambers), some oxygen-rich blood leaks
back to the right side of the heart. It then goes back to the lungs even though it is already rich in
oxygen. Because of this, there is significant increase in the blood that goes to the lungs.
Tx: Some ASDs will close on their own and no surgery is needed.
oAtrial septal defects can vary greatly in size.
Some ASDs are closed in the catheterization lab and do not require open-heart surgery.
Some ASDs will need to be corrected with open-heart surgery to restore normal blood circulation
and/or to repair subsequent damage, which has occurred in the heart.
Many ASDs are not detected until adulthood. Left untreated for decades, potential problems include lung
disease, exercise intolerance, heart rhythm abnormalities, shortened life expectancy and the increased
risk of a stroke.
Incidence: Atrial septal defects occur in 5-10% of all children with CHD.
oGirls 2x as often as boys.
*Sound: Right ventricular heave, fixed second heart sound split, & systolic ejection murmur.
LISA SCHILLING MSN, RN (IN COLLABORATION WITH) TONI YOUNG DOSTON MSN, RN 1

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