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Pediatric Cardiovascular Disorders

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Dominic Etli

on 11 July 2014

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Transcript of Pediatric Cardiovascular Disorders

The Child with Cardiovascular Dysfunction
Acetylsalicyclic acid (ASA) 80 to 100 mg/kg/day for fever
Intravenous immunoglobulin (IVIG)
Then 3 to 5 mg/kg/day antiplatelet
Treatment of KD

An acute systemic vasculitis of unknown cause
In 75% of cases, the child is younger than 5 years of age
Three phases
Acute phase: Sudden high fever, unresponsive to antipyretics and antibiotics
Subacute phase: Lasts from the end of fever through the end of all KD clinical signs
Convalescent phase: Clinical signs have resolved, but laboratory values have not returned to normal; ends when normal values have returned (6 to 8 weeks)

Kawasaki Disease (KD)

Prevention of GABHS
Treatment of streptococcal tonsillitis and pharyngitis
Penicillin G intramuscularly once
Penicillin V by mouth for 10 days
Sulfa by mouth for 10 days
Erythromycin (if patient is allergic to the above agent) by mouth for 10 days
Treatment of recurrent RF
Same as above
Treatment of Rheumatic Heart Disease

Jones criteria (presence of two major manifestations or one major manifestation and two minor manifestations)
Carditis
Polyarthritis
Erythema marginatum
Subcutaneous nodules
Chorea
Clinical Manifestations and Diagnosis of Rheumatic Fever

Bacterial endocarditis (BE) and subacute bacterial endocarditis (SBE) are now referred to as infective endocarditis (IE)
Often a sequela of bacteremia in children with CHD or AHD
Most common causative agents
Streptococcus viridans or Staphylococcus aureus
Fungal agents such as Candida albicans
Endocarditis

Infectious and Inflammatory Cardiac Disorders
Acquired Cardiovascular Disorders

Interventional Cardiac Catheter Procedures in Children
Transposition of the great vessels
Some complex single-ventricle defects
Atrial septal defect
Pulmonary artery stenosis
Interventional Cardiac Catheter Procedures in Children

Hypoplastic Left-Sided Heart Syndrome

All Elsevier items and derived items © 2013, 2009, Mosby, Inc., an imprint of Elsevier Inc.

Total Anomalous Pulmonary Venous Connection

All Elsevier items and derived items © 2013, 2009, Mosby, Inc., an imprint of Elsevier Inc.

Transposition of the Great Arteries or Transposition of the Great Vessels

All Elsevier items and derived items © 2013, 2009, Mosby, Inc., an imprint of Elsevier Inc.

Transposition of the great vessels
Total anomalous pulmonary venous connection
Hypoplastic heart syndrome
Right sided
Left sided
Mixed Defects

Tricuspid Atresia

All Elsevier items and derived items © 2013, 2009, Mosby, Inc., an imprint of Elsevier Inc.

Tetralogy of Fallot

All Elsevier items and derived items © 2013, 2009, Mosby, Inc., an imprint of Elsevier Inc.

Tetralogy of Fallot
Tricuspid atresia

Decreased Pulmonary Blood Flow Defects

All Elsevier items and derived items © 2013, 2009, Mosby, Inc., an imprint of Elsevier Inc.

Pulmonic Stenosis

All Elsevier items and derived items © 2013, 2009, Mosby, Inc., an imprint of Elsevier Inc.

Aortic Stenosis

All Elsevier items and derived items © 2013, 2009, Mosby, Inc., an imprint of Elsevier Inc.

Coarctation of the Aorta

Coarctation of the aorta
Aortic stenosis
Pulmonic stenosis

Obstructive Defects

All Elsevier items and derived items © 2013, 2009, Mosby, Inc., an imprint of Elsevier Inc.

Atrioventricular Canal Defect

Ventricular Septal Defect
Atrial Septal Defect

Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus

Increased Pulmonary Blood Flow Defects
Hemodynamic characteristics
Increased pulmonary blood flow
Decreased pulmonary blood flow
Obstruction of blood flow out of the heart
Mixed blood flow

Newer Classification of CHD

Physical Indicators of Cardiac Dysfunction
Poor feeding
Tachypnea, tachycardia
Diaphoresis
Crackles
Hepatomegaly
Cyanosis
Murmur
Sternal lift

Physical Indicators of Cardiac Dysfunction

Symptoms may appear 4 to 12 weeks after birth
Failure to thrive, poor weight gain, activity intolerance
Developmental delays
Positive prenatal history
Positive family history of cardiac disease
Indicators of Cardiac Dysfunction
All Elsevier items and derived items © 2013, 2009, Mosby, Inc., an imprint of Elsevier Inc.

Changes at Birth

Chromosomal or genetic cause in 10% to 12%
Maternal or environmental cause in 1% to 2%
Maternal drug use
Of infants with fetal alcohol syndrome, 50% have CHD
Maternal illness
Rubella infection in the first 7 weeks of pregnancy is associated with a 50% risk of defects, including patent ductus arteriosus (PDA) and pulmonary branch stenosis
Cytomegalovirus, toxoplasmosis, and other viral illnesses lead to cardiac defects
Infants of diabetic mothers (IDMs) have a 10% risk of CHD (ventricular septal defect, cardiomyopathy, and transposition of the great arteries are most common)
Multifactorial in 85%

Causes of CHD

Congenital
Anatomic, resulting in abnormal function
Acquired
Disease process
Infection
Autoimmune response
Environmental factors
Familial tendencies

Two Types of Cardiac Defects
Rheumatic fever
Most commonly seen with untreated Strep Throat
Inflammatory disease occurring after group A β-hemolytic streptococcal pharyngitis (GABHS)
Infrequently seen in the United States; big problem in developing countries
Self-limiting
Affects joints, skin, brain, serous surfaces, and heart
Rheumatic heart disease
Most common complication of RF
Damage to valves
Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD)

Open-heart surgery
Closed-heart procedures
Staged procedures
Prepare the child and family for the procedure
Surgical Interventions

Impaired myocardial function
Tachycardia, fatigue, weakness, restlessness, pale, cool extremities, decreased blood pressure, decreased urinary output
Pulmonary congestion
Tachypnea, dyspnea, respiratory distress, exercise intolerance, cyanosis
Systemic venous congestion
Peripheral and periorbital edema, weight gain, ascites, hepatomegaly, neck vein distention

CHF in Children

All Elsevier items and derived items © 2013, 2009, Mosby, Inc., an imprint of Elsevier Inc.

Patent Ductus Arteriosus

Abnormal connection between the two sides of the heart
Either the septum or the great vessels
Increased blood volume on the right side of the heart
Increased pulmonary blood flow
Decreased systemic blood flow

Increased Pulmonary Blood Flow Defects

Acyanotic
May become cyanotic
Cyanotic
May be pink
May develop congestive heart failure (CHF)
Older Classifications of CHD

When a newborn takes the first breath, the fetal vascular system undergoes abrupt changes
Umbilical vein and umbilical arteries
Before birth, the umbilical vein delivers oxygen and nutrients to the fetus
Foramen ovale
Closes as pressure in the left atrium exceeds pressure in the right atrium
Ductus arteriosus
Starts to close in the presence of increased oxygen

Normal Fetal Circulation Changes
Incidence is 5 to 8 per 1000 live births
Two or three of these infants are symptomatic in the first year of life
CHD is the major cause of death in the first year of life (after prematurity)
Most common anomaly is ventricular septal defect
In 28% of kids with CHD, another recognized anomaly is also present

Congenital Heart Disease (CHD)
Cardiac Catheter Procedure Care

Check the pulse distal to the site
Monitor the temperature and color of extremities
Take the vital signs every 15 minutes
Monitor the blood pressure
Monitor the dressing for bleeding or hematoma
Monitor intake and output
Monitor blood glucose levels
Postprocedural Care
Prepare the child and family for the procedure
Use developmentally appropriate materials to explain the procedure to the child
Assess and mark pulses
Baseline O2 sats
Nothing by mouth (NPO) prior to the procedure
Preprocedural Care
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