SPECIFIC HEART DEFECTS

Transcription

1 A. Acyanotic Defects 1. Ventricular Septal Defect (VSD): SPECIFIC HEART DEFECTS Which side of the heart is stronger? Left This is when there is an opening between the left and right ventricle (in the septum) When the left ventricle squeezes down it shoots blood forward into the aorta like it s supposed to, but NOW, since there is a hole between these 2 chambers, blood can now shoot over to the right side of the heart (right ventricle). Since the left ventricle is the strongest part of the heart..when it squeezes down on blood it does so with great force, therefore it really SHOOTS blood over to the right side. This increases the volume on the right side of the heart. The right side is having to pump harder so this can lead to right sided heart failure. Many close spontaneously during the first year of life. 1) Signs of heart failure 2) Murmur

2 2. Coarctation of Aorta: The aorta has a narrowing (pretend there is a tourniquet tied around the aorta). This makes it harder for the LV to pump so the client may wind up with left sided heart failure. -There is a BIG difference in the pulses and BP of the upper and lower extremities. -There is always a slight difference in the pulses and BP of the upper and lower extremities..that s why I said BIG difference. -The upper pressures are much greater than the lower pressures. Tx: -Surgery -Can do angioplasty in some

3 3. Patent Ductus Arteriosus (PDA): Normal fetal circulation: Blood goes RA.RV.PA doesn t go to lungs.instead when blood leaves PA it goes straight over to the aorta via the ductus arteriosis. Why does the blood do this? Because in utero the baby s lungs are collapsed, and the baby gets oxygen through the placenta. This ductus arteriosis is supposed to close when the baby is born and takes their first breath. When it closes then blood flows from the PA to the lungs etc.just like in the adult. Now think about the left side of the heart in this condition. Here comes the blood LA, LV, and then the blood moves into the aorta. When the blood gets into the aorta it s confused as to which way to go The blood says should I go straight to the body or should I hang a right here through this opening that was supposed to close. There is a traffic jam of blood in the aorta because the blood doesn t know which way to go. This leads to increased workload on the left side of the heart and therefore left sided heart failure. Some blood is going straight like it s supposed to, but some is going right because the left side is still stronger than the right. -May be asymptomatic -May be in heart failure -They have machinery like murmur Tx:

4 -Indomethacin (Indocin ) (prostaglandin inhibitor) will close PDA -Maybe surgery B. Cyanotic Defects 1. Transposition of the Great Vessels: Notice the PA comes out of right ventricle and goes to the lungs and then the blood goes to the left side of the heart to get pumped out to the rest of the body..the PA s favorite place to go is to the left side of the heart. Noticed the aorta comes out of the left ventricle and then goes throughout the body and eventually winds up back at the right side The aorta s favorite place is the right side of the heart.

5 Notice the PA and aorta have swapped places. They are still going to their favorite side of the heart. The aorta likes to go to the right side of the heart. The PA likes to go to the left side of the heart. So you wind up with 2 separate sets of circulation going in and out of the heart. Yes, some blood is getting out to the systemic circulation, or the client would be dead at birth. Instead, the baby is cyanotic at birth, but alive. What s keeping the baby alive? -There is some other defect that is allowing that baby to get just enough oxygen to stay alive. -Usually cyanotic at birth -If not picked up on until older decreased growth, poor feeding Tx: Surgery

6 2. Tetralogy of Fallot: Consists of 4 defects: a. Ventricular Septal Defect (VSD) b. Stenosis of Pulmonary Artery (PS) c. Overriding Aorta d. Right Ventricular Hypertrophy -Infants may be cyanotic at birth. -Others may have mild cyanosis that progressively worsens during first year -Murmur -Acute cyanotic or hypoxic spells (blue spells/tet spells) *usually seen during crying, after feeding, during bowel movements *at risk for sudden death, seizures -Older children: Squatting, clubbing, poor growth, exercise intolerance Tx: Surgery