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Cardiac Catherazation
Invasive procedure
Radiopaque cathereter is inserted through a peripheral vein and run through the vein to the heart, a dye is inserted  and films are taken.
Need to know baseline o2 levels, height and weight for correct catheter size.
Films show:
  • dilution
  • circulation
Diagnostic Catheterization
  • diagnose congenital cardiac defects
  • Used before surgery
  • Usually through femoral vein as insertion point
  • Right atrium is most common
ASD (Atrial Septal Defect)
Abnormal opening between atria allowing blood from the higher-pressure left atrium to flow into the lower-pressure right atrium.
ASD(Atrial Septal Defect) S/S
Patients may show CHF, systolic murmur with fixed split second heart sound, diastolic murmur. 
AT Risk for: Atrial dysrhythmias, Pulmonary Vascular obstructive disease, and emboli.
ASD Surgical treatment
Surgical Patch closure (pericardial patch or Dacron patch) for moderate to large defects.

Open repair with cardiopulmonary bypass is done before school age.

May require mitral valve repair or replacement of ASD1
ASD Nonsurgical treatment
ASD closure can be treated with cardiac catheterization in the outpatient setting.
Called: Amplatzer Septal Occluder
If large, or irregular, without a rim surgery is required
low dose of aspirin is perscribed post precudure for 6 months following procedure
Ventricular Septal Defect (VSD)
Abnormal opening between the right and left ventricles. Classified by location.
  • Membranous
  • Muscular

May vary in size from a small pinhole to absence of the septum. 20%-60% close independently.
VSD Pathophysiology
Higher pressure in the left ventricle and because of systemic arterial circulation offers more resistance than the pulmonary circulation blood flows directly into the pulmonary artery. Results in increased pulmonary vascular resistence. if the right ventricle cannot handle the increased workload the right atrium may also enlarge to handle the  incomplete right ventricular emptying.
VSD Clinical manifestations
  • CHF is common
  • Loud holosystolic murmur, heard at left sternal border
  • At risk for bacterial endocarditis
  • And Pulmonary vascular disease
  • Excess blood going to the lungs-No cyanosis
VSD Surgical treatments
  • pulmonary artery banding (placement of a band around main pulmonary artery to decrease pulmonary blood flow)
  • Complete repair done in infants mostly and is preffered to be done at that point.
Complete Repair (procedure of choice)
  • small defects are repaired with sutures
  • Large defects ussually require a knitted dacron patch be sewn over opening
  • Cardiopulmonary bypass is required for both
  • Complications: Residual VSD and conduction disturbances
VSD Nonsurgical Treatment
Device closure during cardiac catheterization is being performed under investigational protocols. Experimental at best but the outlook is encouraging.
Tetrology of Fallot: *P.R.O.V.*
P-Pulmonary stenosis
R-Right ventricular hypertrophy
O-Overriding aorta
V-Ventricular septal defect.
Tetrology of Fallot Clinical manifestations
  • TET or Blue Spells
  • Systolic murmur
  • Anoxic spells(Oxygen demand exceeds blood supply) during crying and feeding
  • Some infants are born displaying cyanosis
  • will get worse as the Pulmonic stenous worsens

At risk for: emboli, seizures, loss of conciousness, sudden death following anoxic spell
TET/ Blue Spells
acute episodes of cyanosis and hypoxia,squating is an indicator,  sit them up bring legs to chest or squat as first intervention and then apply O2.
Digoxin for children
  • Apical pulse over 70 must be present to give med
  • not with food
  • toxicity bradycardia
  • N\V
  • dysrythmias
  • Anorexia
  • Infants rarely get more than 1ml
  • Very narrow range between therapuetic and death in children.
Heart Physiology
Deoxygenated blood-superior vena cava, Right atrium, tricuspid valve, right ventrical, Pulmonic Valve, Pulmonary Artery, R and L lungs, (Oxygenated) Pulmonary vein, Left Atrium, Mitral valve, Left Ventricle, Aortic valve, peripheral circulation
Pediatric indicattors
  • (baby) no or limited weight gain
  • Poor feeding
  • Low activity
  • Tachypnea/tachycardia
  • developmental delays
Congenital Heart disease
Prior to eigth week of gestation
Enviornment and genetic factors
Acynanotic or cyanotic
PDA (patent Ductus Arteriosus)
artery connecting the aorta and pulmonary artery doesnt close.

May not be symptomatic
Obstructive defect.
Narrowing of the aorta.
Not enough blood flow to systemic stimulation.

Child will have hypertension, slow pedal pulses to no pedal pulses. Dizziness, fainting, aortic aneurysm.
B/P- 140-160/ 60<
Could lead to stroke.
COA treatments
Surgical- Resection
Antihypertensive drugs
Angioplastic ballon treatment (widens it)
Pulmonary Stenosis
narrowing of PA, pooling blood in right ventricle causes the right ventricle to work harder.
Enlarges Right ventricle (hypertrophy)

Complications: right sided heart failure, pulmonary hypertension
Tetrology of Fallot

"Blue Baby" increasing cyanosis, squatting, clubbing, and poor growth.
Crying and feeding will have cyanosis

Surgery intervention: blalock shunt, repair VSD, resect stenosis
Tricuspid Atresia
Failed to open

goes back to the body or forms hole into left atrium.
Hypoplastic Left heart syndrome
Left ventricle did not grow or develop.

Left ventricle sends the blood to the body (systemic circulation).

Do surgery- leave heart open for manual ressessitation.
Nursing responsibilties

No signs and symptoms Right side heart failure- peripheral edema, hipotomegaly, fluid retention, liver

Left side of heart- Pulmonary edema, Jugular vein disstention

CHF- both sides fail,
CHF interventions
Rest, rest, rest...(decrease the oxygen and metabolic demand) (cluster the nursing care)(decrease fever), Give 02, strict I&O, daily weight,

Collaborative: Diuretics, digoxin,Monitor lab vaules (electrolytes, ABG,), fluid intake,
CHD teaching
Encourage child to be normal.
If child is out of breath or struggling needs to stop.

Must teach medicines, apical pulse, pedal pulses. Teach about diet with diuretics. Any surgery must have prophalactic antibiotics. Maintain temperature at normal level.
Strep throat emitoid (sp?) Carditis
Strep throat travels into the heart and causes inflamation of the valves.
Kawasaki Disease
  • Rare pediatric disease
  • Inflammation of blood vessels
  • Affects the lymph nodes, mucus membranes & walls of blood vessels
  • Also known as Mucocutaneous Lymph Node Syndrome
  • Leading cause of pediatric acquired heart disease in the US at present
  • Rarely occurs in children over age 8

Treatment: immunoglobulin and aspirin (not with viral disease causes reyes syndrome)
Kawasaki disease s/s
  • Rash on the middle of the body (no blistering)
  • Swollen hands & feet, palms & soles red
  • Skin peeling on genitals/hands/feet
  • Joint pain & swelling - one side of body
  • Irritation & redness of whites of eyes
  • Swollen lymph glands in neck
  • Bright red, chapped/cracked lips
  • Red mucous membranes of the mouth
  • Strawberry tongue w/ white coating of tongue/red bumps on back of tongue
  • Bloodshot eyes
Kawasaki disease interventions
  • Monitor Temp frequently
  • asses heart sounds, rate, rhythm
  • asses extremities for edema, redness, and desquamation
  • Examine eyes for conjunctivitis
  • Monitor mucous membranes for inflamation
  • Monitor strict I&O and daily weight
  • Administer luke warm foods and liquids
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