ACYNOTIC

1. Acyanotic heart
Disease

3. ❑ The heart is a roughly cone shaped, hallow
muscular organ
❑ Heart is about 10 cm long
❑ size is owner’s fist
❑ weighs about 225gms in women and heavier in
men
❑ Heart lies in thoracic cavity in mediastinum
between lungs

4. ❑ The umbilical vein
carrying the oxygenated
blood from the placenta.
❑ Enters the fetus at
umbilicus and the blood
goes to liver.
❑ The blood from the liver
enter inferior vena cava
through ductus venosus
and then to right atrium
of heart.

5. ❑ In right atrium, most of blood
{75%} passes into left atrium
by foramen ovale.
❑ Left atrial blood is passed
through the mitral opening to
the left ventricle.
❑ The left ventricular blood is
pumped into the ascending
and arch of aorta and
distributed by their branches
to
heart,head,neck,brain&arms.

6. ❑ The blood passes
directly through the
ductus arteriosus into
descending aorta by
passing the lungs where
it mixes with the blood
from the proximal aorta.
❑ Mixed blood is
distributed by
descending aorta &
leaves the body by way
of two umbilical arteries

7. ❑ The mean CARDIAC OUTPUT 225ml/kg/min. in
uterine life.
❑ Following BIRTH:- cardiac output 500/min.
❑ Heart rate:- 120-140/min.

9. ❑ Acyanotic Heart Disease is the common
congenital heart disease present at birth.
❑ It’s prevalence is mostly unknown.
❑ In this mostly the cyanosis is not seen hence
known as ACYANOTIC HEART DISEASE
❑ It is the one of the major cause of death in the 1st
year of life.

10. ACYANOTIC HEART DISEASE is
a congenital heart disease with
structural malformation of the
heart or great vessels.

11. ❑ Idiopathic {90%} cases.
❑ Hereditary & Consangious marriage.
❑ Genetic disorder & Chromosomal abnormalities.
❑ Other associated factors-
fetal & maternal teratrogenic infection {Rubella}.
Teratogenic drug {Thalidomide} intake
Alcohol intake by mother.
Fetal hypoxia.
Birth asphyxia.

12. There is diminished pulmonary blood flow due to left to
right shut.
• It includes:
❑ ATRIAL SEPTAL DEFECT
❑ VENTRICULAR SEPTAL DEFECT
❑ PATENT DUCTUS ARTERIOSUS
❑ CO-ARCTATION OF AORTA

13. Atrium

14. Atrial septal defect is an
abnormal opening between
right to left atria resulting left to
right shunting of blood.

15. Atrial septal defect are of 3 types
❑ Ostium primum.
❑ Ostium secundum
❑ Sinus venosus defect

21. ❑ Asymptomatic
❑ Dyspnea
❑ Bulging of chest
❑ Easy fatigability
❑ Poor weight gain
❑ Congestive cardiac failure
❑ Cardiac enlargement

22. ❑ History collection
❑ Physical examination
❑ Chest x ray
❑ ECG
❑ 2D Echo
❑ Cardiac catheterization

23. ❑ Infective endocarditis
❑ Pulmonary arterial hypertension
❑ Growth retardation
❑ Congestive cardiac failure
❑ Post- operative complications
❑ Atrial fibrillation

24. ❑ Chest infection :- Antibiotics
Nebulization
Physiotherapy
❑ Fever:-
❑ Poor weight gain :-
Antipyretic
IV infusion

25. ❑ Open heart surgery :-
Done on affected children before
they enter school even if no
symptoms are present.
❑ Purse string closure :-
For small defects a stitching
around the opening and pulling it
closed

26. ❑ Knitted Dacron patch :-
If the defect is larger.
Gortex patch
ASD

27. VENTRICULAR SEPTUM

28. ventricular septal defect is
an abnormal opening in the
septum between right and left
ventricles.

31. ❑ Pansystolic murmur
❑ Breathlessness
❑ Poor feeding
❑ Growth failure
❑ Dyspnea
❑ Sweating

32. ❑ Recurrent respiratory infection
❑ Tachycardia
❑ Poor weight gain
❑ Failure to thrive
❑ Biventricular hypertrophy

33. ❑ History collection
❑ Physical examination
❑ Chest x ray
❑ ECG
❑ 2D Echo
❑ Cardiac catheterization
❑ Doppler

34. ❑ Pulmonary atrial hypertension
❑ Prolapse of aortic valve
❑ Infective endocarditis

35. ❑ Control of congestive cardiac failure
❑ Treatment of repeated chest infection
❑ Prevention and treatment of anemia and infective
endocarditis

36. Surgical treatment is indicated if :-
❑ CCF occurs in infancy
❑ Left to right shunt
❑ Pulmonary stenosis, pulmonary atrial
hypertension , aortic regurgitation

37. Closure of the ventricular septal
defect with the use of a DACRON
patch
The operation can be done
BELOW the age of one year.
If congestive cardiac failure
cannot be controlled with medical
management with evidence of
pulmonary hypertension the
operation should be performed by
the age of two years
Dacron graft
VSD

38. The three major complication are
❑ Complete heart block
❑ Bifasciular block
❑ Re-opened or Residual ventricular septal defect

40. patent ductus arteriosus is the
failure of the fetal ductus
arteriosus {artery connecting
the aorta and pulmonary
artery} to close within the first
weeks of the life.

42. ❑ 11% of all congenital heart disease

45. ❑ Tachypnea
❑ Bounding pulse
❑ Dyspnea
❑ Frequent respiratory infection
❑ Increased systolic pressure
❑ Low diastolic pressure

46. ❑ Pre cordial pain
❑ Feeding difficulty
❑ Weight gain
❑ Growth failure
❑ CCF

47. ❑ History collection
❑ Physical examination
❑ ECG
❑ 2D Echo

48. ❑ Congestive cardiac failure
❑ Pulmonary atrial hypertension
❑ Cyanosis
❑ Endocarditis

49. Supportive medical
management
❑ Fluid restriction

50. ❑ Ligation of the
ductus

52. Co-arctation of aorta is the narrowing near the
insertion of the ductus arterious, resulting in the
increased pressure proximal to the defect {head
and upper extremities} and decreased pressure
distal to the obstruction {body and lower
extremities}

53. ❑ The condition is more commonly found in male.
❑ Accompanies with other defects like VSD,PDA.

55. With coarctation of the aorta, the left
lower heart chamber (left ventricle)
works harder to pump blood through
the narrowed aorta. As a result, blood
pressure rises in the left ventricle. The
wall of the left ventricle may become
thick (hypertrophy)

56. ❑ Blood pressure is higher than normal in upper
part of body
❑ In leg, it is relatively low resulting in absence or
diminution of the femoral pulses
❑ Legs may be cooler than the arms
❑ If child’s exercise muscle cramps in legs
❑ A murmur may or may not be present

57. ❑ Hypertension
❑ Tachypnea
❑ Endocarditis
❑ Congestive cardiac failure
❑ Older children asymptomatic

58. ❑ History collection
❑ Physical examination
❑ Chest x-ray
❑ Barium swallow
❑ Thoracic roentgenogram
❑ 2D Echo

59. ❑ Doppler
❑ Cardiac catheterization

60. ❑ Intracranial hemorrhage
❑ Aortic aneurysm
❑ Infective endocarditis
❑ Congestive heart failure

61. ❑ Antibiotics
❑ Prevention and treatment of complication

62. ❑ Removal of narrowed portion of aorta with
anastomosis of ends
❑ In some cases, a graft of transplanted aorta
❑ Surgery is postponed until the preferred age 3-6
years
❑ Balloon angioplasty

64. ❑ Relieving respiratory distress
❑ Improving cardiac output
❑ Providing adequate nutrition
❑ Preventing infection
❑ Completion of immunization
schedule

65. ❑ Reducing fear and anxiety
❑ Follow up teaching
❑ Avoidance of over protection and
rejection
❑ Promoting growth and
development
❑ Referring social service agency

66. ❑ Admission history
❑ Physical examination
❑ Pre-operative studies
❑ Baseline vital signs
❑ Fluid replacement
❑ Pre-operative teaching

67. ❑ Transfer the child to recovery room or intensive
care unit .
❑ Continues monitoring
❑ Restoring optimal function
❑ Adequate rest
❑ Warm bed

68. ❑ Auscultated apically for a full minute
❑ Asculte the lungs
❑ Check central venous pressure
❑ Close observation of system functioning
❑ Give fluids gradually

69. ❑ Cardiovascular
❑ Respiratory
❑ Renal
❑ Central nervous infection

70. ❑ Hyperthermia related to the chest infection
❑ Ineffective breathing pattern related to the
dyspnea, septal defect
❑ Ineffective airway clearance related to the
retained secretions
❑ Nutritional requirement less than the body
demand

71. ❑ Fear and anxiety related to the long hospital stay
❑ Risk for infection related to the congenital heart
disease or IV cannula
❑ Knowledge deficient regarding the care of the
child at home

72. The acynotic heart diseases are asymptomatic
initially and shows symptoms in later months or
year. So at the birth the child thorough systemic
examination is done for early detection and
treatment
The risk for operation is less in the infancy or
up to 3 years in some cases once the vascular
changes takes place as the years passes then it
may lead to complication like HTN, CCF, surgical
intervention is at greater risk.