Dfghjklhgfdfgghhhhhioolnbcdytt ff cm myyfgyhuuhggggy

1. Pediatric Cardiac Disorders

2. Fetal Circulation
Main Blood Flow
 Placenta  Umbilical
Vein  Liver  Ductus
Venosus  Inferior
Vena Cava
 Vena Cava  Right
Atrium Foramen
Ovale Left Atrium 
Left Ventricle 
 Aorta Body

3. Fetal Circulation
Secondary Route:
 Right Atrium 
 Right Ventricle 
 Pulmonary Artery 
 Ductus Arteriosus 
(so does not go to lungs)
 Aorta 
 Body

4. Fetal Circulation
Third route of blood flow
 Right Atrium 
 Right Ventricle 
 Pulmonary Artery 
 Lungs (needs to perfuse the
lungs and upper body with
oxygen) 
 Left Atrium 
 Left Ventricle 
 Aorta 
 Body

5. Transition from Fetal Circulation to
Pulmonary circulation
 The umbilical arteries and vein and the ductus
venosus become non-functional
 Decreased pulmonary vascular resistance and
increased pulmonary blood flow
 Increase in pressure of the left atrium, decrease
pressure in right atrium, causing closure of
foramen ovale.
 Pulmonary resistance is less than systematic
resistance so there is left-to-right shunting
resulting in closure of the ductus arteriosus.

6. Congestive Heart Failure

7. Congestive heart failure
 The inability of the myocardium to circulate
enough oxygenated blood to meet the
demands of the body.
 When the heart fails, cardiac output is
diminished. Heart rate, preload,
contractitility, and afterload are affected.
 Peripheral tissue is not adequately
perfused.
 Congestion in lungs and periphery
develops.

8. Etiology and Pathophysiology
 Congenital defects – allow blood to flow from
the left side of the heart to the right so that
extra blood is pumped to the pulmonary
system rather than through the aorta when the
ventricle contracts.
 Obstructive congenital defects – restricts the
flow of blood so the heart hypertrophies to
work harder to force blood through the
narrowed structures. The hypertrophied
muscle becomes ineffective.
 Other defects which weaken the heart muscle.

9. Compensatory Mechanisms
 Stimulation of the sympathetic nervous system
which releases norepinephrine from the adrenals.
This stimulates blood vessels to constrict and an
increase in the heart rate.
 Tachycardia increases venous return to the heart
which stretches the myocardial fibers and
increases preload. Only successful for short
period of time.
 Increased renin and ADH secretion caused by
decrease renal perfusion. Resultant increase in
Na and H2O retention to increase fluid to the
heart and leading to edema

10. Signs and Symptoms
1. Diaphoresis / sweating
2. Breathlessness –tachypnoea, coughing,
crepitations
3. Tires easily
4. Poor feeding; poor weight gain, FTT
5. Hepatomegally
6. Cardiomegaly
7. Tachycardia; gallop rhythm
8. Only older children & adults develop signs of
systemic congestion : oedema, orthopnoea,
nocturnal dyspnoea, elevated JVP

11. Investigations
 Directed at finding the cause and quantifying
function
 CXR- cardiomegaly, lungs are oligaemic/oedema
 Echocardiography- Congenital heart defects
 Arterial blood gas- reduced oxygen/ metabolic
acidosis
 ECG, SERUM ELECTROLYTES

12. GENERAL MEASURES
 Bed reest- nurse in a semi – upright position
 Oxygen
 Diet- sufficient calorie intake
 Diuretics
 Digoxin
 Vasodilators e.g ACE inhibitors

13. Treatment of Congestive Heart Failure
 Medication Therapy
 Digitalis – increases contractility and decreases
heart rate.
 ACE-inhibitors - arterial vasodilator / afterload
reducing agent
 Diuretics - enhance renal secretion of sodium and
water by reducing circulating blood volume and
decreasing preload.
 Beta Blocker - increases contractility

14. Treatment of Congestive Heart Failure
 Diet – low sodium, small frequent feedings
(be sure you can pick the right foods for a low NA diet.
 Nursing care:
 Measure intake and output – weighing diapers
 Observe for changes in peripheral edema and
circulation
 If ascites present – take serial abdominal
measurements to monitor changes.
 Skin care
 Turning schedule