Types of cyanotic CHD

- Conditions with decreased pulmonary blood flow

1. TOF (tetralogy of fallot)

- Common in boys

- Problem:

a. pulmonic stenosis

b. overriding of aorta

c. right ventricular hypertrophy

d. ventricular septal defect

- Sx: boot shaped heart

- Frequent squatting/ Tets fell – due to hypoxic episodes because of decrease blood supply to the brain

- Syncope(fainting)

2. Truncus arteriosus

- Common in boys

- Problem: one major artery or trunk arises from the left and right ventricles in place of separate aorta and pulmonary artery

3. Transposition of the great vessels

- Common in boys

- Problem: aorta arises from the right ventricle instead of the left and pulmonary artery arises from the left ventricle instead of the right

4. Tricuspid atresia

- Tricuspid valve is completely closed allowing blood to flow from the right atrium to the right ventricle

General Management:

1. on oxygenation

- oxygen as ordered

- position in semi fowlers with neck slightly hyperextend or place in knee chest (squatting) position to relieve “Tets pell” (paroxysmal dyspnea with cyanosis relieved by squatting)

- digoxin as ordered to strengthen the contraction (+ inotropic effect) and slow down the heart rate ( - chronotropic effect)

2. on cardiac workload conservation

- promote rest (give pacifier)

- organize nursing activity

- avoid extremes of temperature

- diuretics as ordered (to reduce cardiac preload and workload)

3. on nutrition

- low Na formula (prevent fluid retention)

- limit feeding time (avoid tiring)

- monitor weight and rate of growth

4. Prevent infection
5. support coping and education of the family

Mitral Stenosis

- etiology: result from

o rheumatic heart disease/RHF

o atrial myxoma (tumor)

o calcium accumulation

- can lead to narrowing of valve opening due to thickening of the valve resulting from thrombosis, and calcification which may result to abnormal blood flow thus arising left atrial pressure, dilatation of left atrium, increased pressure from the pulmonary artery, and hypertrophy of the right ventricle

- S/Sx: asymptomatic

o But as valve narrows: dyspnea on exertion

· Orthopnea

· PND (paroxysmal nocturnal dyspnea

· Dry cough

· Hemoptysis

· Pulmonary edema

· Hypertension

· Hepatomegaly

· Pitting edema

· Dysrhythmias

Mitral Regurgitation

- Cause: RHF common in women

o Due to fibrotic and calcific changes it may lead to incomplete closure of the valve, then the blood will backflow to the left atrium thus resulting from insufficial mitral supply

Symptoms:

Fatigue

Weakness

Decrease cardiac output

Dyspnea

Chest pain

Palpitation

Progressive RSHF and LSHF

Atrial fibrillation

Normal BP

Systolic murmurs

Mitral Valve Prolapse

- Enlarge valvular leaflets protrudes into the left atrium during systole

- S/Sx:

Asymptomatic

Chest pain

Palpitation

Dizziness

Syncope

Ventricular dysrhythmias

Normal BP

Fatigue

General managemnt:

- vital signs

- administer oxygen supplement

- low Na diet

- give cardiac glycosides

digoxin (Lanoxin)

monitor:

· digoxin level: N: 0.5 – 2 ng/ml (more than 2 – toxic level)

· electrolytes: decrease K+ - prone to toxicity

· renal function test

inotropic action: increase contration of the heart

chronotropic action: decrease heart rate

advise to eat K+ food (dried fruits)

monitor apical pulse (PMI) – less than 60 hold the drug

antidote for toxicity: digoxin immune fab (Digibind)

- prepare for valve replacement

mechanical prosthetic valve

surgically done