• Poor feeding
• low weight, FTT, sweating
• Tachypnea/Tachycardia
• Tripodding
• Older: headaches, chest pain

• heart sounds that reflect flow of blood in heart.
• Occurs in systole, diastole or both
• Classified I-VI

• Normal cardiac anatomy or cardiac function.
• Go away when turned upside down.
• Come and go during childhood

• CX-ray-heart size & configuration
• ECG- electrical activity
• Holter Monitor- 24 hr exam for dysrhythmias
• Echo-cardiac dysfunction & cardiac ouput
• Cardiac catheterization-most invasive (know shellfish allergies). Measures pressure, O2 levels, blood patterns & structures
• exercise stress test

• Transposition of great vessels
• complex single-ventricle defects
• ASD
• Pulmonary artery stenosis
• Considered Routine
• Complications: hemorrhage, low grade fever, n/v

Interventional Cardiac Catheter Procedures

Nursing considerations

• Pressure Dressing: monitor for redness, irritation, swelling, drainage bleeding
• No strenuous exercise or tub bath for 3 days (let dressing fall off)
• Temp, skin color, sensation, pulses, fever, dyspnea, cardiac changes
• tylenol/codeine or ibuprofen

• Congenital- anatomic, abnormal function
• Acquired- infection, autoimmune, environment, familial

• Most common: VSD (ventricular septal defect)
• Causes: 
• Multifactoral 
• Maternal drug use: accutane, dilantin, fetal alcohol syndrome
• Maternal illness: rubella, CMV, chicken pox, high temp with kidney disease, diabetes 
• Genetic: 13-heart flipped, 21-ASV, DSV
• Nursing Considerations:
• Educate family, help cope, prepare for surgery
• Meds, Weights
• Teach to call provider when HR abnormal or temp over 104F

• Causes: blood & fluid accumulate in organs & tissues b/c heart not able to pump & circulate enough blood to supply O2 & nutrient demand of cells

• S/S: Tachycardia, decreased CO, fatigue, weakness, low BP, low urine output, O2 sat low, RR rises, dyspnea, cyanotic, generalized edema, periorbital edema, JVD, coughing: frothy, pink sputum

• Treatment:
• Digoxin 
• pulse over 60-adults,70-kids & 90-infants
• q12 hrs exact dose
• Do not repeat if child vomits
• Keep locked up
• Monitor K levels-decrease causes Digoxin toxicity (n/v, anorexia, bradycardia)
• Diuretics: Lasix- monitor K & lytes. No Na restrictions
• Limit physical activity- keep from getting cold stress, adequate rest, treat existing infections
• Oxygenation: meds, positioning, humidified O2

• Nursing: daily weights, HOB up, I & O, monitor O2 sat

• eventually lead to CHF w/out treatment
• Atrial Septal Defect (ASD)
• Ventricular Septal Defect (VSD)
• Patent Ductus Arteriosus (PDA)

• opening between the atria
• Diagnostics: X-ray, ECHO, Cardiac catheterization
• Treatment: surgery if doesn't close by age 6
• Nursing (post cath): monitor site for hemorrhage, bed rest, pressure dressing, low dose ASA

• Abnormal pathway between right & left ventricles causes shunting and fluid excess. Most close on their own
• S/S: asymptomatic until in CHF. 
• Diagnostics: Loud murmur, ECHO, Cardiac Cath
• Treatment: diuretics, K, Digoxin, surgery (sutures or Dacron patch)

• Failure of patent ductus to close in the first few days or weeks of life. 
• Usually closes 15-24 hrs after birth from O2 concentration after pulm function starts.
• Diagnostics: lack of normal growth, ECHO, heart catheterization, CONSTANT MURMUR, rapid RR, hoarse cry
• Treatment: Indocin (prostaglandin inhibitor), surgical repair after 2 yrs, antibiotic (endocarditis)

• Narrowing of descending aorta obstructs systemic blood flow
• S/S: signs of CHF. Kids: HTN, nosebleeds, ha, bounding pulses in UE & weak pulses in LE,
• Risk for: rupture of aorta, aneurism, or stroke (pressure)
• Diagnostics: ECHO, CXray, MRI
• Treatment: 1st balloon dilation during cardiac cath. If not effective- surgical resection/anastomosis
• usually wait until 2-3 yrs of age due to reocurrences of coarctation.
• Nursing: HTN, endocarditis, antibiotics prophylactically

• narrowing of aortic valve
• Usually in Bicuspid Valve
• S/S: baby: poor feeding, tachycardia, sweating
• kid: exercise intolerance, dizzy upon standing, HTN
• Treatment: balloon cath

• Ventricular Septal Defect
• Overriding Aorta
• Right Ventricular Hypertrophy
• Pulmonary Stenosis

• Diagnosis: CXray (boot shaped heart), EKG (RVH), ECHO
• S/S: Tet spells:hypercyanotic spell, become blue due to spasms, babies bring knees up, Cyanotic w/crying or feedings (after 2-3 months of age), tet squatting- helps return blood to right side of heart
• Treatment:Prostaglandin to keep Ductus arteriosis open and prevent cyanosis. Monitor CBC (polycemia=stroke, thromboembolism)

• Failure of tricuspid valve to develop
• No opening between R atria & L ventricle
• Prostaglandins to keep PDA or VSD open for oxygenation of blood
• 1st surgery ASAP, 2nd @ 6-9 months

• Pulmonary artery leaves L ventricle & aorta leaves R ventricle (switched)
• S/S: CHF, FTT, cyanotic
• Diagnosis: ECHO, Cardiac Cath
• Treatment: Prostaglandin E- maintain PDA, Arterial switch procedure

• Underdeveloped left side of heart
• Boot shaped pattern of heart
• S/S: won't want to feed, ashen, dyspnea, death within few days if not treated, CHD, Pulmonary edema, murmur
• Treatment: Prostaglandin E: need to keep PDA open, Surgery- Norwood procedure. first create new aorta, then new ventrical)
• Cardiac Transplant is best option

• All four pulmonary veins are malpositioned and make anomalous connections to the systemic venous circulation
• More than one surgery involved, be up front with parents
• Nursing: monitor VS, A vs V pressure, O2, rest & pain mgmt (group cares), I/O, lytes, tube feedings, & IV fluids.
• Many post-op complications

• S/S: fever, increased WBCs, pericardial friction rub, pericardial & pleural effusion
• Immediate post-op period or 7-21 days post-op
• Unknown cause

• Caused by staph
• Death within 6 weeks if untreated

• Caused by staph

• Caused by strep
• Death w/in 6 months if untreated
• S/S: night sweats, low grade fever, fatigue, flu-like, ashen, joint pain. May develop CHF & valve damage (leaflets)
• Treatment: High dose ampicillin, gentamycin (bacterial) or amphotericin (fungal) for 2-8 weeks
• Risks Factors: rheumatic fever, CHD, IV drug use

• inflammatory disease after group A β-hemolytic strep pharyngitis
• Self limiting- affects CNS, skin, connective tissue of heart, joint, and lungs
• S/S: Jones Criteria: carditis, enlarged heart, polyarthritis, erythema marginaturm (rash on trunk with clear center), subq nodules on elbow, vertebrae, hands & feet, chorea (st. vitus dance)
• no definitive diagnosis: Jones Criteria, ESR, C-Reactive Protein
• Treatment: Antibiotics, conserve energy, ASA, NSAIDs, Indocin, Corticosteroids for inflammaiton, Digoxin to increase workload of heart
• Nursing: s/s of heart failure (weight gain, edema), prophylactic antibiotics, dental hygiene.

• Cardiac Manifestations of Rheumatic Fever
• Pancarditis (myocarditis, pericarditis, endocarditis)

• Acute, febrile disease, boys < 5 yrs
• Caused by infectious agent
• Acute stage:10-14 days
• fever, conjunctival infection, dry, cracked lips, red mouth (strawberry tongue), edema in hands & feet, erythematous body rash starting on hands & feet->cheeks, unilateral cervical lymphadenopathy
• Subacute stage: 10-25 days
• Resolution of fever, hands & feet start to peel, arthritis
• Convalescent stage: 26-70 days
• Clinical signs subside, arthritis continues, ESR elevated
• Diagnosis: elevated temp + four symptoms, elevated WBC & ESR
• Treatment: Aspirin therapy, IV gamma globulin (IVIG)
• Nursing: pain mgmt, emotional support, monitor: fevers, cardiac, HTN, n/v, bleeding

• Treatment: correct underlying cause, manage CHF & dysrhythmias.
• Digoxin, Diuretics, β blockers, Ca channel blockers, etc.

• remove old heart & replace with new one from donor

• good heart is transplanted on top of the old heart (mostly adults- not enough space in kids)