HEART DISEASE
VENTRICULAR SEPTAL DEFECT
DEFINITION
“A hole in the wall between the two lower
chambers is called a ventricular septal defect.”
RISK FACTORS
• Down syndrome
following conditions during pregnancy can
increase risk of having a newborn with a heart
defect.
• Rubella infection.
Becoming infected with rubella (German
measles) while pregnant can increase the risk
of fetal heart defects. The rubella virus crosses
the placenta and spreads through the fetus'
circulatory system damaging blood vessels and
organs, including the heart.
• Poorly controlled diabetes.
Uncontrolled diabetes in the mother in turn affects the
fetus' blood sugar, causing various damaging effects
to the developing fetus.
• Drug or alcohol use or exposure to certain
substances.
Use of certain medications, alcohol or drugs or
exposure to chemicals or radiation during pregnancy
can harm the developing fetus.
CLASSIFICATION
May be classified according to location:
membranous (accounting for 80%) or
muscular. May vary in size from a small
pinhole to absence of the septum, which results
in a common ventricle.
Pathophysiology:
Congenital causes
cardiac failure
CLINICAL MANIFESTATION
• Signs and symptoms of serious heart defects
often appear during the first few days, weeks
and months of a life.
• Signs and symptoms of a large ventricular
septal defect may include:
• A bluish tint to the skin, lips and fingernails
(cyanosis)
• Poor eating, failure to thrive.
• Fast breathing or breathlessness.
• Easy tiring
• Swelling of legs, feet or abdomen
• Rapid heart rate
• Sometimes a ventricular septal defect isn't
detected until a person reaches adulthood and
develops signs or symptoms of heart failure,
such as shortness of breath.
TESTS AND DIAGNOSIS
Ventricular septal defects often cause a heart
murmur that doctor can hear using a
stethoscope. If doctor hears a heart murmur or
finds other signs or symptoms of a heart
defect, he or she may request one or more of
these tests:
• Chest X-ray
• Electrocardiogram (ECG)
• Echocardiogram
• Cardiac catheterization
TREATMENT
• Spontaneously close
• Antibiotics
• Digoxin and Diurretics
• Surgery
Management of VSD:
1.GENERAL:
a) Treat iron deficiency if present
b) Ineffective endocarditis prophylaxis
c) Treat chest infection promptly
d) Follow up
2.TREATMENT OF CHF
3.SURGICAL TREATMENT:
Indication: Uncontrolled CHF
A) Small Defect : Conservative treatment
Large Defect : Open heart
surgery\Cardiopulmonary bypass.
B) Septal defect are patched up by
a)Prosthetic dacron
b)Direct suture
C).Pulmonary artery banding:
Placing band around the main PA to decrease PBF.
D) Complete repair by:
Small defect : Purse string approach.
Large defect : Knitted Dacron patch seen over opening
Prognosis:
1.Membranous defect : Low mortality < 5%
2.Multiple muscular defects: High mortality >20%
Complication:
“THE GOOD” “THE BAD”
1.Spontaneous closure 1.CHF.
2.Reduction in size 2.Ineffective endocarditis
3.Growth failure
4.Recurring pneumonia
PULMONARY ARTERY BANDING AND PURSE STRING
APPROACH:
Other complication:
1.Pulmonary hypertension
2.CCF
3.Ineffective endocarditis.
NURSING MANAGEMENT
Nursing management of infant with acyanotic heart disease
includes helping family members to adjust to the child’s
care &both preoperative &post operative care.
1.General nursing care:
a) Helping family members to adjust
b) During episodes \ Dyspnoea
c) Need for comfort & rest
e) Nutrional needs
f) Psychosocial needs
g) Continuing care
h) Family relationship
i) Financial support
2.Preoperative care:
It includes
a) Pre operative assessment
b) Pre operative teaching
A)PRE OPERATIVE ASSESSMENT:
1.Admission history &physical examination
2.Pre operative studies
3.Baselines vital status.
4.Anthropometric measurement
5.Additional nursing observation.
B)PRE OPERATIVE TEACHING:
1. Introduction to environment.
2. Introduction to equipment
3.Introduction to postoperative procedures
3.Post operative care:
1. Transfer to ICU
2.Monitor vital signs.
3.Assist in restoring the optimal functioning of the
-Cardiopulmonary
-Gastro intestinal
-Renal
-CNS.
PATENT DUCTUS ARTERIOSUS
(PDA)
DEFINITION
patent ductus arteriosus (PDA) the vessel does
not close and remains "patent" resulting in
irregular transmission of blood between two of
the most important arteries close to the heart,
the aorta and the pulmonary artery.”
Pathophysiology
left to right shunt