NURS 643 Week 7: Cardiology Questions With Complete
Solutions
Coarctation of the Aorta (CoA)
obstructive lesion that involves narrowing of upper thoracic
aorta
- More common in males
- Turner syndrome - 30% have coarctation of aorta
- Common to also have bicuspid aortic valve (85%)
- Can present in infancy or later in life
- Feeling femoral pulses is important!
Infant Coarct S/S
includes:
- CHF w/ poor feeding - need for intervention is urgent
- Dyspnea
- Renal failure (oliguria, anuria)
- General circulatory shock in first 2-6wks of life
- Loud gallop murmur may be present or absent w/ weak or
thready pulses
Coarct Asymptomatic Manifestations
includes:
- Rare complaints of leg pain
- Pulses in legs are weak or delayed
- Bracheofemoral delay - older children
- Collateral circulation not found immediately in infancy
- HTN in the arm or higher BP in arm than thigh or lower
,extremities
- SEM 2-3/6 URSB & MLSB
- Ejection click from bicuspid aortic valve
Coarct Tx
includes:
- Surgical - resection with end to end anastomosis
- Cardiac cath - balloon angioplasty initially or after surgery is
not as effective (higher rate of recoarctation)
- Recheck every 6-12mo for recoarctation especially if repair in
first 1yr of life
- Concern for renal failure post op & NEC w/ feeding d/t dec
blood flow pre intervention in symptomatic infants
Hypoplastic Left Heart Syndrome (HLHS)
underdeveloped LV that can compromise blood flow to the body
in some cases & lungs in other cases
- Mitral valve is closed or atretic
- Aorta is dec in diameter
- Blood flow to body is supplied by ductus arteriosus
- S/S - cyanosis, pale, & shock like S/S
HLHS Tx
tx consists of 3 stages of surgeries
1) Norwood
2) Glenn (Hemi-Fontan)
3) Fontan
Norwood
,first surgical procedure for HLHS tx done at 0-2wks
- Creates new aorta w/ a shunt
- Blood can then go from the RV to the body for systemic
circulation
Glenn (Hemi-Fontan)
second surgical procedure for HLHS tx done at 4-6mo
- Temporary shunt is removed
- Superior vena cava is connected to lungs
- Blood from upper body directly flows to lungs w/o pumping
Fontan
third surgical procedure for HLHS tx done at 2-4yrs
- Inferior vena cava is connected to lungs
- All blood gets oxygenated before returning to the RA
Cyanotic Lesions
include:
- Complete TGA & Congenitally Corrected TGA
- TOF - can be w/ pulmonary atresia or absent pulmonary valve
- TAPVR
- DORV
- Single ventricle variants
- Ebstein anomaly
- Persistent truncus arteriosus
- Heterotaxia
- Persistent Pulm HTN
Defects Requiring Fontan Pathway
, include:
- Single Ventricle Variants
- HLHS/HRHS
- Tricuspid Atresia (TA) & Pulmonary Atresia (PA)
Transposition of Great Arteries (TGA)
cyanotic lesion where the aorta & pulm artery (PA) are
transposed/switched
- Aorta from RV & PA from LV
- 2 separate circuits w/ hypoxemic blood circulating in body &
hyperoxemic blood in pulm circuit
- Requires a defect that allows mixing - ASD, VSD, or PDA
- VSD is present in 40%
- More common in boys
Dextro-TGA (D-TGA)
defect where the aorta is anterior & right of PA
- Not corrected in utero, so L & R atria & ventricles are in the
correct place
Levo-TGA (L-TGA)
transposed aorta lies to the left of the PA & the defect is
corrected in utero
- Aorta & pum artery are switched, but so are the L & R atria &
ventricles
- Still requires intervention, b/c the LV is meant to pump
systemically, not the RV
- Can cause pulmonary over-circulation & dec PVR
TGA S/S
Solutions
Coarctation of the Aorta (CoA)
obstructive lesion that involves narrowing of upper thoracic
aorta
- More common in males
- Turner syndrome - 30% have coarctation of aorta
- Common to also have bicuspid aortic valve (85%)
- Can present in infancy or later in life
- Feeling femoral pulses is important!
Infant Coarct S/S
includes:
- CHF w/ poor feeding - need for intervention is urgent
- Dyspnea
- Renal failure (oliguria, anuria)
- General circulatory shock in first 2-6wks of life
- Loud gallop murmur may be present or absent w/ weak or
thready pulses
Coarct Asymptomatic Manifestations
includes:
- Rare complaints of leg pain
- Pulses in legs are weak or delayed
- Bracheofemoral delay - older children
- Collateral circulation not found immediately in infancy
- HTN in the arm or higher BP in arm than thigh or lower
,extremities
- SEM 2-3/6 URSB & MLSB
- Ejection click from bicuspid aortic valve
Coarct Tx
includes:
- Surgical - resection with end to end anastomosis
- Cardiac cath - balloon angioplasty initially or after surgery is
not as effective (higher rate of recoarctation)
- Recheck every 6-12mo for recoarctation especially if repair in
first 1yr of life
- Concern for renal failure post op & NEC w/ feeding d/t dec
blood flow pre intervention in symptomatic infants
Hypoplastic Left Heart Syndrome (HLHS)
underdeveloped LV that can compromise blood flow to the body
in some cases & lungs in other cases
- Mitral valve is closed or atretic
- Aorta is dec in diameter
- Blood flow to body is supplied by ductus arteriosus
- S/S - cyanosis, pale, & shock like S/S
HLHS Tx
tx consists of 3 stages of surgeries
1) Norwood
2) Glenn (Hemi-Fontan)
3) Fontan
Norwood
,first surgical procedure for HLHS tx done at 0-2wks
- Creates new aorta w/ a shunt
- Blood can then go from the RV to the body for systemic
circulation
Glenn (Hemi-Fontan)
second surgical procedure for HLHS tx done at 4-6mo
- Temporary shunt is removed
- Superior vena cava is connected to lungs
- Blood from upper body directly flows to lungs w/o pumping
Fontan
third surgical procedure for HLHS tx done at 2-4yrs
- Inferior vena cava is connected to lungs
- All blood gets oxygenated before returning to the RA
Cyanotic Lesions
include:
- Complete TGA & Congenitally Corrected TGA
- TOF - can be w/ pulmonary atresia or absent pulmonary valve
- TAPVR
- DORV
- Single ventricle variants
- Ebstein anomaly
- Persistent truncus arteriosus
- Heterotaxia
- Persistent Pulm HTN
Defects Requiring Fontan Pathway
, include:
- Single Ventricle Variants
- HLHS/HRHS
- Tricuspid Atresia (TA) & Pulmonary Atresia (PA)
Transposition of Great Arteries (TGA)
cyanotic lesion where the aorta & pulm artery (PA) are
transposed/switched
- Aorta from RV & PA from LV
- 2 separate circuits w/ hypoxemic blood circulating in body &
hyperoxemic blood in pulm circuit
- Requires a defect that allows mixing - ASD, VSD, or PDA
- VSD is present in 40%
- More common in boys
Dextro-TGA (D-TGA)
defect where the aorta is anterior & right of PA
- Not corrected in utero, so L & R atria & ventricles are in the
correct place
Levo-TGA (L-TGA)
transposed aorta lies to the left of the PA & the defect is
corrected in utero
- Aorta & pum artery are switched, but so are the L & R atria &
ventricles
- Still requires intervention, b/c the LV is meant to pump
systemically, not the RV
- Can cause pulmonary over-circulation & dec PVR
TGA S/S
