PEDIATRIC ABNORMALITIES
🍀 Delayed physical growth and development.
🍀 Exercise intolerance
CARDIOVASCULAR
Diagnostic Findings
• Chest X-ray: “Boot-shaped” heart due to right
1. TETRALOGY OF FALLOT (TOF) ventricular hypertrophy.
• ECG: right axis deviation, right ventricular hypertrophy.
Definition • Echocardiogram: visualizes all four defects.
A cyanotic congenital heart defect • Cardiac catheterization: measures pressures,
characterized by four cardiac abnormalities defines anatomy.
leading to decreased pulmonary blood flow • Pulse oximetry: persistent hypoxemia.
and hypoxemia.
Most common cyanotic CHD beyond the Complications
neonatal period.
• Chronic hypoxemia → polycythemia (↑ risk
of stroke, brain abscess).
The Four Classic Defects
• Developmental delays (growth and
1. Ventricular Septal Defect (VSD): opening
cognitive).
between right and left ventricles.
• Arrhythmias.
2. Pulmonic Stenosis: narrowing of the right ventricular
• Infective endocarditis.
outflow tract or pulmonary valve, obstructing blood flow
to lungs. Management
3. Overriding Aorta: aorta positioned over the VSD, (Immediate/Nonsurgical)
receiving blood from both ventricles.
1. For Tet spells:
4. Right Ventricular Hypertrophy: thickening of the
Place in knee-chest position → increases systemic
right ventricular wall due to increased
vascular resistance, reducing right-to-left
workload.
shunt.
Together, these defects cause right-to-left shunting
Administer oxygen (though effect is limited).
→ unoxygenated blood enters systemic circulation
Give morphine sulfate (calms,
→ cyanosis
decreases oxygen demand).
Beta-blockers (e.g., propranolol)
Pathophysiology
may reduce spasms of right
•Severity depends on degree of pulmonic
ventricular outflow.
stenosis.
IV fluids to increase circulating volume.
• Mild stenosis → more left-to-right shunting, less
cyanosis. Surgical
• Severe stenosis → right-to-left shunting, 1. Palliative procedure (temporary):
marked cyanosis and hypoxemia. Blalock-Taussig shunt – connects
• Cyanosis worsens during crying, feeding, or exertion. subclavian artery to pulmonary artery to increase
pulmonary blood flow.
Clinical Manifestations 2. Definitive repair (curative):
• Cyanosis: most prominent feature, appears Usually performed between 6–12
after ductus arteriosus closes. months of age.
• Clubbing of fingers/toes: develops over time Involves closing the VSD and
due to chronic hypoxemia. relieving pulmonary stenosis.
• Squatting position: instinctively adopted by
older children to increase systemic vascular Nursing Responsibilities
resistance, improving pulmonary blood flow. 1. Monitor oxygen saturation regularly.
• “Tet Spells” (Hypercyanotic Spells): 2. Teach parents to recognize and manage Tet spells
🍀 Sudden episodes of deep cyanosis, hypoxia,dyspnea, (place child in knee-chest position,
irritability. call for help).
🍀 Triggered by crying, feeding, 3. Encourage small, frequent feedings to
defecation, stress. reduce fatigue.
🍀 May lead to syncope, seizures, or 4. Prevent dehydration → dehydration ↑ risk of
even death. polycythemia and stroke.
• Other signs: 5. Administer prophylactic antibiotics for
🍀 Harsh systolic murmur (from pulmonic nfective endocarditis when indicated
stenosis). before dental/surgical procedures).
, 2. ATRIAL SEPTAL DEFECT (ASD) 3. VENTRICULAR SEPTAL DEFECT (VSD)
Definition
Definition
• Congenital defect where there is a
• Most common congenital heart defect.
persistent opening between the atria due to
• An opening in the septum between the ventricles.
failure of the foramen ovale or septum to
• Blood shunts left-to-right from left ventricle to right
close after birth.
ventricle.
• Results in left-to-right shunt (blood flows from
high-pressure left atrium to low-pressure right
Pathophysiology
atrium).
• Increased pulmonary blood flow → pulmonary
congestion and hypertension.
Pathophysiology • Left ventricle works harder → hypertrophy.
1. Oxygenated blood re-enters pulmonary circulation → • Large, untreated VSD → can lead to Eisenmenger
increased pulmonary blood flow. syndrome (irreversible
2. Right atrium and ventricle enlarge due to volume pulmonary hypertension with reversal of
overload. shunt → cyanosis)
3. If untreated → pulmonary hypertension, arrhythmias,
right-sided heart failure. Clinical Manifestations
1. Depends on size of defect:
Clinical Manifestations Small VSD: often asymptomatic, may
• Often asymptomatic in childhood if small. close spontaneously.
• Fatigue and exercise intolerance (older Moderate/Large VSD:
children). Tachypnea, dyspnea, frequent respiratory
• Recurrent respiratory infections. infections.
• Murmur: soft, systolic ejection murmur with Poor feeding, failure to thrive,
fixed split second heart sound (S2). delayed growth.
• Cyanosis is rare (unless Eisenmenger syndrome Signs of congestive heart
develop ) failure (hepatomegaly,
edema).
Diagnostics Murmur: loud, harsh, pansystolic
• Echocardiogram: confirms defect and shunting. murmur best heard at left sternal
• Chest X-ray: cardiomegaly, increased border.
pulmonary markings.
• ECG: right axis deviation, right atrial enlargement. Diagnostics
Management • Echocardiogram: shows size and location of
defect.
• Small ASDs may close spontaneously.
• Chest X-ray: cardiomegaly, pulmonary
• Large ASDs → closure by:
overcirculation.
o Cardiac catheterization device closure.
• ECG: left ventricular hypertrophy.
o Surgical repair with patch if
catheterization not possible.
Medical Management
Nursing Care
Diuretics (e.g., furosemide) for CHF.
• Monitor for signs of respiratory distress and ACE inhibitors or digoxin may be
heart failure. used to reduce workload.
• Provide prophylactic antibiotics before Nutritional support (high-calorie feeds).
invasive procedures (risk of endocarditis).
• Educate family that surgical outcomes are
Surgical Management
generally excellent.
Patch closure (open-heart surgery).
Pulmonary artery banding as
palliative measure in very sick infants until definitive
surgery.
Many small VSDs close spontaneously within first
years of life.
🍀 Delayed physical growth and development.
🍀 Exercise intolerance
CARDIOVASCULAR
Diagnostic Findings
• Chest X-ray: “Boot-shaped” heart due to right
1. TETRALOGY OF FALLOT (TOF) ventricular hypertrophy.
• ECG: right axis deviation, right ventricular hypertrophy.
Definition • Echocardiogram: visualizes all four defects.
A cyanotic congenital heart defect • Cardiac catheterization: measures pressures,
characterized by four cardiac abnormalities defines anatomy.
leading to decreased pulmonary blood flow • Pulse oximetry: persistent hypoxemia.
and hypoxemia.
Most common cyanotic CHD beyond the Complications
neonatal period.
• Chronic hypoxemia → polycythemia (↑ risk
of stroke, brain abscess).
The Four Classic Defects
• Developmental delays (growth and
1. Ventricular Septal Defect (VSD): opening
cognitive).
between right and left ventricles.
• Arrhythmias.
2. Pulmonic Stenosis: narrowing of the right ventricular
• Infective endocarditis.
outflow tract or pulmonary valve, obstructing blood flow
to lungs. Management
3. Overriding Aorta: aorta positioned over the VSD, (Immediate/Nonsurgical)
receiving blood from both ventricles.
1. For Tet spells:
4. Right Ventricular Hypertrophy: thickening of the
Place in knee-chest position → increases systemic
right ventricular wall due to increased
vascular resistance, reducing right-to-left
workload.
shunt.
Together, these defects cause right-to-left shunting
Administer oxygen (though effect is limited).
→ unoxygenated blood enters systemic circulation
Give morphine sulfate (calms,
→ cyanosis
decreases oxygen demand).
Beta-blockers (e.g., propranolol)
Pathophysiology
may reduce spasms of right
•Severity depends on degree of pulmonic
ventricular outflow.
stenosis.
IV fluids to increase circulating volume.
• Mild stenosis → more left-to-right shunting, less
cyanosis. Surgical
• Severe stenosis → right-to-left shunting, 1. Palliative procedure (temporary):
marked cyanosis and hypoxemia. Blalock-Taussig shunt – connects
• Cyanosis worsens during crying, feeding, or exertion. subclavian artery to pulmonary artery to increase
pulmonary blood flow.
Clinical Manifestations 2. Definitive repair (curative):
• Cyanosis: most prominent feature, appears Usually performed between 6–12
after ductus arteriosus closes. months of age.
• Clubbing of fingers/toes: develops over time Involves closing the VSD and
due to chronic hypoxemia. relieving pulmonary stenosis.
• Squatting position: instinctively adopted by
older children to increase systemic vascular Nursing Responsibilities
resistance, improving pulmonary blood flow. 1. Monitor oxygen saturation regularly.
• “Tet Spells” (Hypercyanotic Spells): 2. Teach parents to recognize and manage Tet spells
🍀 Sudden episodes of deep cyanosis, hypoxia,dyspnea, (place child in knee-chest position,
irritability. call for help).
🍀 Triggered by crying, feeding, 3. Encourage small, frequent feedings to
defecation, stress. reduce fatigue.
🍀 May lead to syncope, seizures, or 4. Prevent dehydration → dehydration ↑ risk of
even death. polycythemia and stroke.
• Other signs: 5. Administer prophylactic antibiotics for
🍀 Harsh systolic murmur (from pulmonic nfective endocarditis when indicated
stenosis). before dental/surgical procedures).
, 2. ATRIAL SEPTAL DEFECT (ASD) 3. VENTRICULAR SEPTAL DEFECT (VSD)
Definition
Definition
• Congenital defect where there is a
• Most common congenital heart defect.
persistent opening between the atria due to
• An opening in the septum between the ventricles.
failure of the foramen ovale or septum to
• Blood shunts left-to-right from left ventricle to right
close after birth.
ventricle.
• Results in left-to-right shunt (blood flows from
high-pressure left atrium to low-pressure right
Pathophysiology
atrium).
• Increased pulmonary blood flow → pulmonary
congestion and hypertension.
Pathophysiology • Left ventricle works harder → hypertrophy.
1. Oxygenated blood re-enters pulmonary circulation → • Large, untreated VSD → can lead to Eisenmenger
increased pulmonary blood flow. syndrome (irreversible
2. Right atrium and ventricle enlarge due to volume pulmonary hypertension with reversal of
overload. shunt → cyanosis)
3. If untreated → pulmonary hypertension, arrhythmias,
right-sided heart failure. Clinical Manifestations
1. Depends on size of defect:
Clinical Manifestations Small VSD: often asymptomatic, may
• Often asymptomatic in childhood if small. close spontaneously.
• Fatigue and exercise intolerance (older Moderate/Large VSD:
children). Tachypnea, dyspnea, frequent respiratory
• Recurrent respiratory infections. infections.
• Murmur: soft, systolic ejection murmur with Poor feeding, failure to thrive,
fixed split second heart sound (S2). delayed growth.
• Cyanosis is rare (unless Eisenmenger syndrome Signs of congestive heart
develop ) failure (hepatomegaly,
edema).
Diagnostics Murmur: loud, harsh, pansystolic
• Echocardiogram: confirms defect and shunting. murmur best heard at left sternal
• Chest X-ray: cardiomegaly, increased border.
pulmonary markings.
• ECG: right axis deviation, right atrial enlargement. Diagnostics
Management • Echocardiogram: shows size and location of
defect.
• Small ASDs may close spontaneously.
• Chest X-ray: cardiomegaly, pulmonary
• Large ASDs → closure by:
overcirculation.
o Cardiac catheterization device closure.
• ECG: left ventricular hypertrophy.
o Surgical repair with patch if
catheterization not possible.
Medical Management
Nursing Care
Diuretics (e.g., furosemide) for CHF.
• Monitor for signs of respiratory distress and ACE inhibitors or digoxin may be
heart failure. used to reduce workload.
• Provide prophylactic antibiotics before Nutritional support (high-calorie feeds).
invasive procedures (risk of endocarditis).
• Educate family that surgical outcomes are
Surgical Management
generally excellent.
Patch closure (open-heart surgery).
Pulmonary artery banding as
palliative measure in very sick infants until definitive
surgery.
Many small VSDs close spontaneously within first
years of life.
