Peds, part 23: Cardiovascular Disorders - Congenital Heart Defects - ASD, VSD, AV Canal, PDA, Tetralogy of Fallot, Tricuspid Atresia
by Cathy Parkes December 29, 2021 Updated: December 07, 2022 4 min read
Hi, I'm Cathy, with Level Up RN. In this video, we are going to talk about congenital heart defects that increase pulmonary blood flow, as well as those that decrease pulmonary blood flow. At the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering in this video. And if you have our Level Up RN pediatric nursing flashcards, definitely pull those out so you can follow along with me, and pay close attention to the bold red items on these cards because there are a lot of important points you have to know about these congenital heart defects. Let's start off by talking about defects that cause increased pulmonary blood flow. This includes an atrial septal defect, or ASD, a ventricular septal defect, or VSD, an AV canal defect, as well as a patent ductus arteriosus, or PDA defect. So with ASD, an atrial septal defect, this is where we have a hole in the septum that separates the left and right atria. Patients with this type of defect may be asymptomatic, but it can also cause signs and symptoms of heart failure as well as a murmur. So this murmur will be a systolic murmur with a wide fix splitting of S2. Treatment options include closure with cardiac catheterization as well as surgical patch closure.
With a ventricular septal defect, or VSD, this is where we have a hole in the septum between the left and right ventricles. Signs and symptoms include signs and symptoms of heart failure as well as a murmur. This murmur can be described as a loud systolic murmur at the left sternal border. Treatment options for VSD include surgery to suture or patch the hole. With an AV canal defect, we have basically a hole in the center of the heart that allows blood to flow between all four chambers. Instead of a mitral valve and a tricuspid valve, we have a single AV valve, and this can cause signs and symptoms of heart failure as well as a loud systolic murmur. Treatment includes surgical patch closure as well as valve reconstruction. And then the last congenital heart defect that results in increased pulmonary blood flow is a PDA, or patent ductus arteriosus. So this is where the fetal artery that connects the aorta to the pulmonary artery fails to close after birth. And this can cause signs and symptoms such as a machine hum murmur, bounding pulses, and a wide pulse pressure, meaning that we have a big difference between the systolic blood pressure and the diastolic blood pressure. Treatment can include the use of Indomethacin, which is an NSAID. It can also include using coils to occlude the PDA during cardiac catheterization. A little cool chicken hint here at the bottom of the card is Indomethacin goes in the hole and closes it.
Another little story that may be helpful for you to remember some of the signs and symptoms of this congenital heart defect, if you look at PDA, that also stands for public displays of affection. So I imagine a dad looking out his window and seeing his daughter engaging in PDA with a boy he really doesn't like, and that causes him to have bounding pulses. And he wished he had a machine gun, which he doesn't have, and he opens up the window and he yells, "Get in here." So this little story will help you remember, with PDA, that will cause bounding pulses, a machine hum murmur, and that Indomethacin is used to treat it. When he yells, "Get in here," that will help you to remember Indomethacin. So hopefully, that little story helps. Let's talk about congenital heart defects that result in decreased pulmonary blood flow. The first to know is tetralogy of Fallot, or TOF. This is actually a combination of four different defects. And we have a cool chicken hint here on the card to help you remember those four defects. So the cool chicken hint states, "Prove that you know all four." So with prove, the P stands for pulmonary stenosis, the R stands for right ventricular hypertrophy, the O stands for overriding aorta, and the V stands for ventricular septal defect, and the E doesn't stand for anything. It just stands for, "Excellent. You got the other four right."
So that's our little trick to remember those four. Signs and symptoms of this defect include cyanosis. So the child may have hypercyanotic or tet spells. And to address those, you should place the patient in a knee-chest position in order to increase blood flow to the lungs. In addition, the patient may have a systolic murmur present. Treatment includes surgical repair within the first year of life. Then, the second condition that causes increased pulmonary blood flow is tricuspid atresia. This is where the tricuspid valve, which normally separates the right atrium from the right ventricle, fails to develop and blood flows through a ventricular septal defect or an atrial septal defect. So signs and symptoms include cyanosis, tachycardia, dyspnea, as well as clubbing. So clubbing is where we have those upside down spoon-shaped nails, which are indicative of hypoxia. So treatment of this condition requires multiple surgeries, which include shunt placement, a glen procedure, and a Fontan procedure.
All right. It's quiz time. I have three questions for you. First question, with a ventricular septal defect, where is the murmur heard? The answer is at the left sternal border Question number two, which congenital heart defect is characterized by a machine hum murmur and bounding pulses? The answer is a PDA or patent ductus arterios. Question number three, for hyper synthetic episodes associated with tetralogy of Fallot, how do you position the child? The answer is in a knee-chest position. All right. I hope we did well with that quiz. I hope this video and our cards are helpful. In my next video, we will talk about congenital heart defects that result in obstruction of blood flow and mixed blood flow. So definitely stay tuned for that. And if you enjoyed this video and learned a lot, be sure to like the video and leave me a comment. Take care and good luck studying.
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