This document summarizes several pediatric cardiac disorders including fetal circulation, congenital cardiac anomalies, acquired cardiac diseases, and specific conditions. It describes the pathophysiology, signs and symptoms, and treatment approaches for conditions like congenital heart defects, congestive heart failure, rheumatic fever, endocarditis, and Kawasaki disease. Diagrams illustrate fetal circulation patterns and defects such as atrial and ventricular septal defects, patent ductus arteriosus, and coarctation of the aorta. The treatment sections outline surgical procedures, cardiac catheterization, medications, and nursing care.

1. Pediatric Cardiac Disorders

2. Fetal Circulation
Main Blood Flow
 Placenta  Umbilical
Vein  Liver  Ductus
Venosus  Inferior
Vena Cava
 Vena Cava  Right
Atrium Foramen
Ovale Left Atrium 
Left Ventricle 
 Aorta Body

3. Fetal Circulation
Secondary Route:
 Right Atrium 
 Right Ventricle 
 Pulmonary Artery 
 Ductus Arteriosus 
(so does not go to lungs)
 Aorta 
 Body

4. Fetal Circulation
Third route of blood flow
 Right Atrium 
 Right Ventricle 
 Pulmonary Artery 
 Lungs (needs to perfuse the
lungs and upper body with
oxygen) 
 Left Atrium 
 Left Ventricle 
 Aorta 
 Body

5. Transition from Fetal Circulation to
Pulmonary circulation
 The umbilical arteries and vein and the ductus
venosus become non-functional
 Decreased pulmonary vascular resistance and
increased pulmonary blood flow
 Increase in pressure of the left atrium, decrease
pressure in right atrium, causing closure of
foramen ovale.
 Pulmonary resistance is less than systematic
resistance so there is left-to-right shunting
resulting in closure of the ductus arteriosus.

6. Congestive Heart Failure

7. Congestive heart failure
 The inability of the myocardium to circulate
enough oxygenated blood to meet the
demands of the body.
 When the heart fails, cardiac output is
diminished. Heart rate, preload,
contractitility, and afterload are affected.
 Peripheral tissue is not adequately
perfused.
 Congestion in lungs and periphery
develops.

8. Signs and Symptoms
1. Tires easily during feeding
2. Periorbital edema, weight gain
3. Rales and rhonchi
4. Dyspnea, orthopnea, tachypnea
5. Diaphoretic / sweating
6. Tachycardia
7. Failure to gain weight

9. Treatment of Congestive Heart Failure
 Medication Therapy
 Digitalis – increases contractility and decreases
heart rate.
 ACE-inhibitors - arterial vasodilator / afterload
reducing agent
 Diuretics - enhance renal secretion of sodium and
water by reducing circulating blood volume and
decreasing preload.
 Beta Blocker - increases contractility

10. Treatment of Congestive Heart Failure
 Diet – low sodium, small frequent feedings
(be sure you can pick the right foods for a low NA diet.
 Nursing care:
 Measure intake and output – weighing diapers
 Observe for changes in peripheral edema and
circulation
 If ascites present – take serial abdominal
measurements to monitor changes.
 Skin care
 Turning schedule

11. Congenital Cardiac Anomalies

12. Defects that increase pulmonary
blood flow
Patent Ductus Arterious
Atrial septal defects
Ventricle septal defects

13. Atrial Septal Defect
1. Oxygenated blood is shunted
from left to right side of the
heart via defect
2. A larger volume of blood
than normal must be
handled by the right side of
the heart hypertrophy
3. Extra blood then passes
through the pulmonary
artery into the lungs,
causing higher pressure
than normal in the blood
vessels in the lungs 
congestive heart failure

14. Treatment
 Medical Management
 Medications – digoxin
 Cardiac Catheterizaton -
 Amplatzer septal occluder
 Open-heart Surgery

15. Cardiac Catheterization
 Pre-care:
 History and Physical
 Lab work – EKG, ECHO cardiogram, CBC
 NPO
 Preprocedural teaching
 Post Care:
 Monitor vital signs
 Monitor extremity distal to the catheter instertion,
 Keep leg immobilized
 Vital signs
 Check for bleeding at insertion site
 Measure I&O

16. Treatment
 Device Closure – Amplatzer septal
occluder
During cardiac catheterization the occluder is placed in the
Defect

17. Ventricle Septal Defect
1. Oxygenated blood is shunted
from left to right side of the
heart via defect
2. A larger volume of blood
than normal must be
handled by the right side of
the heart hypertrophy
3. Extra blood then passes
through the pulmonary
artery into the lungs,
causing higher pressure
than normal in the blood
vessels in the lungs 
congestive heart failure

18. Treatment
Surgical repair with a patch inserted

19. Patent Ductus Arteriosus
1. Blood shunts from
aorta (left) to the
pulmonary artery
(right)
2. Returns to the lungs
causing increase
pressure in the lung
3. Congestive heart
failure

20. Treatment for PDA
 Medical Mangement
 Medication
 Indomethacin - inhibits prostaglandin's
which help keep the ductus arteriosus
open
 Surgery
Ligate the
ductus arteriosus

21. Treatment for PDA
 Cardiac Catheterization
 Insert coil – tiny fibers
occlude the ductus
arteriosus when a
thrombus forms in
the mass of fabric and
wire

22. Pulmonic stenosis
Tetralogy of fallot
Transposition of the great arteries
Truncus arteriosus
Defects with decrease blood flow and
mixed defects

23. Pulmonic Stenosis
 Narrowing of entrance that
decreases blood flow
 Treatment:
 Medications – Prostaglandins to keep the
PDA open
 Cardiac Catheterization
 Baloon Valvuloplasty
 Surgery
 Valvotomy

24. Tetralogy of Fallot
Four defects are:
1. 2.
3.
4.

25. Signs and Symptoms
1. Failure to thrive
2. Squatting
3. Lack of energy
4. Infections
5. Polycythemia
6. Clubbing of fingers
7. Cerebral absess
8. Cardiomegaly

26. Treatment
 Surgical interventions
 Blalock – Taussig or Potts procedure –
increases blood flow to the lungs.
 Open heart surgery

27. Transposition of Great Vessels
 Aorta arises from the right
ventricle, and the pulmonary
artery arises from the left
ventricle - which is not
compatible with survival
unless there is a large defect
present in ventricular or
atrial septum.
artery
aorta

28. Truncus arteriosus
 A single arterial trunk
arises from both
ventricles that supplies
the systemic,
pulmonary, and
coronary circulations. A
vsd and a single,
defective, valve also
exist.
 Entire systemic
circulation supplied from
common trunk.

29. Defects obstructing Systemic blood
flow
• Aortic stenosis
• Coarctation of the Aorta

30. Coarctation of the Aorta
1. Narrowing ofAorta causing
obstruction of left
ventricular blood flow
2. Left ventricular hypertrophy
Signs and Symptoms
1.  B/P in upper extremities
2. B/P in lower extremities
3. Radial pulses full/bounding and
femoral or popliteal pulses weak
or absent
4. Leg pains, fatigue
5. Nose bleeds

31. Treatment
 Goals of management are to improve ventricular
function and restore blood flow to the lower body.
 Medical management with Medication
 A continuous intravenous medication,
prostaglandin (PGE-1), is used to open the ductus
arteriosus (and maintain it in an open state)
allowing blood flow to areas beyond the
coarctation.
 Baloon Valvoplasty

32. Surgery for Coarctation of Aorta
1. Resect
narrow
area 2. Anastomosis

33. Acquired Cardiac Diseases

34. RHEUMATIC FEVER
A systemic inflammatory (collagen) disease of
connective tissue that usually follows a group A
beta-hemolytic streptococcus infection.
This disorder causes changes in the entire heart
(especially the valves), joints, brain, and skin
tissues.

35. Rheumatic Fever
 Assessment
 Jones Criteria
 Major
 Minor
 Treatment
 Antibiotic Therapy
 Aspirin

36. Subacute Bacterial Endocarditis /
Ineffective Endocarditis:
Microorganisms grow on the
endocardium, forming vegetations,
deposits of fibrin, and platelet thrombi.
The lesion may invade adjacent tissues
such as aortic and mitral valves.

37. Subacute Bacterial Endocarditis /
Ineffective Endocarditis:
 Assessment
 Diagnosis – blood cultures
 Treatment
 Antibiotics
 Patient teaching – take antibiotics prior to
surgery, dental work, etc.

38. Kawasaki Disease
Multisystem vasculitis – inflammation of
blood vessels in the body especially the
coronary arteries with antigen-antibody
complexes.

39. Kawasaki Disease
Signs and Symptoms / Treatment
 Three Phases of clinical manifestations:
 Acute
 Subacute
 Convalesant
 Treatment
 Aspirin
 Gamma Globulin
 Nursing Care