Congenital Heart Defects

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Congenital cardiac defects occurrences are not uncommon. Immediate or pending complications will depend on the type and degree of the defect. The patient may have mild signs of distress that require no direct intervention. In more severe defects, the patient may have life-threatening forms of distress and require immediate intervention. In this lesson, we will discuss types of cardiac abnormalities, clinical presentations, and treatment strategies for congenital cardiac defects. Congenital cardiac defects are categorized as cyanotic and non-cyanotic.

Cyanotic Heart Diseases

Transposition of the Great Vessels

This congenital defect connects the two main arteries to the wrong heart chambers. More specifically, the aorta is connected to the right ventricle, and the pulmonary artery is connected to the left ventricle. Most infants with this condition are also born with other cardiac defects like an atrial septal defect (ASD) or ventricular septal defect (VSD). These defects allow for the mixing of oxygenated and non-oxygenated blood which would enable low levels oxygen throughout the body. Transposition of the Great Vessels requires surgery within the first week of life. 

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Tetralogy of Fallot

Tetralogy of Fallot describes four types of heart lesions present at birth. This defect is a combination of a ventricular septal defect (VSD), an overriding aorta, hypertrophy of the right ventricle, and obstruction to flow through the pulmonary artery. In the heart with Tetralogy of Fallot, blood bypasses the lungs, where it would typically pick up oxygen-rich blood and send it on to the body. An ultrasound is used to diagnose this disorder. Surgical repair includes the closure of the VSD and relief of the pulmonary outflow obstruction.

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Tricuspid Atresia

The tricuspid valve is a three-leaf valve that lies between the right atrium and right ventricle; it is designed to keep blood moving in the right direction. In an infant with tricuspid atresia, the valve is either missing or broken. Because of this, blood flow is prevented from flowing from the right atrium to the right ventricle, through the pulmonary trunk, and into the lungs. Infants with tricuspid atresia will present blue at birth, indicating low oxygen blood levels. This condition is dangerous, and the infant will need mechanical ventilation until the heart is surgically repaired within the first few weeks of life. 

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Non-Cyanotic Heart Diseases

Patent Ductus Arteriosus (PDA)

This defect is characterized by the ductus shunt failing to close shortly after birth. The ductus arteriosus is one of three fetal heart shunts that allow blood to bypass the lungs while in utero. This shunt connects the aorta to the pulmonary artery which allows oxygen-rich blood to pass from the mother to the fetus. This shunt typically closes within a few hours after birth, failure to close will result in respiratory distress and hypoxemia. Treatment involves intravenous drugs such as indomethacin or ibuprofen within the first 10-14 days of life. Catheter closure and surgical ligation are also other options.  

 

Atrial Septal Defect (ASD)

This heart condition is characterized as a hole somewhere between the right and left atria that usually closes naturally during childhood. The majority of ASD’s are symptomless and go undetected as they cause no problems in infancy. Moderate to significant septal defects can cause large left-to-right shunts in children, which can promote congestive heart failure. In this case, it will eventually require surgery to be corrected. 

Ventricular Septal Defect (VSD)

This condition is characterized by one or more holes in the wall between the right and left ventricles. It is seen more often than other congenital heart defects. Small ventricular septal defects can self-close and are asymptomatic. Large ventricular septal defects allow excessive amounts blood into the lungs, which leads to congestive heart failure, therefore must be surgically repaired. Babies with large VSD may require extra nutrition or tube feeding to help them grow, because of their inability to thrive.  

Finally, so what makes this information relevant to you as a respiratory therapist? Because heart defects contribute to respiratory distress, patients will require some form of respiratory care. The care you will administer will range from oxygen therapy to mechanical ventilation and post-surgery care. If you decide that home respiratory care or working in a neonatal or pediatric hospital will be your career path,this information will be most valuable to you. However, as a respiratory therapist working in any medical facility, you must have a basic understanding of neonatal and pediatric cardiopulmonary disorders. Being able to make clinical connections and recommend appropriate therapy quickly will be vital to your patient’s treatment and management of potential life threating complications.  

Prompt

For this assignment, choose two cardiac defects from the list above and discuss treatment options that are available. Based on your readings of the topic, what methods are the most and least effective in the management and treatment of the disorder? 

Provide your answer in 500 words or more. You must submit the assignment in IWG format including two peer-reviewed references with 2 citations. 

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