Patent Ductus Arterious
Patent ductus arteriosus (PDA) is a congenital heart defect in which the openings between the pulmonary and aortic valves stay open after birth. The ductus arteriosus serves as a bypass while the child is in utero to bypass the lungs since their blood is oxygenated by the mother. In most cases, the ductus arteriosus closes shortly after birth because the lungs now need to oxygenate the blood. When the ductus stays open the oxygenated and deoxygenated blood mix (Boston Children’s Hospital, 2014).
Symptoms
PDA is the sixth most common birth defect and occurs twice as often in girls than in boys (Boston Children’s Hospital, 2014). A PDA most commonly occurs when the child is premature. The symptoms of PDA depend on the severity of the PDA but are most commonly diagnosed by auscultation of a heart murmur. When a PDA is small, sometimes the child is asymptomatic and is not diagnosed until later in life. If the PDA is more severe, the child may experience fatigue, sweating, rapid or heavy breathing, congested breathing, disinterest in feeding or tiring while feeding, or poor weight gain (Boston Children’s Hospital, 2014).
Outcomes
Some testing that can also be done to diagnose PDA are chest x-rays, echocardiogram, EKG, cardiac catheterization and MRI (Boston Children’s Hospital, 2014). When treatment is needed in newborns, medication is highly effective with few side effects. Indomethacin or ibuprofen is typically the first choice and the earlier the treatment is given, the more likely it is to succeed (ADAM Health Solutions, 2014). If medication is not effective or if the child is too old for medication to be effective, surgery can be performed to ligate the PDA. Another method is coil insertion during cardiac catheterization (Cincinnati Children’s Hospital Medical Center, 2014).
Atrial Septal Defect
Atrial septal defect (ASD) is a condition present at birth. ASD is the third most common congenital defect and is present more often in females than males (Cleveland Clinic, 2014). During fetal development there is an opening in the septum located between the right and left atria; ASD occurs when this opening remains open after birth. Due to this opening, blood flows between both atria which can lead to pulmonary hypertension and heart failure in adults (Mayo Clinic Staff, 2011).
Causes
The exact cause of ASD is unknown but similar to other congenital defects they are thought to be caused by environmental and genetic factors. Evidence shows that diabetes, rubella and lupus are linked to cases of ASD (Cleveland Clinic, 2014).
Symptoms
There are usually no overt symptoms of ASD at birth. A small ASD often resolves on its own during infancy (Mayo Clinic Staff, 2011). Individuals with a large (greater than 2cm) ASD may not begin having symptoms until their 30’s and may be asymptomatic into their 50’s (Cleveland Clinic, 2014). Assessment findings of an individual with ASD include an irregular heart rhythm, heart murmur, shortness of breath, fatigue, edema, frequent lung infections and a bluish skin tone (Mayo Clinic Staff, 2011).
Outcomes
An echocardiogram is used most frequently used to diagnose ASD. Individuals with a detected ASD are treated based on the type, size and the overall effect the defect has on the heart (Cleveland Clinic, 2014). Medications will not assist in closing an ASD but may be used to treat symptoms (Mayo Clinic Staff, 2011). An ASD in those with a high risk of long term complications may be repaired percutaneously with a closure device. Those with more severe forms of an ASD may need open heart surgery for repair (Cleveland Clinic, 2014).
Mitral Stenosis
Mitral stenosis occurs when the mitral valve will not open appropriately. Because the valve does not open properly, blood flow into the left ventricle is impeded during diastole. Overtime, the left atrium enlarges and left atrium pressure is increased (Jarvis, 2012). This occurs from scarring of the mitral valve leaflets and the chordae tendenae. The structures around the valve shorten and thicken which causes a “fish mouth” shape of the mitral valve. Overtime, a pressure difference between the left atrium and ventricle occurs and will eventually cause pressure overload of the left atrium, pulmonary bed, and right ventricle (Lewis, Heitkemper, Dirksen, O’Brien, & Bucher, 2007).
Causes
Mitral stenosis can actually occur in both young children and adults (Davidson, London, & Ladewig, 2008). Although more common in adults it can also be found during infancy or early childhood (Porth, 2007) Oftentimes, the cause is from rheumatic heart disease. Other causes of mitral stenosis include rheumatoid arthritis, and systemic lupus erythematosus (Lewis, et al., 2007). Rheumatic heart disease has greatly declined within the past four decades due to advances in healthcare however still continues to be the main cause of congenital mitral stenosis and results in the most serious lesions. In cases where streptococcal infections go untreated, rheumatic fever may occur. If the heart becomes involved, mitral valve stenosis may develop. During pregnancy, the risk for developing mitral stenosis also increases for the same reasons. Additionally, increased blood volume and the need for increased cardiac output during pregnancy places additional stress on the heart and makes the pregnant client more susceptible to mitral stenosis (Davidson, London, & Ladewig, 2008).
Symptoms
The nurse should be assessing for signs and symptoms such as fatigue, palpitations, exertional dyspnea, and orthopnea (Jarvis, 2012). The main symptom is dyspnea on exertion due to decreased lung compliance. The patient may also experience palpitations, hoarseness, hemoptysis, chest pain, and seizures. Because blood flow is altered and may be obstructed, the patient is at risk for embolization and stroke (Lewis, et al., 2007). When auscultating heart sounds, the nurse should expect to hear a low-pitched murmur. This will often sound like a rumble during diastole. Be sure to auscultate near the apex of the heart (Jarvis, 2012). Using the bell of the stethoscope will help the nurse to better hear the low pitch (Lewis, et al., 2007).
Outcomes
Mitral valve stenosis is a progressive, life-long disorder. The course of the disease starts out slow, however, in later years, signs and symptoms accelerate progressively. As the valve becomes more obstructed, decreased cardiac output occurs and arrhythmias may occur. The normal valve opening is approximately 4 to 5 cm with mild symptoms occurring when narrowing reaches 2cm. Atrial fibrillation occurs in approximately 30-40% of all cases (Porth, 2007).