Chapter 26: Cardiovascular Disorders in Children

Cardiovascular Disorders in Children begins by contrasting fetal circulation with extrauterine adaptation, noting how the cessation of placental blood flow shifts pressures to the lungs. A major portion of the text is dedicated to Congenital Heart Disease (CHD), classifying defects based on hemodynamic patterns: those increasing pulmonary blood flow, such as Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), and Patent Ductus Arteriosus (PDA), which often present with murmurs and potential heart failure rather than immediate cyanosis; and those restricting ventricular blood flow, notably Coarctation of the Aorta, which is characterized by a significant disparity in blood pressure between the upper and lower extremities. The chapter details cyanotic defects that decrease pulmonary blood flow, specifically Tetralogy of Fallot, explaining its four component anomalies and the management of hypoxic "Tet spells" using the knee-chest position. Complex mixed defects like Hypoplastic Left Heart Syndrome are also reviewed alongside surgical and palliative interventions. The focus then shifts to Acquired Heart Disease, providing in-depth management strategies for Congestive Heart Failure (CHF), where nursing care prioritizes reducing cardiac workload, nutritional support with high-caloric formulas, and strict monitoring of Digoxin toxicity (holding doses if the apical pulse is under 100 beats per minute in infants). Furthermore, the text covers Rheumatic Fever, an autoimmune reaction to Group A beta-hemolytic streptococcus diagnosed via the Jones Criteria, emphasizing the prevention of cardiac valve damage through antibiotic prophylaxis. Kawasaki Disease is explored as a leading cause of acquired cardiovascular disease, identified by symptoms like the "strawberry tongue" and peeling skin, with treatment centering on Intravenous Immune Globulin (IVIG) and aspirin to prevent coronary artery aneurysms. Finally, the chapter addresses preventative cardiology, outlining screening protocols for Systemic Hypertension and Hyperlipidemia, advocating for the DASH diet, and defining heart-healthy lifestyle guidelines to mitigate cardiovascular risks from a young age.