ACYANOTIC HEART

DISEASE

COARCTATION OF THE
AORTA(COA)

 DEFINITION
COA is a narrowing of part of the aorta ,it
is a type of birth defect
Localized narrowing near the insertion of
ductus arteriosus,resulting in increased
pressure proximal to the defect and
decreased pressure distal to the
obstruction

 It is third most common congenital heart

defect.
Coarction occurs more than twice as often
in males as in females.

CAUSES
Genetic disorders-turner syndrome is a
genetic condition in which female does not
have the usual fair of two X chromosomes
Congenital heart condition such as;
Aortic stenosis
P.D.A
Defect in which only one ventricle is
present
Ventricular septal defect.

PATHOPHYSIOLOGY
The effect of a narrowing within the aorta
is increased pressure proximal to the
defect and decreased pressure distal to it
Blood pressure increased in the heart and
upper portions of the body& decreased in
lower part of body

 Left ventricular after load is increased&

leads to heart failure
Collateral circulation developes,increase
BP
Risk for aortic rupture ,aneurysm &CVA

TYPES
1.Preductal coarctation-The narrowing is
proximal to the ductus arteriosus.Blood
flow to the aorta that is distal to the
narrowing is dependent on the ductus
arteriosus,this is the type seen in
approximately 5% of infants with Turner
Syndrome.

2. Ductal coarction-Narrowing occurs at

the insertion of the ductus arteriosus.This
kind usully appears when the ductus
arteriosus closes.

3.Postductal coarctation Narrowing is

distal to the insertion of the ductus
arteriosus. Open ductus arteriosus blood
flow to the lower body can be
impaired.This type is most common in
adults.

CLINICAL MANIFESTATION

High blood pressure

Bounding pulses in the arm
Weak &delayed femoral pulse(radio femoral delay)
Signs of CHF in infants
In adolescence symptoms include,
Dizziness or fainting
Shortness of breath
Chest pain
Cold feet or legs
Nose bleed
Leg cramps

 Prominent pulsations in the neck

Suzmans sign is dilated, tortuous,
pulsatile arteries seen around the
scapulae and intercostal regions in the
back. It is better seen with the patient bent
forwards and hands hanging down
Cork screw shaped retinal arteries

Diagnostic test

History and physical examination

Echocardiogram
Chest x-ray
rib notching or docks sign is the notching
of the undersurface of posterior ribs
extending from 3rd to 9th ribs seen in after 6
years
E.C.G
C.T.OR MRI

Complications

Aortic aneurysm
Aortic rupture
Bleeding in the brain
Endocarditis
Heart failure
Impaired kidney function
Hypertension

SURGICAL TREATMENT
Resection of coarcted portion with end-to
end anastomosis of the aorta
Percutaneous balloon angioplasty

AORTIC STENOSIS
Aortic valve stenosis is narrowing of
the orifice between the left ventricle
and the aorta.

Pathophysiology

Clinical features

Exertional dyspnea
PND
Syncope
Angina, palpitations
Pulmonary congestion: Left sided heart
failure
Decreased cardiac output
Systolic murmur

Diagnostic measures
History
Physical examination: a loud, rough
systolic crescendo-decrescendo murmur
is heard over the aortic area. If the
examiner rests a hand over the base of
the heart, a vibration may be felt. The
vibration is caused by turbulent blood flow
across the narrowed valve orifice

 Chest x-ray: shows valvular calcification,

left ventricle enlargement, pulmonary vein
congestion.
Echocardiography: shows decreased valve
area, increased left ventricular wall
thickness
Cardiac catheterization: increased pressure
across aortic valve; increased left
ventricular pressures; presence of coronary
artery disease.
ECG: LVH

Medical Management
Low-sodium, low-fat, low-cholesterol diet:
treats left-sided heart failure
Diuretics: treat left sided heart failure
Periodic noninvasive evaluation: monitors
severity of valve narrowing
Cardiac glycosides: control atrial fibrillation
Antibiotics before medical, dental, surgical
procedures: prevent endocarditis
Oxygen, NTG relieves angina

Surgical solutions
Percutaneous
balloon aortic
valvuloplasty:
reduces degree of
stenosis.
Aortic valve
replacement:
replaces diseased
valve

Nursing Assessment of patient with

valvular disoders
Past health history: rhematic fever,
congenital defects, MI, chest truma,
cardiomyopathy, endocarditis, Marfan
syndome.
Ask for palpitations, activity intolerance,
orthopnea, PND, cough, hemoptysis.
Ask patient about symptoms of fever or
throat or joint pain.

 Ask patient about chest pain, dyspnea,

fatigue.
Observe for skin lesions or rash on trunk
and extremities.
Palpate for firm, non tender movable
nodules near tendons or joints.
Auscultate heart sounds for murmurs
and/or rubs.

Decreased Cardiac Output related to valvular

incompetence
Assess frequently for change in existing murmur
or new murmur.
Assess for signs of left- or right-sided heart
failure.
Assess vital signs, cardiovascular status.
Monitor and treat dysarrhythmias as ordered.
Administer inotropic medications to increase
myocardial contractility
Prepare the patient for surgical intervention

Activity Intolerance related to reduced

oxygen supply
Maintain bed rest while symptoms of heart failure
are present.
Allow patient to rest between interventions.
Encourage patient to choose activities that
gradually build endurance to increase cardiac
tolerance.
Begin activities gradually (e.g. chair sitting for
brief periods).
Assist with or perform hygiene needs for patient
to reserve strength for ambulation.

Ineffective Tissue Perfusion (renal, cerebral,

cardiopulmonary, GI, and peripheral) related to
interruption of blood flow

Observe patient for altered mentation,

hemoptysis, aphasia, loss of muscle strength,
complaints of pain.
Observe for splinter hemorrhages of nail beds,
Osler's nodes, and Janeway's lesions.
Notify health care provider of observed changes
in the patient's status.
Reposition patient frequently to prevent skin
breakdown and pulmonary complications
associated with bed rest.

Imbalanced Nutrition: Less Than Body

Requirements related to anorexia
Assess patient's daily caloric intake.
Discuss food preferences with patient.
Consult with a dietitian about nutritional needs of
patient and food preferences.
Encourage small meals and snacks throughout the
day.
Record daily caloric intake and weight.
Educate family about the patient's caloric needs.
Encourage family to assist the patient with meals
and bring in patient's favorite foods.