July 2008/KPJ

1. Heart: Congenital AbnormalitiesPresented by: APS HealthcareSouthwestern PA Health Care Quality Unit(HCQU) July 2008/KPJ

2. Disclaimer Information or education provided by the HCQU is not intended to replace medical advice from the consumer’s personal care physician, existing facility policy or federal, state and local regulations/codes within the agency jurisdiction. The information provided is not all inclusive of the topic presented. Certificates for training hours will only be awarded to those who attend a training in its entirety. Attendees are responsible for submitting paperwork to their respective agencies.

3. Note of Clarification While mental retardation (MR) is still recognized as a clinical diagnosis, in an effort to support the work of self-advocates, the APS SW PA HCQU will be using the terms intellectual and/or developmental disability (I/DD) to replace mental retardation (MR) when feasible.

4. Objectives The Participant will: • Identify normal heart structures • Recognize symptoms of congenital heart abnormalities • List supports for someone with a congenital heart abnormality

5. The Cardiac Muscle/Heart • As a muscle, the heart works as a pump • Sends blood to the lungs • Removes carbon dioxide and other wastes • Adds more oxygen to the blood • Carries oxygen-rich blood to the body

6. Left Atrium Right Atrium Left Ventricle Right Ventricle Four Chambers

7. Pulmonary Valve Mitral Valve Aortic Valve Tricuspid Valve Four Valves

8. Superior Vena Cava Aorta Pulmonary Artery Pulmonary Vein Inferior Vena Cava Blood Vessels

9. Facts About Congenital Heart • Structural heart problems present at birth • Usually diagnosed shortly after birth • Some heart defects require life-long medication • Not all heart defects need surgery • For some defects, surgery can be postponed • Regardless of age, heart health must be maintained • Good diet • Adequate exercise • Stress control

10. Medications Used To Treat Heart Conditions • Inotropics • Diuretics • Potassium Supplements • Antihypertensives • Antianginals • Anti-Arrythmic Drugs • Anticoagulants • Antibiotics • Antipyretics

11. Patent Ductus Arteriosus (PDA) • Failure of fetal artery to close • Allows blood to flow from aorta into pulmonary artery • Symptoms • Shortness of breath • Poor feeding & weight gain • Treatment may/may not include surgery

12. Atria Septal Defect (ASD) • Hole between the atria (top chambers of the heart) • Allows oxygenated blood to flow through the hole • Rarely show symptoms • Treatment may/may not include surgery

13. Ventricular Septal Defect (VSD) • Hole between ventricles • Allows oxygenated blood to flow from left to right side of heart and back to lungs • May see shortness of breath • Treatment may/may not include surgery

14. Atrioventricular Septal Defect (AVSD) • Most common heart defect in children with Trisomy 21 • Combination of defects • Two holes in the heart • Abnormalities of tricuspid & mitral valves • Symptoms • Enlarged heart & liver • Cyanosis • Treatment • Medications

15. Pulmonary Stenosis • Narrowing or leaking of the pulmonary valve • Malformation of “leaflets” of the valve • Leaflets can be damaged • Symptoms dependent on severity • Treatment may/may not include surgical intervention

16. Pulmonary Hypertension • May be due to extra blood being pumped through lungs at excessive pressure • Occurs when normal separation between right sided circulation & left sided circulation is incomplete • Occurs when a connection develops between the aorta and pulmonary artery

17. Treatment of Pulmonary Hypertension • Banding • Surgical Repair • Oxygen • Nitrogen based drugs • Inotropics • Diuretics

18. Four Components Ventricular septal defect Hole between the two ventricles Allows unoxygenated blood to circulate thru body Stenosis (narrowing) of pulmonary valve Blocks flow of venous blood into lungs Varies in severity Right ventricle is more muscular than normal Aorta lies directly over ventricular septal defect Tetralogy of Fallout

19. Tetralogy of Fallout (cont’d) • Symptoms • Cyanosis (blueness) • Shortness of breath with exertion • Treatment • Surgery • Long term treatment • Medications • Ongoing care

20. Coarctation of the Aorta • Localized narrowing of aorta • Obstructs blood flow from the heart to body • Pressure increases above narrowed area • Classic symptom is difference in pulse & BP in arms and legs • Treatment may/may not include surgery

21. To Recap: Congenital Heart Defects • “Congenital” means present at birth and many congenital heart problems are diagnosed and treated shortly after birth • It is important to remember when someone has a congenital heart abnormality, even if repaired, especially if restrictions are needed • Heart health must be maintained – exercise, good diet, adequate sleep, and stress control are vital!

22. References • www.cardioaccess.com • www.phs.on.ca • www.nlm.nih.gov • www.luphealth.com • www.siumed.com • www.healthsquare.com • www.healthyhearts.com • www.emedicine.com • www.sma.org • www.pediheart.com • www.med.umn.com • www.mayo.edu • www.heartpoint.com • www.findarticles.com

23. To register for future trainings,orfor more information on this or any other physical or behavioral health topic, please visit our website at www.hcqu.apshealthcare.com

25. EvaluationPlease take a few moments to complete the evaluation form found in the back of your packets.Thank You!

26. Test ReviewThere will be a test review after all tests have beencompleted and turned in to the Instructor.