Nursing Care of Patient with Congenital Acyanotic Heart Disease for Diagnostic Cardiac Catheterization Done

T Jasmine Rajareegam Princely

Non Critical Ward Nursing Supervisor, Kauvery Heartcity, Trichy, India

Abstract

Acyanotic heart disease is a type of congenital heart defect, which causes abnormal blood flow. These defects do not interfere with the amount of oxygen or blood given to the rest of the body. It may range from mild to severe. Babies with this condition might seem out of breath and fatigued.

Types of Acyanotic Heart diseases: 

  • Ventricular septal defect (VSD)
  • Atrial septal defect (ASD)
  • Atrioventricular septal defect
  • Patent ductus arteriosus (PDA)
  • Pulmonary valve stenosis
  • Aortic valve stenosis
  • Coarctation of aorta
  • Mitral Valve Stenosis

Discussion

Bicuspid Aortic Valve:

Bicuspid aortic valve is a form of heart disease in which two of the leaflets of the aortic valve fuse during child’s development in the womb resulting in a two-leaflet valve instead of the normal three-leaflet valve. BAV is the most common cause of heart disease present at birth and affects approximately 1.3% of adults.

Parachute mitral valve:

Parachute mitral valve (PMV) is a congenital valvular anomaly in which all the chordae tendineae of the mitral valve attached to a single papillary muscle.

Coarctation of the Aorta:

Coarctation of the aorta is a narrowing in a part of the body’s main artery, called the aorta. The heart must pump more forcefully to send blood through the aorta and on to the rest of the body.

Patent Ductus Arteriosus:

A congenital heart defect, caused by problems during the development of the heart. Patent ductus arteriosus (PDA) is an opening between two major blood vessels leading from the heart (the aorta and pulmonary arteries).

Shone’s Variant:

Shone’s variant, or incomplete Shone’s syndrome, is more common and typically diagnosed when only two or three left-sided obstructions are present in the setting of left heart hypoplasia (mitral valve, aortic valve, left ventricle aortic arch).

Past History of the patient:

A 29-yr old female asymptomatic software engineer was admitted for diagnostic catheterization procedure. Patient delivered normally at full term, no cardiac symptoms. By the age of 3 months, baby was noticed to have poor weight gain and breathing difficulty. Baby was diagnosed of congenital heart disease in a outside hospital and was on regular follow-up and treatment till 24 years of age.

At the age of 24 years (2019) patient got admitted for mitral valve replacement but intra-op decision was to do mitral valve repair instead of mitral valve replacement, also diagnosed of large patent ductus arteriosus and pulmonary artery hypertension, the patient was on Tab.Tadalafil 20 mg once a day and Tab. Ambrisentan 5 mg once a day for severe PAH. CT Angiogram confirmed intra operative finding.

In 2022 he underwent PDA device closure but failed, completed with Cath study alone. Again, patient was continued with same dual pulmonary artery anti hypertensive drugs. Presently patient got admitted for diagnostic catheterization study for PDA device closure and to be followed up for intervention.

Signs and Symptoms:

  • Pulmonary hypertension
  • Breathlessness
  • Fatigue
  • Dizziness
  • Fainting

Diagnosis:

Congenital Acyanotic Heart Disease
Shone’s Variant
Bicuspid Aortic Valve
Parachute Mitral Valve with Mild residual stenosis
Large PDA with Coarctation of Aorta
Severe PAH

ECG Report:

ECHO Report – 2019:

Subvalvular Fusion (+)

Severe Mitral stenosis

Trivial tricuspid regurgitation

Moderate pulmonary artery hypertension

No RWMA

Borderline Left ventricular dysfunction

OT Notes:

Findings:

Mitral valve- stenotic, subvalvular fusion present
Severe PAH
( Large PDA with anomalous vessel arising near ductus coursing to posterior mediastinum present

CT Angiogram Report:

Variant Anatomy in Aortic Arch (Bovine Arch) with Patent Ductus Arteriosus in between pulmonary artery and distal aortic arch. No evidence of dissection / Thrombosis.

ECHO Report – 2024:

Bicuspid Aortic Valve

Parachute Mitral Valve with mild residual stenosis

Large Patent Ductus Arteriosus with coarctation of aorta

Nursing Management:

Physical Assessment:

Vital signs:

Heart rate: 80 b/m

Blood pressure: 110/70 mm of hg

Respiratory rate: 22b/m

Spo2: 99%

Temperature:98.4 ŸF

Inspection: Patient was inspected thoroughly and found no skin lesions or scar

Palpation: Patient was palpated thoroughly absence of skin mass

Percussion: Patient was assessed and had no fluid collection

Auscultation:

  • NVBS heard (Normal Vesicular Breath Sound)
  •  S1 and S2 sounds present
  • Abnormal sound– Murmur sound heard

Clinical Sign:

Breathing difficulty present on and off

Nursing Management Pre Management:

  1. Routine blood investigations such as CBC and RFT and electrolytes were collected for PDA Device closure procedure.
  2. Every four hours, vital signs was monitored.
  3. Physicians explained the patient situation.
  4. After thorough counselling, nurses were able to secure consent for the clinical procedures.
  5. When speaking with patients and visitors, nurses employed the AIDET strategy (Acknowledge, Introduce, Duration, Explanation and Thank you) to build trust and raise satisfaction levels.
  6. Intravenous (IV) insertion performed using aseptic technique.
  7. The patient’s hemodynamic status monitored.
  8. Skin preparation was done.
  9. NPO instructions were explained to the patient and maintained to ensure an empty stomach.
  10. Patient was shifted to Cath lab.

Nursing Management Post Op Management:

  1. The patient was received from the Cath lab to Cath recovery and was monitored vital signs
  2. After 2 hours of observation patient was shifted to the ward.
  3. Instruction was given to the patient to observe strict bed rest for 6-8 hours following the procedure and advice not to mobile the femoral site
  4. Vital signs checked every 4 hours
  5. The procedure site was observed for any signs of bleeding or complications.
  6. The procedure site cleaned using aseptic technique
  7. Diversional activities were provided for the patient to keep them engaged by reading news paper and watching television during the recovery period.
  8. Following the surgery, effective hydration and I/O chart maintained
  9. Quiet and calm environment provided
  10. Demonstrated and encouraged the use of stress management behaviors, relaxation techniques and slow/deep breathing.

Post Procedure and Education:

Educating the patient and family on post procedure care includes

observing the operative site

Monitoring vital signs

Cardiac rhythm

Ensuring patient comfort

Immediate post procedure:

Assess the site of the procedure

Check for bleeding, hematoma, or signs of infection at the catheter insertion site

Maintain proper bed rest:

Keep the patient flat in bed for the recommended period as directed by the cardiologist usually (4-6) hours

Pain management:

Provide pain relief as needed using prescribed analgesics

Hydration:

Ensure adequate hydration to help flush out the contrast dye used during the procedure

Monitor the urine output:

Closely monitor urine output as the contrast dye can be nephrotoxic

Ongoing monitoring:

Monitoring ECG for any arrhythmias or other cardiac changes

Discharge advice:

Tab. Datalafil      20mg    PO  1-0-0

Tab. Ambrisentran  5 mg    PO  1-0-0

Outcome:

Cath study was done successfully. Plannedsss for PDA device closure.

References

1. American Heart Association. About Congenital Heart Defects (https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects). Accessed 9/1/2021.

2. Centers for Disease Control and Prevention. Living with a Congenital Heart Defect (https://www.cdc.gov/ncbddd/heartdefects/living.html). Accessed 9/1/2021.

3. National Health Service. Congenital Heart Disease (https://www.nhsinform.scot/illnesses-and-conditions/heart-and-blood-vessels/conditions/congenital-heart-disease). Accessed 9/1/2021.

4. Saenz RB, Beebe, DK, Triplett LC. Caring for infants with congenital heart disease and their families (https://www.aafp.org/afp/1999/0401/p1857.html). Am Fam Physician. 1999;59(7):1857-1866. Accessed 9/1/2021.

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