Cyanotic lesions mostly start with T.
For a tet spell: knee-chest position immediately.
💡 The one idea
Sort congenital heart defects by whether blood shunts the wrong way, and which way.Left-to-right = too much lung blood = heart failure. Right-to-left = blue baby.
PROV. The classic sign is the “tet spell” — sudden deep cyanosis
during crying or feeding.
For a tet spell, put the infant in KNEE-CHEST position immediately. It raises systemic resistance and pushes blood back through the lungs.
⭐ Heart failure in an infant looks like feeding trouble
Sweating with feeds and tiring after a few minutes
Poor weight gain — often the earliest sign
Tachypnoea, tachycardia at rest
Hepatomegaly — the pediatric equivalent of peripheral edema
Nursing care: small frequent feeds, higher-calorie formula, cluster care to allow rest.
🚨 Digoxin in children
Count the apical pulse for a full minute before every dose. Hold and report if
<90–110 in an infant or <70 in a child.
Early toxicity in a child is usually vomiting and bradycardia, not visual changes.
Never repeat a dose that was vomited, and never mix digoxin into a bottle of formula - if the feed is not finished, the dose is unknown.
✅ Kawasaki disease
Fever ≥5 days plus red eyes, strawberry tongue, cracked lips, rash, swollen red
hands and feet with later peeling.
It causes coronary artery aneurysms, so treatment is IVIG plus aspirin —
the one situation where a child is given aspirin.
⭐ High-yield — what the exam actually asks
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Fetal shunts: foramen ovale closes with the first breaths, ductus arteriosus within 2–3 days, ductus venosus shortly after birth. Failure to close produces congenital defects.
Left-to-right shunts (ASD, VSD, PDA) are acyanotic — the child stays pink. Right-to-left shunts (tetralogy, tricuspid atresia, transposition) are cyanotic — blue.
All cyanotic lesions are ductal-dependent.Prostaglandin E1 keeps the duct OPEN pre-op and needs a reliable IV; watch for apnea and hypotension. Indomethacin does the opposite and CLOSES a PDA — the only defect medication can fix.
Tetralogy of Fallot: pulmonary stenosis, RV hypertrophy, VSD, overriding aorta. For a tet spell, knee-to-chest raises systemic vascular resistance and reduces right-to-left shunting.
PDA gives a continuous machine-like murmur; VSD a harsh murmur at the lower left sternal border.
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Coarctation: four-point BP shows high pressure and bounding pulses in the arms with weak pulses and hypotension in the legs.
Digoxin: apical pulse for a full minute before the dose, give on an empty stomach, never repeat a dose after vomiting. Toxicity = nausea, vomiting, bradycardia.
Heart failure in infants: tachycardia at rest, sweating with feeds, poor weight gain, hepatomegaly as the earliest sign. Infants lose weight; older children gain fluid weight. Cluster care, feed upright, higher-calorie smaller feeds.
Post cardiac cath: keep the leg straight 4–8 hr, check bilateral pulses/temperature/color, push fluids to clear contrast.
Kawasaki: fever >5 days unresponsive to antipyretics, conjunctivitis, strawberry tongue, peeling hands and feet. IVIG plus high-dose aspirin. Coronary aneurysm is the feared complication. No live vaccines for 11 months after IVIG.
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Rheumatic fever follows untreated group A strep; ASO titer confirms it; carditis is the most serious criterion.
SVT: vagal maneuvers first, then adenosine.
📕 From your ATI review book
Covered by ch. 20 (cardiovascular disorders).
Timing of repairs is examinable. Transposition of the great arteries is switched within the first 2 weeks; truncus arteriosus within the first month; tetralogy of Fallot is fully repaired within the first year.
Hypoplastic left heart takes three staged operations: shunt, then Glenn, then modified Fontan.
Infective endocarditis is treated with IV antibiotics for 2 to 6 weeks, usually through a PICC — a family who says "seven days" has misunderstood.
Prophylaxis is for the high-risk group only: prosthetic valves, previous endocarditis, and unrepaired cyanotic defects.
Kawasaki disease: low-dose aspirin continues for about 6 months after the procedure or acute phase. This is the one childhood condition where aspirin is deliberately given.
High altitude worsens hypoxia in a child with a cyanotic defect and is avoided where possible.
📚 From your Maternal & Child textbook
Pillitteri, Maternal and Child Health Nursing — ch. 41 (cardiovascular).
High altitude worsens hypoxia in a child with a cyanotic defect and is avoided where possible.
Endocarditis prophylaxis is for the high-risk group only: prosthetic valves, previous endocarditis, unrepaired cyanotic defects. Treatment is IV antibiotics for 2 to 6 weeks.
⚠️ Exam traps
Prostaglandin E1 (opens) vs prostaglandin inhibitor (closes) is the highest-yield reversal in the whole course.
Aspirin is the exception in Kawasaki — the one place you do give it to a child.
More oxygen is not the answer for cyanotic defects. Some are kept at sats of 75–85% until surgery.
🧠 Mind maps 1
One per disorder, built from the structure of your ATI chapter.
Cardiovascular Disorders
🎯 Who gets it
Maternal factors: infection, alcohol or substance use during pregnancy, diabetes mellitus
Genetic factors: family history of congenital heart disease, trisomy 21, other congenital anomalies or chromosomal abnormalities
Pulmonary artery hypertension can have a familial link
Infective endocarditis: congenital or acquired heart disease, indwelling catheters
👀 What you see
Increased pulmonary blood flow defects shunt blood left to right from higher to lower pressure, raising pulmonary volume and producing heart failure signs
VSD: opening in the ventricular septum, loud harsh murmur at the left sternal border, heart failure; many close on their own early in life
ASD: opening in the atrial septum, systolic murmur with fixed split S2, often asymptomatic
PDA: fetal connection between pulmonary artery and aorta stays open — machinery-hum systolic murmur, wide pulse pressure, bounding pulses, rales
🧪 What confirms it
CBC, urinalysis, ABGs with pH, hemoglobin, hematocrit, electrolytes
Diuretics such as furosemide, and afterload reducers such as ACE inhibitors, for heart failure
Beta blockers, calcium channel blockers, ACE inhibitors, and anticoagulants for cardiovascular management
High-dose IV anti-infectives for 2-6 weeks for infective endocarditis
💬 What you teach
High-risk children need prophylactic antibiotics before dental procedures, respiratory tract surgery, and procedures on infected skin or musculoskeletal tissue, per American Heart Association guidance
Watch for and report signs of infection and keep follow-up appointments
⚠️ What goes wrong
Hypercyanotic (Tet) spell causing severe hypoxemia and cerebral hypoxia is an emergency — position the child comfortably, give 100% oxygen, and maintain airway, breathing, and circulation
Cardiac catheterization risks: nausea and vomiting, low-grade fever, loss of pulse in the catheterized limb, transient dysrhythmias, hypoglycemia, and acute hemorrhage at the entry site
For catheterization bleeding, apply direct continuous pressure 2.5 cm (1 in) above the entry site over the vessel puncture, lay the child flat to slow bleeding, notify the provider immediately, and prepare replacement fluids and antiemetics; teach families to watch for bleeding and infection at home
Heart failure progressing to transplant — maintain oxygen, diuretics, digoxin, and ACE inhibitors
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
🎥 Lecture recordings 2
Tap a card to open that recording in Google Drive. The same list lives in the lecture library.
ATI Active Learning Template — System DisorderCardiovascular Disorders
Filled from ATI chapter 20, row by row from that chapter’s own sections — 12 of 12 rows have content.
1 rows came from outside your ATI chapter — 1 cite a source, 0 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Pediatric heart disease is either congenital or acquired. A congenital defect is an anatomic abnormality present from birth that usually produces heart failure and hypoxemia. Heart failure means output cannot meet the body's metabolic and physical demands. Defects group by flow pattern: increased pulmonary flow (VSD, ASD, PDA), decreased pulmonary flow (tricuspid atresia, tetralogy of Fallot), obstructed flow (aortic stenosis, pulmonary stenosis, coarctation of the aorta), and mixed flow (truncus arteriosus, transposition of the great arteries, hypoplastic left heart syndrome). Acquired conditions include Kawasaki disease, rheumatic fever, infective endocarditis, cardiomyopathy, pulmonary artery hypertension, shock, and dyslipidemia. Hyperlipidemia is rising with poor diet and inactivity, increasing later obesity and adult heart disease risk.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from AHA, n.d..
Children with certain congenital heart defects may need antibiotic prophylaxis before dental work involving the gum tissue.
A cardiologist determines whether a specific heart condition warrants prophylaxis, since not every defect requires it.
Families of at-risk children are advised to carry an AHA wallet card listing the recommended antibiotic and dose.
American Heart Association · Infective Endocarditis · open the source →
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Maternal factors: infection, alcohol or substance use during pregnancy, diabetes mellitus
Genetic factors: family history of congenital heart disease, trisomy 21, other congenital anomalies or chromosomal abnormalities
Pulmonary artery hypertension can have a familial link
Infective endocarditis: congenital or acquired heart disease, indwelling catheters
Cardiogenic shock after cardiac surgery and with acute dysrhythmias, heart failure, trauma, or cardiomyopathy; anaphylaxis in children with allergies, asthma, or family history
Rheumatic fever follows 2-4 weeks after untreated or partially treated group A strep pharyngitis
Dyslipidemia: family history, genetics, obesity, inactivity, diabetes, hypertension, congenital heart disease, transplant recipients, cancer survivors, Kawasaki disease with coronary aneurysms, chronic inflammatory disease, and medications such as oral contraceptives, diuretics, and beta blockers
Assessment — Expected Findings
Increased pulmonary blood flow defects shunt blood left to right from higher to lower pressure, raising pulmonary volume and producing heart failure signs
VSD: opening in the ventricular septum, loud harsh murmur at the left sternal border, heart failure; many close on their own early in life
ASD: opening in the atrial septum, systolic murmur with fixed split S2, often asymptomatic
PDA: fetal connection between pulmonary artery and aorta stays open — machinery-hum systolic murmur, wide pulse pressure, bounding pulses, rales
Obstructive defects narrow the outflow, raising pressure behind the defect and lowering it beyond, cutting cardiac output and causing heart failure signs
Pulmonary stenosis: narrowed pulmonary valve or artery, systolic ejection murmur, cardiomegaly, cyanosis proportional to severity
Coarctation of the aorta: weak femoral pulses and lower blood pressure in the legs than the arms
Decreased pulmonary flow defects combine outflow obstruction with an ASD or VSD, shunting deoxygenated blood right to left into the systemic circulation; hypercyanotic 'Tet' spells bring acute cyanosis and hyperpnea
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
CBC, urinalysis, ABGs with pH, hemoglobin, hematocrit, electrolytes
Erythrocyte sedimentation rate and C-reactive protein elevated with inflammation
Throat culture for group A strep; screening is recommended for all school-age children with sore throat
Antistreptolysin O titer elevated or rising is the most reliable test for rheumatic fever
Diagnostic Procedures
Chest radiograph for cardiomegaly
ECG for conduction disturbances and to evaluate heart and valve function, and to identify dysrhythmias
Echocardiography, transthoracic or transesophageal, shows vegetations and pericardial effusion, and evaluates heart size and ventricular and valve function; repeat 4-6 weeks after treatment for rheumatic fever
Cardiac catheterization is the gold standard
Modified Jones criteria diagnose rheumatic fever — two major criteria, or one major plus two minor, after a documented strep infection
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Support child and family through diagnosis and treatment decisions
Monitor vital signs and cardiac status with continuous cardiac monitoring
Give IV fluids so the child does not become dehydrated, and offer clear liquids plus soft foods that are not acidic
Rheumatic fever: bed rest during acute illness, prescribed antibiotics, balanced meals, and assessment for chorea shown as nervousness, behavior change, and shortened attention span
Kawasaki: give IV gamma globulin per policy and aspirin as prescribed, provide oral hygiene and lip balm, apply cool cloths and lotion, keep the environment quiet, and cluster care to allow rest
Antibiotic prophylaxis: watch for allergic response such as anaphylaxis, hives, or rash, and for nausea, vomiting, or diarrhea
Bile acid sequestrants (cholestyramine, colesevelam, colestipol): mix the powder in 4-6 oz of water or juice and give immediately; monitor for constipation, abdominal pain, flatulence, nausea, and bloating, and check liver function, CBC, creatine kinase, and fasting lipids at 4 and 8 weeks and after any dose change
Medications
Digoxin improves myocardial contractility
Diuretics such as furosemide, and afterload reducers such as ACE inhibitors, for heart failure
Beta blockers, calcium channel blockers, ACE inhibitors, and anticoagulants for cardiovascular management
High-dose IV anti-infectives for 2-6 weeks for infective endocarditis
Rheumatic fever prophylaxis: oral penicillin V twice daily or monthly IM penicillin G; with penicillin allergy use an oral cephalosporin, clindamycin, or a macrolide; duration ranges from 5 years to lifelong depending on residual heart disease
Kawasaki gamma globulin: 2 g/kg IV over 8-12 hr, ideally within the first 10 days of illness; repeat 1000-2000 mg with or without corticosteroids if fever persists 36 hr or more after the first infusion
Kawasaki aspirin: high dose 30-100 mg/kg/day divided every 6 hr, then 3-5 mg/kg/day once afebrile until platelet count and CRP/ESR normalize at about 6-8 weeks, and indefinitely if coronary abnormalities develop
Enoxaparin anticoagulation when coronary aneurysms are present
Therapeutic Procedures
VSD: watch for spontaneous closure, diuretics, catheter-based closure, or patch repair which carries heart block risk
ASD: patch closure with cardiopulmonary bypass, low-dose aspirin for 6 months after the procedure
PDA: indomethacin, ibuprofen, or acetaminophen to close the duct; coil occlusion during catheterization; furosemide; neutral thermal environment; treat anemia; thoracoscopic ligation
Pulmonary stenosis: balloon angioplasty or valvuloplasty during catheterization, or pulmonary valvotomy in children
Aortic stenosis: balloon dilation during catheterization, Ross procedure, or aortic valvotomy
Coarctation of the aorta: balloon angioplasty in infants and children, stents in adolescents, or surgical repair
💬 Around the patientClient Education · Interprofessional Care
Client Education
High-risk children need prophylactic antibiotics before dental procedures, respiratory tract surgery, and procedures on infected skin or musculoskeletal tissue, per American Heart Association guidance
Watch for and report signs of infection and keep follow-up appointments
Adhere strictly to the medication schedule
Avoid high altitude when possible because of hypoxia risk; supplemental oxygen can prevent hypoxia
After discharge: avoid smoking, follow a heart-healthy diet, and continue screening with cholesterol testing, blood pressure monitoring, and periodic cardiac imaging
Interprofessional Care
Dietitian consultation and dietary counseling to guide food choices
⚠️ What goes wrongComplications
Complications
Hypercyanotic (Tet) spell causing severe hypoxemia and cerebral hypoxia is an emergency — position the child comfortably, give 100% oxygen, and maintain airway, breathing, and circulation
Cardiac catheterization risks: nausea and vomiting, low-grade fever, loss of pulse in the catheterized limb, transient dysrhythmias, hypoglycemia, and acute hemorrhage at the entry site
For catheterization bleeding, apply direct continuous pressure 2.5 cm (1 in) above the entry site over the vessel puncture, lay the child flat to slow bleeding, notify the provider immediately, and prepare replacement fluids and antiemetics; teach families to watch for bleeding and infection at home
Heart failure progressing to transplant — maintain oxygen, diuretics, digoxin, and ACE inhibitors
Infective endocarditis complications: myocardial infarction and embolism
Kawasaki coronary artery dilation or aneurysm, most common in the subacute phase — serial echocardiograms and anticoagulation
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Fetal shunts: foramen ovale closes with the first breaths, ductus arteriosus within 2–3 days, ductus venosus shortly after birth. Failure to close produces congenital defects.
All cyanotic lesions are ductal-dependent.Prostaglandin E1 keeps the duct OPEN pre-op and needs a reliable IV; watch for apnea and hypotension. Indomethacin does the opposite and CLOSES a PDA — the only defect medication can fix.
Digoxin: apical pulse for a full minute before the dose, give on an empty stomach, never repeat a dose after vomiting. Toxicity = nausea, vomiting, bradycardia.
Post cardiac cath: keep the leg straight 4–8 hr, check bilateral pulses/temperature/color, push fluids to clear contrast.
Kawasaki: fever >5 days unresponsive to antipyretics, conjunctivitis, strawberry tongue, peeling hands and feet. IVIG plus high-dose aspirin. Coronary aneurysm is the feared complication. No live vaccines for 11 months after IVIG.
SVT: vagal maneuvers first, then adenosine.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.