Heart problems among children (new)Presentation Transcript
Anna Dominique Adul AAPD2A Heart Problems Among Children
Tetralogy of Fallot Tetralogy of Fallot(fuh-LOE) is a rare condition caused by the combination of four heart defects that are present at birth. These defects, which affect the structure of the heart, cause oxygen-poor blood to flow out of the heart and into the rest of the body. Infants and children with tetralogy of Fallot usually have blue-tinged skin because their blood doesn't carry enough oxygen. Tetralogy of Fallot is often diagnosed during infancy or soon after. However, tetralogy of Fallot may not be detected until later in life, depending on the severity of the defects and symptoms. With early diagnosis followed by appropriate treatment, most children with tetralogy of Fallot live relatively normal lives, though they'll need regular medical care and may have restrictions on exercise.
Signs and Symptoms Tetralogy of Fallot symptoms vary, depending on the extent of obstruction of blood flow out of the right ventricle and into the lungs. Signs and symptoms may include:
A bluish coloration of the skin caused by blood low in oxygen (cyanosis)
Shortness of breath and rapid breathing, especially during feeding
Loss of consciousness (fainting)
Clubbing of fingers and toes
Poor weight gain
Tiring easily during play
A heart murmur
Causes Tetralogy of Fallot occurs during fetal growth, when the baby's heart is developing. While factors such as poor maternal nutrition, viral illness or genetic disorders may increase the risk of this condition, in most cases the cause of tetralogy of Fallot is unknown. The four abnormalities that make up the tetralogy of Fallot include:
Pulmonary valve stenosis. This is a narrowing of the pulmonary valve, the flap that separates the right ventricle of the heart from the pulmonary artery, the main blood vessel leading to the lungs. Constriction of the pulmonary valve reduces blood flow to the lungs. The narrowing may also affect the muscle beneath the pulmonary valve.
Right ventricular hypertrophy. When the heart's pumping action is overworked, it causes the muscular wall of the right ventricle to enlarge and thicken. Over time this may cause the heart to stiffen, become weak and eventually fail.
Ventricular septal defect. This is a hole in the wall that separates the two lower chambers (ventricles) of the heart. The hole allows deoxygenated blood in the right ventricle — blood that has circulated through the body and is en route to the lungs to replenish its oxygen supply — to flow into the left ventricle and mix with oxygenated blood fresh from the lungs. Blood from the left ventricle also flows back to the right ventricle in an inefficient manner. This ability for blood to flow through the ventricular septal defect dilutes the supply of oxygenated blood to the body and eventually can weaken the heart.
Overriding aorta. Normally the aorta, the main artery leading out to the body, branches off the left ventricle. In tetralogy of Fallot, the aorta is shifted slightly to the right and lies directly above the ventricular septal defect. In this position the aorta receives blood from both the right and left ventricles, mixing the oxygen-poor blood from the right ventricle with the oxygen-rich blood from the left ventricle.
Risk Factors While the exact cause of tetralogy of Fallot is unknown, several factors may increase the risk of a baby being born with this condition. These include:
A viral illness in the mother, such as rubella (German measles), during pregnancy
A mother older than 40
A parent with tetralogy of Fallot
Babies who are also born with Down syndrome or DiGeorge syndrome
Tests and Diagnosis After your baby is born, your baby's doctor may suspect tetralogy of Fallot if the baby has blue-tinged skin or if a heart murmur — an abnormal whooshing sound caused by turbulent blood flow — is heard in your child's chest. By using several tests, your doctor can confirm the diagnosis.
Oxygen level measurement (pulse oximetry
Treatment and Drugs Surgery is the only effective treatment for tetralogy of Fallot. There are two types of surgery that may be performed, including intracardiac repair or a temporary procedure that uses a shunt. Most babies and children will have intracardiac repair.
Intracardiac repairTetralogy of Fallot treatment for most babies involves a type of open-heart surgery called intracardiac repair. This surgery is typically performed during the first year of life. During this procedure, the surgeon places a patch over the ventricular septal defect to close the hole between the ventricles. He or she also repairs the narrowed pulmonary valve and widens the pulmonary arteries to increase blood flow to the lungs. After intracardiac repair, the oxygen level in the blood increases and your baby's symptoms will lessen.
Temporary surgery Occasionally babies need to undergo a temporary surgery before having intracardiac repair. If your baby was born prematurely or has pulmonary arteries that are underdeveloped (hypoplastic), doctors will create a bypass (shunt) between the aorta and pulmonary artery. This bypass increases blood flow to the lungs. When your baby is ready for intracardiac repair, the shunt is removed.
Patent DuctusArteriosus Patent ductusarteriosus(PDA) is a persistent opening between two major blood vessels leading from the heart. This heart defect present at birth (congenital) often closes on its own or is readily treatable. Left untreated, a patent ductusarteriosus can cause too much blood to flow through the heart, weakening the heart muscle and causing heart failure and other complications. A small patent ductusarteriosus often doesn't cause symptoms. A doctor may discover it during a routine exam. An infant with a larger patent ductusarteriosus often has trouble gaining weight and has other signs and symptoms. An older child who has a patent ductusarteriosus may not be as active as normal, may tire more easily and may have frequent lung infections. Occasionally, a small patent ductusarteriosus may not be detected until adulthood.
Signs and Symptoms A large PDA, found during infancy or childhood, may cause:
Poor eating, poor growth
Sweating with crying or play
Persistent fast breathing or breathlessness
Rapid heart rate
Frequent lung infections
A bluish or dusky skin tone
When to see a doctor Call your doctor if your infant or child:
Tires easily when eating or playing
Is not gaining weight
Becomes breathless when eating or crying
Always breathes rapidly or is short of breath
Turns dusky or blue when crying or eating
Causes A patent ductusarteriosus that doesn't close on its own is more common in premature babies, but rare in infants born at full term. As a baby develops in the womb, a vascular connection (ductusarteriosus) between two major blood vessels leading from the heart — the aorta and pulmonary artery — is a normal and necessary part of your baby's blood circulation while in the womb. But, this connection is supposed to close within two or three days after birth once the newborn's heart adapts to life outside the womb. In premature infants, the connection often closes on its own within a few weeks of birth. But if it remains open, it's referred to as a patent ductusarteriosus. The abnormal opening causes too much blood to circulate to the lungs and heart. If not treated, the blood pressure in the lungs may increase (pulmonary hypertension) and the heart may weaken. Congenital heart defects arise from problems early in the heart's development — but there's often no clear cause. Genetics and environmental factors may play a role.
Risk Factors Risk factors for having a patent ductusarteriosus include:
Being born too soon (premature)
Having other heart defects
Family history and other genetic conditions
Rubella infection during pregnancy
Poorly controlled diabetes during pregnancy
Drug or alcohol use or exposure to certain substances during pregnancy
Complications A small patent ductusarteriosus may not cause any complications. Larger defects that are untreated could cause:
High blood pressure in the lungs (pulmonary hypertension
An infection of the heart (endocarditis)
Irregular heartbeat (arrhythmia)
Tests and Diagnosis Your child's doctor may first suspect your child has a patent ductusarteriosus based on listening to your child's heartbeat. Patent ductusarteriosus can cause a heart murmur that the doctor can hear through a stethoscope. If the doctor hears a heart murmur or finds other signs or symptoms of a heart defect, he or she may request one or more of these tests:
Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI)
Treatments and Drugs Treatments for patent ductusarteriosus depend on the age of the person being treated.
Nonsteroidal anti-inflammatory drugs
Preventive In most cases, you can't do anything to prevent having a baby with a patent ductusarteriosus, or any other heart defect. However, it's important to do everything possible to have a healthy pregnancy. Here are the basics:
Get early prenatal care, even before you're pregnant.Quitting smoking, reducing stress, stopping birth control — these are all things to talk to your doctor about before you get pregnant. Also, be sure you talk to your doctor about any medications you're taking.
Eat a balanced diet. Include a vitamin supplement that contains folic acid. Also, limit caffeine.
Exercise regularly. Work with your doctor to develop an exercise plan that's right for you.
Avoid risks. These include harmful substances such as alcohol, cigarettes and illegal drugs. Also, avoid X-rays, hot tubs and saunas.
Avoid infections. Be sure you are up to date on all of your vaccinations before becoming pregnant. Certain types of infections can be harmful to a developing baby.
Keep diabetes under control. If you have diabetes, work with your doctor to be sure it's well controlled before and after getting pregnant.