Cardio vascular system in children

Anatomical and physiological featuresAnatomical and physiological features
of cardio-vascular systemof cardio-vascular system

ActualityActuality
 Heart and vascular system of the child areHeart and vascular system of the child are
very different from that of an adult.very different from that of an adult.
Immediately after birth, are intenselyImmediately after birth, are intensely
morphological changes of themorphological changes of the
cardiovascular system. After ligation of thecardiovascular system. After ligation of the
umbilical vessel fetal circulation stops andumbilical vessel fetal circulation stops and
starts functioning postnatal circulation.starts functioning postnatal circulation.

Embryogenesis of the heart and greatEmbryogenesis of the heart and great
vesselsvessels
 Starts of heart is from the late 2nd -earlyStarts of heart is from the late 2nd -early
3rd week of fetal development;3rd week of fetal development;
 The heart develops from the mesoderm ofThe heart develops from the mesoderm of
the double folds to form the primary heartthe double folds to form the primary heart
tube;tube;
 Since the inner layer of the primary heartSince the inner layer of the primary heart
tube formed endocardium, on the outsidetube formed endocardium, on the outside
- the myocardium and pericardium.- the myocardium and pericardium.

 On the 3rd week of embryonicOn the 3rd week of embryonic
development is the rapid development ofdevelopment is the rapid development of
the tube;the tube;
 The heart is divided into right and left halfThe heart is divided into right and left half
(chambers);(chambers);
 Passes atriums division into two parts;Passes atriums division into two parts;
 Formed oval hole;Formed oval hole;
 Heart consist of 3 chambers;Heart consist of 3 chambers;

SponsoredSponsored
Medical Lecture Notes – All SubjectsMedical Lecture Notes – All Subjects
USMLE Exam (America) – PracticeUSMLE Exam (America) – Practice

 During 5 week from primary ventricularDuring 5 week from primary ventricular
muscle the interventricular septum beginsmuscle the interventricular septum begins
to develop;to develop;
 By the end of 7-8 weeks heart consist of 4By the end of 7-8 weeks heart consist of 4
chambers;chambers;
 After 4 weeks is forming the point of originAfter 4 weeks is forming the point of origin
of the pulmonary artery and aorta;of the pulmonary artery and aorta;

 At the 2nd month formed atrioventricularAt the 2nd month formed atrioventricular
hole;hole;
 Structural design of the heart and largeStructural design of the heart and large
vessels is completed by 7-8 weeks ofvessels is completed by 7-8 weeks of
embryo development.embryo development.

 All abnormalities of the cardiovascularAll abnormalities of the cardiovascular
system arising from 3rd to 8th week ofsystem arising from 3rd to 8th week of
gestation.gestation.
 During the placenta period of embryonicDuring the placenta period of embryonic
development, the main changes relate todevelopment, the main changes relate to
an increase in heart size and extentan increase in heart size and extent
muscular layer and differentiation ofmuscular layer and differentiation of
vessels.vessels.
 During this period formed a complexDuring this period formed a complex
functional system - cardiovascular.functional system - cardiovascular.

Abnormal placement of theAbnormal placement of the
heart (ectopic)heart (ectopic)
 Ectopic heart - an anomaly in which theEctopic heart - an anomaly in which the
heart is located outside the mediastinum:heart is located outside the mediastinum:
 Chest or thoracic, abdominal, neck.Chest or thoracic, abdominal, neck.
 Ectopia may accompany congenital heartEctopia may accompany congenital heart
disease.disease.

FFetal Circulationetal Circulation

Features fetal circulationFeatures fetal circulation
 1. The oxygen saturation is in the1. The oxygen saturation is in the
placenta, where it goes through umbilicalplacenta, where it goes through umbilical
vein to the liver of the fetus;vein to the liver of the fetus;
 2. Through arantsiyivu venous blood2. Through arantsiyivu venous blood
enters the v.cava inferiorenters the v.cava inferior
 3. The mixture oxygenated blood from the3. The mixture oxygenated blood from the
placenta and venous blood from the lowerplacenta and venous blood from the lower
limbs and internal organs enters the rightlimbs and internal organs enters the right
atrium .atrium .

 4. Most of the blood from the right atrium4. Most of the blood from the right atrium
through the oval hole enters the leftthrough the oval hole enters the left
atrium, the other - in the right ventricle andatrium, the other - in the right ventricle and
the pulmonary artery;the pulmonary artery;
 5. In the lungs enters a small amount of5. In the lungs enters a small amount of
blood because the pulmonary circulationblood because the pulmonary circulation
is not functioning;is not functioning;
 6. Most of the blood from the pulmonary6. Most of the blood from the pulmonary
artery through ductus arteriosus enters theartery through ductus arteriosus enters the
aorta.aorta.

 7. From the left atrium through the left7. From the left atrium through the left
ventricle blood is pumped to theventricle blood is pumped to the
ascending aorta, and oxygenise the head,ascending aorta, and oxygenise the head,
neck and upper extremities.neck and upper extremities.

Circulation of newbornCirculation of newborn

Features of circulation of theFeatures of circulation of the
newbornnewborn
 Stopped to function once the six mainStopped to function once the six main
structures: umbilical vein, venous duct,structures: umbilical vein, venous duct,
two umbilical arteries that provide thetwo umbilical arteries that provide the
placental circulation, oval window and theplacental circulation, oval window and the
arterial duct, which direct blood from thearterial duct, which direct blood from the
pulmonary circulation into the aorta.pulmonary circulation into the aorta.

 In the postnatal period is gradualIn the postnatal period is gradual
obliteration of the fetal circulatoryobliteration of the fetal circulatory
pathways during the 5-6 first monthspathways during the 5-6 first months
of life.of life.

HeartHeart
 Newborn heart is relatively large and is 0.8% ofNewborn heart is relatively large and is 0.8% of
body weight.body weight.
 By 3 years of age weight of the heart is atBy 3 years of age weight of the heart is at
0.5%, that falls within the adult heart.0.5%, that falls within the adult heart.
 Children's heart grows unevenly: the mostChildren's heart grows unevenly: the most
energetic in the first two years of life and duringenergetic in the first two years of life and during
maturation; 2 years of intensively growing atriummaturation; 2 years of intensively growing atrium
of 10 years - the ventricles. However, in allof 10 years - the ventricles. However, in all
periods of childhood increase the volume of theperiods of childhood increase the volume of the
heart behind the growth of the body. The heartheart behind the growth of the body. The heart
of a newborn baby has a rounded shape, whichof a newborn baby has a rounded shape, which
is associated with the development of ventricularis associated with the development of ventricular
and atrial relatively large size. Up to 6 yearsand atrial relatively large size. Up to 6 years
form the heart close to the oval, typical adultform the heart close to the oval, typical adult
heartheart

Children's HeartChildren's Heart

Radiographs of preterm infantsRadiographs of preterm infants

Radiographs of full-term newborn babyRadiographs of full-term newborn baby

In all periods of childhood increase the volume ofIn all periods of childhood increase the volume of
the heart behind the growth of the body.the heart behind the growth of the body.
The heart of a newborn baby has a roundedThe heart of a newborn baby has a rounded
shape, which is associated with theshape, which is associated with the
development of ventricular and atrial relativelydevelopment of ventricular and atrial relatively
large size.large size.
Up to 6 years form the heart close the ovalUp to 6 years form the heart close the oval
peculiar to the adult heartpeculiar to the adult heart

PosiPositiontion ofof heartheart
 depends on the age of the child:depends on the age of the child:
 in infants and children during the first twoin infants and children during the first two
years of life because of the high standingyears of life because of the high standing
of the diaphragm heart arrangedof the diaphragm heart arranged
horizontally;horizontally;
 2-3 years it takes a slanting position.2-3 years it takes a slanting position.

Radiograph of a child 3 yearsRadiograph of a child 3 years

Radiographs of high school age childRadiographs of high school age child

 The thickness of the right and leftThe thickness of the right and left
ventricles in neonatal period is almostventricles in neonatal period is almost
identical.identical.
 Further growth is irregular, due to theFurther growth is irregular, due to the
greater thickness of the left ventriculargreater thickness of the left ventricular
load increases faster than the right.load increases faster than the right.

Blood supply of the heartBlood supply of the heart

The projection auscultation points of the heartThe projection auscultation points of the heart

Children PhonendoscopesChildren Phonendoscopes

Possible congenital disordes of heartPossible congenital disordes of heart

Hypoplastic left heart syndromeHypoplastic left heart syndrome

Three-chambered heartThree-chambered heart

 The child, especially the first weeks andThe child, especially the first weeks and
months of life saved links betweenmonths of life saved links between
different types of blood vessels, the leftdifferent types of blood vessels, the left
and right heart, open foramen oval in theand right heart, open foramen oval in the
atrial septum, the arterial duct-ventricularatrial septum, the arterial duct-ventricular
arteriolar anastomoses in the pulmonaryarteriolar anastomoses in the pulmonary
circulation and others.circulation and others.

Arteriolar-ventricular communicationArteriolar-ventricular communication

As a result of these links blood from theAs a result of these links blood from the
high pressure chamber is dischargedhigh pressure chamber is discharged
into the chamber with low pressure.into the chamber with low pressure.

 In some cases, such as pulmonaryIn some cases, such as pulmonary
hypertension or development ofhypertension or development of
respiratory failure, pulmonary arteryrespiratory failure, pulmonary artery
pressure and right heart begins to exceedpressure and right heart begins to exceed
the pressure in the arteries of the systemicthe pressure in the arteries of the systemic
circulation, leading to a change in thecirculation, leading to a change in the
direction of discharge of blood (from rightdirection of discharge of blood (from right
to left shunt) and mixing with venousto left shunt) and mixing with venous
arterial blood.arterial blood.

Vessels.Vessels.
In infants vessels are relatively greater.In infants vessels are relatively greater.
 Clearance veins approximately equalClearance veins approximately equal
lumen of arteries.lumen of arteries.
 Veins are growing more intense and in 15-Veins are growing more intense and in 15-
16 years are 2 times wider than arteries.16 years are 2 times wider than arteries.
 Aorta to 10 years lower pulmonary arteryAorta to 10 years lower pulmonary artery
gradually their diameters are the same.gradually their diameters are the same.
 During puberty aorta become more wideDuring puberty aorta become more wide
then pulmonary trunk.then pulmonary trunk.

 The capillaries are well developed.The capillaries are well developed.
 Their permeability is much higher than inTheir permeability is much higher than in
adults.adults.
 Width and a large number of capillariesWidth and a large number of capillaries
leads to blood stagnation, which is one ofleads to blood stagnation, which is one of
the reasons for the frequent developmentthe reasons for the frequent development
of some diseases in children, such asof some diseases in children, such as
pneumonia and osteomyelitis.pneumonia and osteomyelitis.
 Blood flow velocity in children is high, itBlood flow velocity in children is high, it
slows down with age, due to the extensionslows down with age, due to the extension
of the vascular system as the child growsof the vascular system as the child grows
and slowing the heart rate.and slowing the heart rate.

PulsePulse
 Arterial pulse in children is more often than inArterial pulse in children is more often than in
adults; This is due to the more rapid decline inadults; This is due to the more rapid decline in
heart muscle, prevalence of sympathicotonia inheart muscle, prevalence of sympathicotonia in
child and less impact on cardiac function vaguschild and less impact on cardiac function vagus
nerve, a higher level of metabolism.nerve, a higher level of metabolism.
 Elevated tissue levels need not be satisfiedElevated tissue levels need not be satisfied
due to the greater volume of systole, but due todue to the greater volume of systole, but due to
frequent heart rate.frequent heart rate.

The heart rateThe heart rate
 The highest heart rate (HR) is in newbornThe highest heart rate (HR) is in newborn
infants (140-160 in min.).infants (140-160 in min.).
 With age, it gradually decreases;With age, it gradually decreases;
 to year HR is 110-120 in 1 min .;to year HR is 110-120 in 1 min .;
 to 5 years - 100;to 5 years - 100;
 10 years - 90;10 years - 90;
 to 12-13 years - 80-70 in 1 min.to 12-13 years - 80-70 in 1 min.

 Pulse in childhood is distinguished by highPulse in childhood is distinguished by high
lability.lability.
 Cry, physical stress, fever causing hisCry, physical stress, fever causing his
noticeable acceleration.noticeable acceleration.
 Pulse of children is characterized byPulse of children is characterized by
respiratory arrhythmia, frequent inhaling it,respiratory arrhythmia, frequent inhaling it,
exhale slows down.exhale slows down.

Blood pressure in childrenBlood pressure in children
 lower than in adults, the lower it is, thelower than in adults, the lower it is, the
younger the child;younger the child;
 low blood pressure caused by the smalllow blood pressure caused by the small
volume of the left ventricle, wide vesselsvolume of the left ventricle, wide vessels
and elasticity of arterial walls.and elasticity of arterial walls.
 To assess blood pressure in child weTo assess blood pressure in child we
most us sphygmanometersmost us sphygmanometers

 The range of normal blood pressureThe range of normal blood pressure
values are limits on the 10th to the 90thvalues are limits on the 10th to the 90th
division.division.
 Values from 90th to 95th and from 10thValues from 90th to 95th and from 10th
to 5th graduation appropriate limit ofto 5th graduation appropriate limit of
arterial hyper- and hypotension.arterial hyper- and hypotension.
 If blood pressure values above 95If blood pressure values above 95
graduation - a hypertension if less than 5graduation - a hypertension if less than 5
graduations - hypotension.graduations - hypotension.

In full-term newborn baby systolic bloodIn full-term newborn baby systolic blood
pressure is 65- 85 mm Hg. c .;pressure is 65- 85 mm Hg. c .;
maximum level of blood pressure inmaximum level of blood pressure in
children 1 year of age can be calculatedchildren 1 year of age can be calculated
by the formula: 76 + 2 n, where n -by the formula: 76 + 2 n, where n -
number of months;number of months;
76 - the average systolic blood pressure76 - the average systolic blood pressure
in the newborn.in the newborn.

Calculations of blood pressure in childrenCalculations of blood pressure in children
older than one yearolder than one year
AT approximately calculated by the formula:AT approximately calculated by the formula:
100 + 2n100 + 2n
where n - number of yearswhere n - number of years
thus allowed fluctuations of ± 15; diastolicthus allowed fluctuations of ± 15; diastolic
pressure is 2/3 - 1/2 systolic pressure.pressure is 2/3 - 1/2 systolic pressure.

Terms of measuring blood pressureTerms of measuring blood pressure
 BP should be measured not only on the hands, but alsoBP should be measured not only on the hands, but also
on their feet.on their feet.
 To measure blood pressure in most children usuallyTo measure blood pressure in most children usually
sufficient set of cuff width of 3, 5, 7, 12 and 18 cmsufficient set of cuff width of 3, 5, 7, 12 and 18 cm
 The cuff should capture about 2/3 of the forearm orThe cuff should capture about 2/3 of the forearm or
thigh.thigh.
 Using a very narrow cuff leads to an overestimation ofUsing a very narrow cuff leads to an overestimation of
the measured parameters, wide - to overshoot.the measured parameters, wide - to overshoot.
 To determine the blood pressure on the foot stethoscopeTo determine the blood pressure on the foot stethoscope
placed over the poplitea artery.placed over the poplitea artery.
 Blood pressure of lower extremity is more higher thanBlood pressure of lower extremity is more higher than
those at the upper extremity about 10 mm Hg. c.those at the upper extremity about 10 mm Hg. c.

Measurement of blood pressureMeasurement of blood pressure

findingsfindings
 Due to the large mass of the heart and theDue to the large mass of the heart and the
wide vascular vessels circulation inwide vascular vessels circulation in
children is in more favorable conditionschildren is in more favorable conditions
than in adults.than in adults.

Congenital heart defectsCongenital heart defects
 Heart defect form stable pathological changes inHeart defect form stable pathological changes in
the structure of the heart, in violation of itsthe structure of the heart, in violation of its
function.function.
 Congenital heart and vessels defects areCongenital heart and vessels defects are
formed as a result of violations offormed as a result of violations of
embryogenesis at 2-8 weeks of pregnancy orembryogenesis at 2-8 weeks of pregnancy or
transferred in utero endocarditis.transferred in utero endocarditis.
 In the development of congenital heart andIn the development of congenital heart and
vessels defects important role played thevessels defects important role played the
mother viral diseases (rubella, measles, mumps,mother viral diseases (rubella, measles, mumps,
chicken pox, influenza) and toxoplasmosischicken pox, influenza) and toxoplasmosis
during pregnancy.during pregnancy.

Congenital heart defects in childrenCongenital heart defects in children

 Heart defects that are found in close relatives,Heart defects that are found in close relatives,
often accompanied by chromosomal diseasesoften accompanied by chromosomal diseases
and developmental abnormalities, indicating thatand developmental abnormalities, indicating that
the genetic hereditary predisposition.the genetic hereditary predisposition.
 Some importance in their occurrence are:Some importance in their occurrence are:
radiation exposure, age of parents, the effect onradiation exposure, age of parents, the effect on
pregnant toxic and chemical substances, use ofpregnant toxic and chemical substances, use of
certain drugs.certain drugs.

A child with microcephaly and heart defectA child with microcephaly and heart defect

Phase of Congenital disordersPhase of Congenital disorders
 The first phase (initial adaptation) - isThe first phase (initial adaptation) - is
characterized by the adaptation of the organismcharacterized by the adaptation of the organism
to hemodynamic disorders.to hemodynamic disorders.
 2-3 years following the second phase - the2-3 years following the second phase - the
phase of relative compensation. During thisphase of relative compensation. During this
period, significantly improves the condition of theperiod, significantly improves the condition of the
child, his physical development and physicalchild, his physical development and physical
activity.activity.

 The third phase - terminal. It occurs whenThe third phase - terminal. It occurs when
the compensatory possibilities have beenthe compensatory possibilities have been
exhausted and dystrophic andexhausted and dystrophic and
degenerative changes in the heart muscle.degenerative changes in the heart muscle.
 The third phase of the disease inevitablyThe third phase of the disease inevitably
ends in death of the patient.ends in death of the patient.

Research MethodologyResearch Methodology
 Review general appearance of the patient,Review general appearance of the patient,
position in bed, facial expression, a form ofposition in bed, facial expression, a form of
chest, visible pulsation of the heart and bloodchest, visible pulsation of the heart and blood
vessels, skin color and visible mucousvessels, skin color and visible mucous
membranes.membranes.
 Palpation of the area of the heart, placing largePalpation of the area of the heart, placing large
vessels.vessels.
 Pulse.Pulse.

..
 Percussion: determination of relative andPercussion: determination of relative and
absolute limits of cardiac dullness.absolute limits of cardiac dullness.
 Auscultation: listening to the point of heartAuscultation: listening to the point of heart
valves: evaluation of rhythm, heart rate,valves: evaluation of rhythm, heart rate,
heart tones, characteristic noise. Theheart tones, characteristic noise. The
ability to differentiate organic fromability to differentiate organic from
functional murmurs.functional murmurs.

The sequence of auscultation points:The sequence of auscultation points:
 First listen mitral valve on top of the heart, forFirst listen mitral valve on top of the heart, for
better listening on the left side of the patient.better listening on the left side of the patient.
 Second - the aortic valve in a standing position,Second - the aortic valve in a standing position,
slightly tilted forward with their hands, or on theslightly tilted forward with their hands, or on the
right side - II m / d right.right side - II m / d right.
 Third - pulmonary trunk II m / d from the left,Third - pulmonary trunk II m / d from the left,
directly at the site of its projection.directly at the site of its projection.
 Fourth - ticuspid valve from xiphoid process.Fourth - ticuspid valve from xiphoid process.
Fifth - more Botkin-Erb point to the aortic valveFifth - more Botkin-Erb point to the aortic valve
in place of attachment to the sternum III-IV ribsin place of attachment to the sternum III-IV ribs
on the left.on the left.

Changes toneChanges tone

Changes sonority;Changes sonority;
 Splitting;Splitting;
 Bifurcation.Bifurcation.
 Reasons for change ringing sonority can be in heart andReasons for change ringing sonority can be in heart and
without heart .without heart .

Reasons for change ringing sonorityReasons for change ringing sonority
 The main reason is intracardiac changesThe main reason is intracardiac changes
sonority tones.sonority tones.
 The weakening of both tone indicates weaknessThe weakening of both tone indicates weakness
is observed in the myocardium: myocarditis;is observed in the myocardium: myocarditis;
dystonia infarction; heart attacks;dystonia infarction; heart attacks;
cardiosclerosis; collapse; pericarditis.cardiosclerosis; collapse; pericarditis.

Strengthening both familiar tones caused byStrengthening both familiar tones caused by
the predominance of the influence of thethe predominance of the influence of the
sympathetic nervous system observed insympathetic nervous system observed in
patients with:patients with:
heavy physical labor;heavy physical labor;
excitement;excitement;
thyrotoxicosis.thyrotoxicosis.

ДЯКУЮ ЗА УВАГУДЯКУЮ ЗА УВАГУ
Thank youThank you

Cardio vascular system in children

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Cardio vascular system in children

Similar to Cardio vascular system in children (20)

More from Eneutron

More from Eneutron (20)

Recently uploaded

Recently uploaded (20)

Cardio vascular system in children