Cardiac notes for children

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Cardiac notes for children

  1. 1. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1 Alterations of Cardiovascular Function in Children
  2. 2. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2 Congenital Heart Defects  Major cause of death in the first year of life other than prematurity  Prenatal, environmental, and genetic risk factors:  Maternal rubella or increased age, type 1 diabetes, alcoholism, PKU, drugs, and hypercalcemia  Antepartal bleeding  Prematurity  Chromosome aberrations
  3. 3. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3 Congenital Heart Disease (cont’d)  Heart defects  Hemodynamic alterations  Right-to-left shunt, left-to-right shunt  Status of tissue oxygenation  Cyanotic defects  Acyanotic defects
  4. 4. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4 Obstructive Defects  Coarctation of the aorta  Narrowing of the lumen of the aorta that impedes blood flow  Almost always in a juxtaductal position  Manifestations: • If severe decreased CO, acidosis, hypotension at birth • If mild, no manifestations until find hypertension in upper extremities at older age
  5. 5. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5 Coarctation of the Aorta
  6. 6. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 6 Obstructive Defects  Aortic stenosis  Narrowing of the aortic outflow tract  Caused by malformation or fusion of the cusps  Causes increased workload on left ventricle and left ventricular hypertrophy  Various types  Manifestations: • Infant: if significant faint pulses, hypotension, tachycardia, and poor feeding • Older children: may have complaints of exercise intolerance • Risk for bacterial endocarditis
  7. 7. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 7 Aortic Stenosis
  8. 8. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 8 Obstructive Defects  Valvular aortic stenosis  Malformed or fused cusps  Progressive obstruction with episodes of ischemia  Strenuous activity limited  Subvalvular aortic stenosis  Stricture caused by a fibrous ring below a valve  Konno procedure used to correct
  9. 9. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 9 Obstructive Defects (cont’d)  Pulmonic stenosis  Narrowing of the pulmonary outflow tract  Abnormal thickening of the valve leaflets  Narrowing of the valve with resistance to flow from right ventricle to pulmonary artery  Right ventricular hypertrophy  Pulmonary semilunar valve atresia  Manifestations: • If severe: cyanosis from right-to-left shunt through atrial septal defect; decreased CO
  10. 10. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 10 Pulmonic Stenosis
  11. 11. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 11 Defects Increasing Pulmonary Blood Flow  Patent ductus arteriosus (PDA)  Failure of the ductus arteriosus to close  PDA allows blood to shunt from the aorta to pulmonary artery causing left-to-right shunt  Manifestations: • Asymptomatic or pulmonary overcirculation (dyspnea fatigue, poor feeding)  Complications: • Risk for bacterial endocarditis
  12. 12. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 12 Patent Ductus Arteriosus (PDA)
  13. 13. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 13 Defects Increasing Pulmonary Blood Flow  Atrial septal defect  Abnormal opening between the atria; blood flows from left atria to right atria  Three major types: • Ostium primum defect • Ostium secundum defect • Sinus venosus defect  Manifestations: • Asymptomatic at early age • Pulmonary symptoms on exertion at later age
  14. 14. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 14 Defects Increasing Pulmonary Blood Flow (cont’d)  Ventricular septal defect (VSD)  Abnormal communication between the ventricles  Most common type of congenital heart lesion  Two types  Manifestations: • May be asymptomatic • If severe: increased pulmonary blood flow from left- to-right shunt; pulmonary hypertension  Eisenmenger syndrome
  15. 15. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 15 Defects Increasing Pulmonary Blood Flow (cont’d)  Atrioventricular canal defect (AVC)  Results from nonfusion of the endocardial cushions  Demonstrates abnormalities in the atrial and ventricular septa and atrioventricular valves  Complete, partial, and transitional AVCs  Manifestations • Left-to-right shunt and pulmonary overcirculation
  16. 16. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 16 Atrioventricular Canal Defect
  17. 17. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 17 Defects Decreasing Pulmonary Blood Flow  Tetralogy of Fallot  Syndrome represented by four defects: • Ventricular septal defect (VSD) • Overriding aorta • Pulmonary valve stenosis • Right ventricle hypertrophy  Manifestations: • Acute cyanosis at birth or gradual cyanosis • Gradual clubbing, poor growth; Tet spells • If untreated, emboli, stroke, brain abscess, seizures
  18. 18. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 18 Tetralogy of Fallot
  19. 19. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 19 Defects Decreasing Pulmonary Blood Flow  Tricuspid atresia  Imperforate tricuspid valve  Lack of communication between the right atrium and right ventricle  Additional defects: • Atrial septal defect • Hypoplastic or absent right ventricle • Enlarged mitral valve and left ventricle • Pulmonic stenosis  Manifestations: • In newborn, cyanosis, tachycardia, dyspnea, poor feeding • In older child, signs of chronic hypoxemia
  20. 20. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 20 Tricuspid Atresia
  21. 21. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 21 Mixed Defects  Transposition of the great arteries  Aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle  Results in two separate, parallel circuits • Unoxygenated blood circulates continuously through the systemic circulation • Oxygenated blood circulates continuously through the pulmonary circulation
  22. 22. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 22 Mixed Defects (cont’d)  Transposition of the great arteries (cont’d)  Extrauterine survival requires communication between the two circuits  Manifestation:  Depends on size and associated defects
  23. 23. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 23 Transposition of the Great Arteries
  24. 24. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 24 Mixed Defects  Total anomalous pulmonary venous connection (TAPVC)  Pulmonary veins connect to the right side of the heart, directly or indirectly through one or more systemic veins that drain into the right atrium  Classified by point of attachment • Supracardiac • Cardiac • Infracardiac
  25. 25. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 25 Total Anomalous Pulmonary Venous Connection (TAPVC)
  26. 26. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 26 Mixed Defects  Truncus arteriosus  Failure of the embryonic artery and the truncus arteriosus to divide into the pulmonary artery and the aorta  The trunk straddles an always present VSD  Types I, II, and III
  27. 27. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 27 Truncus Arteriosus
  28. 28. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 28 Obstructive Defects  Hypoplastic left heart syndrome  Abnormal development of the left-sided cardiac structures • Obstruction to blood flow from the left ventricular outflow tract  Underdevelopment of the left ventricle, aorta and aortic arch; mitral atresia or stenosis; coarctation of the aorta  Manifestations occur early in newborn (cyanosis, tachypnea, decreased CO)  Fatal in early life if untreated
  29. 29. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 29 Hypoplastic Left Heart Syndrome
  30. 30. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 30 Heart Failure  Heart is not able to maintain cardiac output at level that meets demands of body  Result from poor ventricular function  Complication of many congenital heart defects
  31. 31. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 31 Acquired Cardiovascular Disorders  Kawasaki disease  Also known as mucocutaneous lymph node syndrome  Acute, self-limiting systemic vasculitis that may result in cardiac sequelae  Usually occurs in children under 5 years of age and in winter or spring
  32. 32. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 32 Kawasaki Disease  Stages:  Acute: capillaries, venules, arterioles, and the heart become inflamed  Subacute: inflammation of larger vessels; coronary aneurysms appear  Convalescent: medium-sized arteries begin granulation process; small vessel inflammation decreases  Post-convalescent: scarring of vessels, thickening of tunica intima, calcification, coronary artery stenosis
  33. 33. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 33 Kawasaki Disease (cont’d)  Diagnosis (five of six major findings)  Fever for 5 or more days (unresponsive to antibiotics)  Bilateral conjunctivitis without exudation  Erythema of oral mucosa (strawberry tongue)  Changes in the extremities, such as peripheral edema and erythema with desquamation of palms and soles  Polymorphous rash  Cervical lymphadenopathy
  34. 34. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 34 Acquired Cardiovascular Disorders  Systemic hypertension  In children defined as systolic and diastolic pressure that is over the 95th percentile for age and gender on at least three occasions • Hypertension in children differs from adults:  Often has an underlying disease  Renal disease or coarctation of aorta  A cause of the hypertension in children is almost always found  Children commonly asymptomatic  Seeing increased incidence of primary hypertension in older children related to obesity
  35. 35. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 35 Acquired Cardiovascular Disorders (cont’d)  Childhood obesity  Multivariable and multidimensional  Risks: • Insulin resistance, diabetes, cardiovascular disease • Childhood nutrition, level of physical activity, and engagement of sedentary activities (TV, computer use, etc.)  Association with parental obesity  Epidemic in the USA

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