The document discusses various congenital heart diseases, including their classification, clinical presentation, diagnosis, and management. It covers cyanotic and acyanotic congenital heart defects, diseases that cause duct-dependent pulmonary circulation, transposition of the great arteries, cardiac arrhythmias, and heart failure in pediatric patients. The classification system divides congenital heart diseases into acyanotic without shunt, acyanotic with shunt, and cyanotic categories. Diagnostic testing including echocardiography, ECG, chest x-ray and cardiac catheterization are outlined. Management approaches such as prostaglandin administration, balloon dilation, and various surgical procedures are also summarized.
The lecture is for medical student. It is from Dr RUSINGIZA Emmanuel, MD, senior lecture at UR( UNIVERSITY OF RWANDA) .
It will help to understand heart diseases in newborn, infants and children.
Acyanotic Congenital Heart Diseases;
1. Left-to-right shunts
a. Ventricular Septal Defect(VSD)
b. Atrial Septal Defect(ASD)
c. Patent Ductus Arteriosus(PDA)
d. Atrioventricular Septal Defect(AVSD)
e. Aortopulmonary window
* Eisenmenger Syndrome – The shunt becomes right-to-left
2. Left-sided obstructive lesions
a. Coarctation of the Aorta(COA)
b. Congenital Aortic Stenosis
c. Mitral Stenosis
d. Interrupted Aortic Arch
Cyanotic Congenital Heart Diseases;
1. Right-to-left shunts
a. Tetralogy of Fallot
b. Pulmonary stenosis
c. Pulmonary atresia
d. Tricuspid atresia
e. Ebstein’s anomaly
2. Complete mixed lesions
a. Transposition of the great vessels
b. Double outlet right ventricle(DORV)
c. Total anomalous pulmonary venous return
d. Truncus arteriosus
e. Hypoplastic left heart syndrome
The lecture is for medical student. It is from Dr RUSINGIZA Emmanuel, MD, senior lecture at UR( UNIVERSITY OF RWANDA) .
It will help to understand heart diseases in newborn, infants and children.
Acyanotic Congenital Heart Diseases;
1. Left-to-right shunts
a. Ventricular Septal Defect(VSD)
b. Atrial Septal Defect(ASD)
c. Patent Ductus Arteriosus(PDA)
d. Atrioventricular Septal Defect(AVSD)
e. Aortopulmonary window
* Eisenmenger Syndrome – The shunt becomes right-to-left
2. Left-sided obstructive lesions
a. Coarctation of the Aorta(COA)
b. Congenital Aortic Stenosis
c. Mitral Stenosis
d. Interrupted Aortic Arch
Cyanotic Congenital Heart Diseases;
1. Right-to-left shunts
a. Tetralogy of Fallot
b. Pulmonary stenosis
c. Pulmonary atresia
d. Tricuspid atresia
e. Ebstein’s anomaly
2. Complete mixed lesions
a. Transposition of the great vessels
b. Double outlet right ventricle(DORV)
c. Total anomalous pulmonary venous return
d. Truncus arteriosus
e. Hypoplastic left heart syndrome
WEIGHT MANAGEMENT Do it yourself Motivation and TipsRyan Fernando
A weight management presentation delivered at GOA in Jan 2013. Small tips to help you understand weight loss and what you should really be doing to start of as soon as you can!
Hypertension, its causes, types and managementAbu Bakar
hypertention,it's causes, epidemiology, mechanism,primary and secondary hypertention, preeclampsia and eclampsia, disease related hypertention, classification, dietary plan, diagnosis, clinical presentation, drug related hypertention, treatment,
Kindly leave your comment if you found this helpful ;)
Some of the slides, i hide it from my real presentations for my own reference. Download to see all of them.
A detailed discussion on embryogenesis of heart and ennumeration of all congenital diseases and description of cyanotic congenital heart disease , each disease in detail.
arrythmias and cardiac tumorsCone excision of the major ducts (subareolar res...ssuser8eb265
Cone excision of the major ducts (subareolar resection). When the duct of origin of nipple bleeding is uncertain or when there is bleeding or discharge from multiple ducts, the entire major duct system
it is a term used to refers to several kidney disease (both kidney) characterized by inflammation either of the glomeruli or of the small blood vessels in the kidney. but not all the disease necessarily have an inflammatory component.
It occurs due to repeated episodes of acute nephritic syndrome, nephrosclerosis and hyperlipidemia.
A curriculum Plan is the advance arrangement of learning opportunities for a particular population of learners.
Curriculum guide is a written curriculum.
Curriculum Planning is the process whereby the arrangement of curriculum plans or learning opportunities are created.
Master rotation plan is the overall plan of rotation of all students in a particular educational institution, showing the placement of the students belonging to total programme (4 years in B.Sc.(N) and 3 years in GNM) includes both theory and practice denoting the study block, partial block, placement of student in clinical blocks, team nursing, examinations, vacation, co-curricular activities etc.
Curriculum Evaluation is the process of collecting data on a programme to determine its value or worth with the aim of deciding whether to adopt, reject, or revise the programme.
Indian citizens possessing foreign nursing qualification are examined individually & after examination the syllabi and conformation from concerned foreign authorities, the nurses are granted approval for registration in India with the recommendation of equivalence committee under Section 11(2)(a) INC Act. 1947.
A model is a three-dimensional representation of a person or thing or of a proposed structure, typically on a smaller scale than the original:"a model of St. Paul's Cathedral“
A Model is a pattern of something to be made or reproduced and means of transferring a relationship `or process from its real (actual) setting to one which it can be more conveniently studied.
Curriculum development is a process in which participants at many levels make decisions about the purposes of learning, teaching- learning situation.
It is the process of gathering, setting, selecting, balancing and synthesizing relevant information from many sources in order to design the goals of curriculum.
Let’s examine what happens in each step of the curriculum development/revision cycle. This cycle is a dynamic system that helps each school re-vitalize and replenish what is taught to its students.
Determinants of curriculum are the factors that affect the process of assessing needs, formulating objectives and developing instructional opportunities and evaluations.
The term philosophy is derived from the Greek word Philein meaning to love, to strive after or search for and from the word Sophia which means wisdom.
Therefore, Philosophy is the search for wisdom by philosophers.
Teachers use curricula when trying to see what to teach to students and when, as well as what the rubrics should be, what kind of worksheets and teacher worksheets they should make, among other things.
It is actually up to the teachers themselves how these rubrics should be made, how these worksheets should be made and taught; it's all up to the teachers.
Perception (from the Latin perceptio) is the organization, identification, and interpretation of sensory information in order to represent and understand the presented information, or the environment.
The somatoform disorders are a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition. Medically unexplained physical symptoms account for as many as 50% of new medical outpatient visits. [1] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [2] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms.
Somatization in children consists of the persistent experience and complaints of somatic distress that cannot be fully explained by a medical diagnosis. They can be represented by a wide spectrum of severity, ranging from mild self-limited symptoms, such as stomachache and headache, to chronic disabling symptoms, such as seizures and paralysis. These psychological disorders are often difficult to approach and complex to understand. It is important to note that these symptoms are not intentionally produced or under voluntary control.
In somatoform disorders, somatic symptoms become the focus of children and their families. They generally interfere with school, home life, and peer relationships. These youngsters are more likely to be considered sickly or health impaired by parents and caretakers, to be absent from school, and to perform poorly in academics. Somatization is often associated temporarily with psychosocial stress and can persist even after the acute stressor has resolved, resulting in the belief by the child and his or her family that the correct medical diagnosis has not yet been found. Thus, patients and families may continue to seek repeated medical treatment after being informed that no acute physical illness has been found and that the symptoms cannot be fully explained by a general medical condition. When somatization occurs in the context of a physical illness, it is identified by symptoms that go beyond the expected pathophysiology of the physical illness.
Recurrent complaints often present as diagnostic and treatment dilemmas to the primary care practitioner (PCP) who is trying to make sense of these symptoms. The PCP may feel poorly prepared and/or may have little time to assess or treat the somatic concerns. While the more disabling somatic complaints are more likely to be referred to a mental health professional, these youngsters presenting with these disabling physical symptoms bridge both medical and psychological domains and present a puzzling quandary for professionals from either field if working with them alone. [3] The nature of these symptoms requires an integrated medical and psychiatric treatment approach to successfully decrease the impairment caused by these disorders.
Schizophrenia is a mental disorder that usually appears in late adolescence or early adulthood. Characterized by delusions, hallucinations, and other cognitive difficulties, schizophrenia can often be a lifelong struggle. In this article, we will cover the causes, symptoms, and treatment of schizophrenia
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LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
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COVID-19 PCR tests remain a critical component of safe and responsible travel in 2024. They ensure compliance with international travel regulations, help detect and control the spread of new variants, protect vulnerable populations, and provide peace of mind. As we continue to navigate the complexities of global travel during the pandemic, PCR testing stands as a key measure to keep everyone safe and healthy. Whether you are planning a business trip, a family vacation, or an international adventure, incorporating PCR testing into your travel plans is a prudent and necessary step. Visit us at https://www.globaltravelclinics.com/
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Under Pressure : Kenneth Kruk's StrategyKenneth Kruk
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Rate Controlled Drug Delivery Systems, Activation Modulated Drug Delivery Systems, Mechanically activated, pH activated, Enzyme activated, Osmotic activated Drug Delivery Systems, Feedback regulated Drug Delivery Systems systems are discussed here.
This document is designed as an introductory to medical students,nursing students,midwives or other healthcare trainees to improve their understanding about how health system in Sri Lanka cares children health.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
3. 01/09/15 3
CLINICAL CLASSIFICATION OF
CONGENITAL HEART DISEASES
Cardiac Malpositions- Ectopia cordis
Dextrocardia
Acyanotic without a shunt–
Malformations on left side
Malformations on right side
Acyanotic with a shunt
Cyanotic
4. 01/09/15 4
Acyanotic without a shunt
Left sided malformations
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Coarctation of aorta
5. 01/09/15 5
Acyanotic without a shunt
Right sided malformation
Ebsteins anomaly of Tricuspid valve
Pulmonary stenosis
Pulmonary regurgitation
Primary pulmonary hypertension
6. 01/09/15 6
Acyanotic with a shunt
Shunt at atrial level
ASD
PAPVC
Shunt at ventricular level
VSD
Shunt at great artery level
PDA
AP Window
Shunt at more than one level
7. 01/09/15 7
Acyanotic without a shunt
Left sided malformations
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Coarctation of aorta
8. 01/09/15 8
Aortic Stenosis
Age
Symptoms
Types
Valvular
Supra valvular
Sub valvular
Clinical Presentation
Management
9. 01/09/15 9
Coarctation of Aorta
Age
Types
Pre ductal
Post ductal
Clinical presentation
Associations
Management
Age of intervention
Surgery // Cath based intervention
10. 01/09/15 10
Acyanotic without a shunt
Right sided malformation
Ebsteins anomaly of Tricuspid valve
Pulmonary stenosis
Pulmonary regurgitation
Primary pulmonary hypertension
13. 01/09/15 13
Acyanotic with a shunt
Shunt at atrial level
ASD
PAPVC
Shunt at ventricular level
VSD
Shunt at great artery level
PDA
AP Window
Shunt at more than one level
14. 01/09/15 14
VSD
Types – based on location
Size
With or without PAH
Associations
Clinical features
Management
19. 01/09/15 19
Cyanotic lesions
Tetralogy of Fallots
Tricuspid atresia
Transposition of Great arteries
Truncus arteriosus
Single ventricle
Hypoplastic left heart syndrome
Eisenmenger Syndrome
20. 01/09/15 20
Classification of Cong Cyanotic
Heart diseases
Pulmonary stenosis, without VSD
Critical PS, Ebsteins
Pulmonary Stenosis with Large VSD
TOF
Increased Pulmonary flow with/ without PAH
TGA ( Transposition of great arteries )
Decreased pulmonary flow with PAH
Eisenmenger Syndrome
Pulm venous congestion with PAH
TAPVC, HLHS
Cyanosis without Pulm stenosis , Normal PA pressure
Single atrium, Pulm AV fistula
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Clinical Characteristics of TOF
Prominent a wave in JVP
Normal heart size
Mild parasternal impulse
Systolic thrill – though uncommon
Single second sound ( P 2 absent )
Ejection systolic murmur
Diastolic period clear
Decreased pulmonary flow on Chest X ray
25. 01/09/15 25
Congenital Cyanotic Heart diseases
Ejection Systolic Murmur / Pan systolic murmur
Continuous murmur
TOF with
PDA
Bronchial collaterals
Surgically created shunts ( BT shunt )
Peripheral PS
26. 01/09/15 26
DIFFERENTIAL DIAGNOSIS
Tetralogy of Fallot
Transposition of Great Arteries, VSD, PS
Tricuspid atresia, VSD, PS
Single ventricle, PS
Double outlet right ventricle, VSD, PS
Corrected transposition of great arteries, VSD,PS
AV Canal defects with PS
Eisenmenger’s Syndrome
27. 01/09/15 27
Assessment of Severity
Cyanosis – More the cyanosis more severe the disease
but mild cyanosis also to be taken seriously
Age of onset – earlier the onset more severe the lesion
Symptoms – more the symptoms more severe the
disease
29. 01/09/15 29
ECG in CHD
Rate, Rhythm
Look at P wave in Lead I
PR interval
QRS axis ( Left / Right )
RVH, LVH, Bivebtricular Hypertrophy
Incomplete / Complete RBBB
30. 01/09/15 30
X Ray Chest
Cardiac Size
C T Ratio
Pulmonary Vascularity
Classical images
32. 01/09/15 32
Management of TOF
Age of presentation
Severity of symptoms
Anatomical considerations
Palliative - Shunts
Definitive
33. 01/09/15 33
Management of Complex
CHD
Define anatomy by Echo, if required
Cath/ MRI/ CT Angio
Decide whether Two Ventricle repair is
possible or not
Glenn shunt
Fontan repair
36. 01/09/15 36
Reversal of shunt in following with development of
Pulmonary arterial hypertension
Eisenmenger’s Syndrome
Shunt at atrial level
ASD
PAPVC
Shunt at ventricular level
VSD
Shunt at great artery level
PDA
AP Window
Shunt at more than one level
AV Canal defect
Patients with Cyanotic Heart diseases with Increased pulmonary blood
flow – TGA, TAPVC
37. 01/09/15 37
Characteristics with
Eisenmenger physiology
History of frequent chest infections
Age of onset of cyanosis?
No cardiomegaly or thrill
No parasternal heave
Constant ejection click of PAH
Palpable P 2
Diastolic murmur of PR or systolic
murmur of TR
45. 01/09/15 45
Principles of Therapy
Removal of underlying cause
- Surgical Correction
- Medical m/m of IE
Removal of Precipitating cause
- Intercurrent Infections
- Arryhthmias
- Anemia
46. 01/09/15 46
DUCT DEPENDENT PULMONARY
CIRCULATION
DEFINITION
Complete absence or severe restriction
of antegrade pulmonary blood flow
resulting in severe hypoxemia with
dependance on a patent arterial duct to
maintain pulmonary perfusion
compatible with life
47. 01/09/15 47
Duct Dependant Pulmonary
Circulation
ETIOLOGY
A) Anatomical restriction/discontinuity of
ventricle and pulmonary artery
B) Admixture lesions- TGA
C) Functional pulmonary atresia
Severe Ebsteins anomaly
Hypoplastic right ventricle without PS
48. 01/09/15 48
DUCT DEPENDANT PULMONARY
CIRCULATION
Clinical Presentation
90% have progressive hypoxemia,
cyanosis,acidosis 1-7 days after birth
5% present in
infancy/childhood,adolescent
Rarely heart failure ( PS with TR, PA
intact septum)
51. 01/09/15 51
DUCT DEPENDANT PULMONARY
CIRCULATION
MANAGEMENT
Early recognition- Key
Structural diagnosis- Less crucial
52. 01/09/15 52
DUCT DEPENDANT PULMONARY
CIRCULATION
MANAGEMENT
Secure good I/V and I/A line
Correction of acidosis
Volume -colloid(5% Albumin 5-10ml/Kg)
53. 01/09/15 53
DUCT DEPENDANT PULMONARY
CIRCULATION
MANAGEMENT
Prostaglandin- Life saving
Oxygen(?)
Balloon Dilation of duct
Stenting of Duct
Surgery
54. 01/09/15 54
DUCT DEPENDANT PULMONARY
CIRCULATION
MANAGEMENT
Prostaglandin
Before transfer-0.01mcg/kg/min I/V
Tertiary centre- 0.1mcg/kg/min scale to
0.05-0.01mcg/kg/min I/V
Oral- 12-65 mcg/kg at 4hrly interval
55. 01/09/15 55
DUCT DEPENDANT PULMONARY
CIRCULATION
MANAGEMENT
Prostaglandin- predictors of
response
Widely open duct- Nil
Closed duct-Nil
Constricted duct- Best response
57. 01/09/15 57
DUCT DEPENDANT PULMONARY
CIRCULATION
VENTILATION
Transport to tertiary centre
Apnea of prostaglandin( premature, LBW)
Stabilisation of the sick child
58. 01/09/15 58
TRANSPOSITION COMPLEX
TGA intact septum/Small VSD
Diagnosis- Echocardiography
100% detection rate
ASD size- need for septostomy
PDA size-need for prostaglandin
59. 01/09/15 59
TRANSPOSITION COMPLEX
TGA intact septum/Small VSD
Management
a) Stable, no acidosis - BAS Plan Sx
b) Acidosis,severe hypoxemia- PGE
BAS
c) Transfer- PGE (?Ventilation) BAS
64. 01/09/15 64
Long term treatment
Long term treatment till cath ablation is
safe or LV dysfunction
Digoxin/B blockers
Verapamil
Amiodarone/Sotalol
Flecanide
65. 01/09/15 65
Symptomatic second or third degree AV
block
SA node Dysfunction , symptoms
correlating with ↓ HR
Persistent ( > 7days) post op second or
third degree AV block
contd….
Indications of Permanent Pacemaker Implantation
66. 01/09/15 66
Indications of Permanent Pacemaker
Implantation
Congenital AV Block with
a. Wide QRS escape
b. HR < 50-55 bpm in infancy
without
ass structural CHD
c. HR < 70 bpm with ass structural
CHD
72. 01/09/15 72
SUCCESSFUL
SEPTOSTOMY
Cinical improvement
Equalization of atrial pressures
Change in arterial O2 saturation
Angiogram before and after septostomy
Increase in arterial pressure
Decrease in pulmonary arterial pressure
Balloon calibration of defect
Echo visualization of defect
73. 01/09/15 73
BALLOON DILATATION OF
STENOTIC VALVES
Balloon dialtation of
Aortic valve
Pulmonary valve
Coarctation of aorta
74. 01/09/15 74
BALLOON DILATATION OF
THE AORTIC VALVE
Palliative procedure
Procedural success is almost 100%
Mortality may be high if associated conditions
Endocardial fibroelastosis
LV hypoplasia
Others
Risks- aortic regurgitation
76. 01/09/15 76
AORTIC VALVULOPLASTY
PRE DILATATIONPRE DILATATION BALLOON ACROSSBALLOON ACROSS
THE AORTIC VALVETHE AORTIC VALVE
POST DILATATIONPOST DILATATION
NO ARNO AR
77. 01/09/15 77
BALLOON DILATATION OF
PULMONARY VALVE
Neonatal critical Pulmonary stenosis
Majority present during first week
Duct dependant (require PGE1)
RV morphology- well developed or
poorly developed
Echo assessment
Immediate success rate > 80%
79. 01/09/15 79
Pulmonary valvotomy and VSD closurePulmonary valvotomy and VSD closure
Effective balloon diameter should be 1.2 to 1.4 timesEffective balloon diameter should be 1.2 to 1.4 times
the measured Pulmonary Valve Annulusthe measured Pulmonary Valve Annulus
80. 01/09/15 80
Pulmonary valvotomy and VSD closurePulmonary valvotomy and VSD closure
Effective balloon diameter should be 1.2 to 1.4 timesEffective balloon diameter should be 1.2 to 1.4 times
the measured Pulmonary Valve Annulusthe measured Pulmonary Valve Annulus
81. 01/09/15 81
Pulmonary valvotomy and VSD closurePulmonary valvotomy and VSD closure
Effective balloon diameter should be 1.2 to 1.4 timesEffective balloon diameter should be 1.2 to 1.4 times
the measured Pulmonary Valve Annulusthe measured Pulmonary Valve Annulus
82. 01/09/15 82
BALLOON DILATATION OF
COARCTATION
Controversial role in neonates
Indications
Symptomatic newborn
CCF
Failure to thrive
Upper extremity hypertension
Severe LV dysplasia
Severe PAH
94. 01/09/15 94
Coil closure of PDA
Coil closure for small ducts
Coil made up of stainless steel wire with
Dacron strands – promote thrombosis
Cheap
PROCEDURE
96. 01/09/15 96
Device closure of ASD
Amplatzer septal occluder device is most
widely used
Only used for Secundum ASD
Continuous TEE monitoring
Adequate rim is required otherwise any size
of ASD can be closed
PROCEDURE
102. 01/09/15 102
Device closure of VSD
Amplatzer device for Muscular VSD
Amplatzer device for Peri membranous
VSD – defect >5 mm away from aortic
valve
PROCEDURE