disorders of cardiovascular function. r pulmonary artery

Disorders of cardiovascular function

R Pulmonary Artery

Congenital heart disease an abnormality or anomaly of the heart,

present at birth Consequences include CHF, predisposition to

infection, alterations in growthAcquired heart disorders Abnormalities occurring after birth that

compromise the heart’s function

Congenital heart disease

Etiology/pathophysiologyEnvironmental

intrauterine rubella exposure, maternal alcoholism, DM, advanced maternal age, maternal drug ingestion

Geneticsibling or parent with heart disease, chromosomal anomalies, presence of other noncardiac congenital anomalies

Principals of fetal and postnatal circulation Types of defects- (CHD) based on

physiologic characterisitics Increased pulmonary blood flow Decreased pulmonary blood flow Obstruction to systemic blood flow Mixed blood flow

Clinical manifestations Cyanosis, pallor, cardiomegaly, pericardial rubs,

murmurs, additional heart sounds, discrepancies between apical and radial pulses, tachypnea, dyspnea, grunting, digital clubbing, hepatomegaly, splenomegaly, discrepancies between upper and lower extremity blood pressures, crackles and wheezing

Diagnostic tests Urine culture, arterial blood gases,

electrocardiogram, echocardiogram, fluoroscopy, angiography, cardiac catheterization, and cardiac mri

Defects with increased pulmonary blood flow

Communication of some type between right and left side of the heart, pressure on left side of heart pushes blood back into right side of heart and then into the lungs

Patent ductus arteriosus Can be asymptomatic or show s/s of heart failure Give indomethacin or surgery

Atrial septal defect Asymptomatic or s/s of heart failure Surgical correction- purse string stitches or

Dacron patch

Ventricular septal defect Initially asymptomatic but eventually s/s of heart

failure 50% close spontaneously, others require banding

then complete surgical repair with Dacron patch

Defects with decreased pulmonary blood flow Tetralogy of Fallot

Combination of 4 defects Pulmonary stenosis, VSD, right ventricular

hypertrophy and overriding aorta Cyanotic at birth Blalock-Taussig shunt

Mixed defects

Transposition of the great vessels Profound cyanosis if no other defects Less cyanosis if large septal defect is present

Temporary defect is created until open heart surgery to switch vessels into their proper positions

http://www.thic.com/transposition.htm

Defects with obstruction to systemic blood flow Coarctation of the aorta

Narrowing of the lumen of the aorta Increased pressure in head and upper extremities

and decreased pressure in body and lower extremities

Surgical correction