congenital heart disease msn. khetam awamreh. outline * classification of congenital heart disease....
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Congenital Heart Disease
MSN. khetam awamreh
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Outline * Classification of Congenital
Heart Disease. 1. Acyanotic Heart Disease a. Increase pulmonary blood
flow b. Obstruction of blood flow 2. Cynatoic Heart disease a. Decrease pulmonary blood
flow b. Mixed blood flow .
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A Cyanotic Heart Defect Move blood from arterial …to…venous system
A Cyanotic
Increased in pulmonary blood flow1. ASD2. VSD3. AVC4. PDA
Obstruction of blood flow form ventricle
1. Pulmonary stenosis2. Aortic stenosis
3.Coarctation of the Aorta
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* Defect with increased pulmonary blood flow
1. VSD (ventricular septal defect )
2. ASD (Atrial septal defect )
3. AVC (Atrioventricular canal defect )
4. PDA ( patent ductus artriosus)
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** 1.VSD (ventricular septal defect )
**1. VSD …30% of CHD
85% spontaneous closed
*Assessment . (4 to 8 week of age ) fatigue…murmur 3 ICS depend on P.E …thrill may be palpable..
Echo .ECG, MRI , (RT ventricle hypertrophy )
Treatment …
cardiac catheterization .. Surgery
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VSD
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** 2.ASD (blood flow from left to right atrium) Tow type ..1. Ostium primum ASD1 ( lower end of the
septum )2. Ostium secundum ASD2( center of the
septum )
**Assessment ...systolic murmur 3 ICS enlarged RT side of the heart ..increased in
pulmonary circulation…Echo.**Management …cath repaired, or open heart
surgery (1 to 3 y/d )…especially in girls **Complication ..arrhythmias …emboli
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ASD
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A trial Sepal Defect
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** 3.AVC ( Arterioventricular Canal Defect)
…Low a trial septal defect continuous with high ventricular defect and distortion of the mitral and tricuspid valve
**Assessment …Echo …surgical is important some time need new valve
**Treatment …after surgery give antibiotic and anticoagulant
Closed observation to the jaundice
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AVC
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**4.PDA ( Patent Ductus Arteriosus)
• it’s failed to closed at birth ,blood will shunt from the aorta to the pulmonary artery.
• Complete closure occurs…3 month• More common in girls than boys **Assessment ….direct after birth..P.E
cardiac catheterization**Treatment…in infant give IV or OR
indomethacin(3time \12hr or 24hr) to lower the PGE & lead to closed the
ductus closer
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Cont…PDASide effect…
1. Reduce glomerular filtration rate.
2. Impaired plat aggregation
3. Demention GI & CNS blood flow
** Treatment…
Cath at age of (6m to 1y) or surgical intervention by Thoraoctomy
If not treatment …
1. CHF
2. Infected Endocardities
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PDA
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**Obstruction of blood flow form ventricle
1.Pulmonary stenosis
2.Aortic stenosis
3.Coarctation of the Aorta
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**1.pulmonary stenosis 10%
• Narrowing in pulmonary valve • Assessment like RT side heart
failure * Systolic murmur…thrill • ECG …Echo (RT side
hypertrophy )• Treatment Balloon angioplasty
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Pulmonary stenosis
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**2. Aortic stenosis
* 7% of total cases of CHD
• Increased pressure in the LF side of the heart (LV hypertrophy)
• Assessment… murmur ,thrill ,faint pulses, high BP,high HR.
• Treatment..
- Beta-blocker or ca channel blocker to decreased hypertrophy
- Bolloon valvoplasty
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Aortic stenosis
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** 3.Coarctation of the Aorta 6% in boys more than in girls** assessment high BP in upper body part in the arm
20mmhg more than leg, headache, vertigo, epistaxis.
Assessment murmur, LV. hypertrophy ECG,Cho
• Treatment Digoxin & diuretic before surgery Surgical at the age of 2y/d end of the
aorta anastomosed
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Coarctation of the Aorta
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Cyanotic Heart Defect
Cyanotic
Decreased pulmonary blood flow
Mixed blood flow
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mixed blood flow
1. Transposition of the great Arteries
2. Total pulmonary venous return
3. Truncus Arteriosus
4. Hypo plastic left Heart Syndrome
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**1.Transposition of the great Arteries 5%
In boys more than girls
*assessment …cyanotic from birth, murmur may or not ,Echo,ECG cath.
*Treatment.
PGE to keep PDA opining
Surgical at 1week to 3months
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Transposition of the great Arteries
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** 2. Total Pulmonary venous return 2%
Pulmonary vein return to the right atrium or the superior vena cava instead of the left atrium
An absent spleen is associated with this disorder
* Treatment
Give PGE,cath, and surgical treatment
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Total Anomalous pulmonary venous return
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** 3.Truncus Arteriosus 1%
One major artery or (trunk) arises from the LF & RT ventricle in place of a separate Aorta & Pulmonary Artery
with VSD.
• Assessment … Cyanosis, murmur
• Treatment … surgical at school age
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Truncus Arteriosus
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** 4.Hypo plastic left Heart Syndrome *assessment of HLHS Infants may appear healthy at birth, but signs of
HLHS soon become apparent after the ductus arteriosus closes. These signs include the following:
Cyanosis (a blue skin, lips, fingernails and other areas of the body as a result of the lack of oxygen-rich blood to the body)
1. Heart murmur 2. Enlargement of the heart (as seen in an
echocardiogram) 3. Noticeably troubled breathing 4. Apparent weakness 5. Inability to feed normally 6. Cold extremities
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Echocardiogram
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**Defect with Decreased pulmonary blood flow
1. Tricuspid Artesia
2. Tetrology of Fallot
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**1. Tricuspid Artesia
Tricuspid valve closed no blood from RA to RV
* if still foramen ovale and PDA still open will maintain good O2 blood so you have to give PGE IV.
• If not open … sever cyanosis ,tachycardia ,dyspnea
* Treatment Surgically
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Tricuspid Atresia
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**2. Tetrology of Fallot 10%
1. Pulmonary stenosis
2. VSD *usually large*
3. dextra position (overriding of the Aorta )
4. Hypertrophy of the right ventricle.
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Tetrology of Fallot
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TOF
Assessment ..
1. Incresed activity .increased cyanosis
2. Polycythemia
3. Dyspnea, murmur
4. Growth retardation
5. Clubing finger
6. syncop
7. Hypoxic episodes with crying
8. knee/chest position
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TOF
Treatment …
1.Give O2 therapy, give morphine sulfate ,Propranol,
knee-chest position
3.Surgical …1 to 2 y/d
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Cardiac catheter