Cardiac Disease Of The Newborn Flashcards
3 important shunts in the newborn
PFO
Aterial ductus
Venous ductus liver
What changes take place at birth and the timing
Cardiac
Breathing
Pulmonary vascular resistance PVR decreases (drops 4-8/52)/ more with oxygen decreases resistance
Systemic vascular resistance increases
Closure of shunts PFO, Ductus arteriosis , ductus venosis
Syndromes association with congenital cardiac problems
Down’s syndrome AVSD
Turners Sx CoA/ bicuspid aorta
Velocardial Facial syndrome VSD, T of F/ Ca++ levels
Congenital Cardiac disease how does it present
1 cyanosis OR
2 CCF tachyponea/ increased WOB
Poor feeding HMG, Tachycardia
Incidence of Congenital heart disease
6-8/1000
VSD features
Commonest type of CHD
VSD many different points and this effects outcome
Eg high assoc with valvular disease and rarely close
Peri membranous rarely close
VSD presents about 6/52 Left to right shunt
Murmur not present at birth the pressures are the same no mumrmur
As time goes on the PVR decreases and the pressure gradient increases across the right and left ventricle and therefore you get murmur
don’t give O2 as this decreases the PVR and makes the murmur worse
long term untreated VSD pulmonary a damage
If CCF treat with diuretics
CoA of aorta
Presentation varies greatly
Poor feeding
Poor weight gain
Metabolic collapse
Decrease femoral pulses BP can be different in the upper and lower limbs
Ductus closes 3-7 days and that shows the CoA symptoms
TREAT PROSTIN reopens the ductus
Tetralogy of Fallot
Cyanotic heart disease 2 things 1 large VSD right to left shunt 2 tight/narrowing of right vent outflow/pulmonary a stenosis and all the blood mixes and goes into the aorta Cyanosis If they do have increased Pulmonary flow CCF and increased WOB Tet spells Murmurs
Aortic stenosis
Too little systemic blood flow
Treat with PROSTIN keeps the ductus open and this helps flow
Otherwise catheter
Surgery
Transposition of the great vessels TGA
Aorta comes out of the right ventricle Pulmonary a comes out of the left V End up with parallel circulation CYANOSIS at birth USS 18-20/52 may pick up TREAT make the PDA larger
Murmurs that would concern
Loud Diastolic Continuous Associate with other abnormalities eg cyanosis FTT poor feeding HMG
CXR changes in CHD
Increased Pul blood flow
Large heart size
Abnormal cardiac contour
Blood test are helpful in CHD
ABG
Ca++ LOW in VCFS
Genetic Down’s syndrome, Turners VCFD
Management principals
LARGE VSD
Cyanosis
Large VSD too much blood flow to lungs wet lungs Diurectics
Avoid Oxygen and may need pulmonary a banding ( prevents the increased pressure that damages the pulmonary a
Cyanosis too little blood flow to lungs PROSTIN PGE1
Catheter
Surgery
Arrhythmias in new born
SVT Atrial Flutter Complete heart block Prolonged QT VT
SVT
Accessory short circuit leads to increased rate
Treat a gal maneuvers iced cold water
2 adenosine AV node blocked - SR
3 often further episodes
4 long term 2/3 resolve by 12/12 age
5 cease anti arrhythmia meds 6/23
6 1/3 will need ablation of the accessory pathway
Long QT
1/2500 Inherited autosomal dominant Abnormal K+/Na+ channels Risk of VF/VT 10% SIDS
If parents have prolonged qt ECG and if neonatal QT b blocker
Innocent murmur features
Murmur found in a very normal child completely normal examination Systolic murmur Ejection murmur Musical Grade 2-3/6 Changes with body position sitting /standing may go away Varies with review Augmented by illness
Ix. May do nothing
ECG don’t forget paed population different standards RHS dominant
CXR ?CCF
ECHO needs a paed cardiologist doing it
Clues of a congenital heart murmur /problem
Appearance of the child eg Down’s syndrome other facial changes
FTT
Cyanosis ( pO2 <85%) periph vs central ( look in the mouth)
Symptoms of CCF. Tachyponea/ poor feeding/ poor exercise tolerance
Clubbing ( late sign) BP ( CoA of A)
Pulses UL/LL. Hepatomegally
Commonest lesions CHD
VSD Persistent Ductus Arteriosis ASD Pulmonary valve stenosis Aortic stenosis CoA of Aorta Tetralogy of fallout Cyanotic Transposition of the great vessels. Cyanotic
Long term consequences of Cyanotic heart disease
Hypoxia
Myocardial dysfunction
Increased risk of thromobisis infection embolus
Neurological effects CVA/ plagia/ abscess
ANC 18-20 week uss normal does not rule out significant congenital heart disease
It will pick about 35-40% but some are normal
Eg ASD and patent ductus arteriosis so wont be commented on
Don’t be lulled into a false sense of security
Prophlaxisis antibiotics
What is and what lesions do you use if for
1 cyanotic heart disease
2 6/12 post cardiac surgery
3 prosthetic valves
4 Rh heart disease
Big thing is to have regular dental check ups avoid dental caries
General care of CHD
1 growth/nutrition 2 CVS risk factors 3 exercise 4 antibiotic prophlaxisis 5 dental care 6 general infections 7 immunizations 8 psychological well-being support the families /stressors
