paeds - cardiology (congenital heart disease & heart failure) Flashcards
embryology - Formation of heart is complete by
9 weeks gestation.
causes CHD
genes, environment & chance
- chromosomes e.g. Downs Syndrome
- Sporadic
- Family History e.g recurrence in siblings is 3-fold
- Maternal/ perinatal history e.g Infant of a diabetic mother(IDM), Rubella syndrome,Medications etc.
CHD prevention
CAAR
- Antenatal ultrasound – possible abortion if serious.
- Avoid medications, drugs and radiation in the first trimester.
- Rubella immunizations to all girls prior to puberty.
- Control diabetes during pregnancy
CHD - acyanotic
L > R shunts w/ increased pulmonary blood flow PBF
increased PBF
- VSD = ventricular septal defect
- PDA = patent ductus arteriosus
- ASD atrial septal defect
normal PBF
- pulmonary stenosis
- aortic stenosis
- congenital MS = mitral stenosis
CHD - cyanotic
increased PBF TTTCC
- Transposition of GV = great vessels
- Truncus Arteriosus
- TAPVD = Total anomalous pulmonary venous return defect
= central cyanosis of tongue & lips
= clubbing
= not relieved by oxygen admin
decreased PBF/ oligaemia TTP
- Tetralogy of Fallot
- Pulmonary Atresia
- Tricuspid Atresia
CHD associations
- downs syndrome
- trisomy 13
- Vater (L) (VSD, ano-rectal, tracheosophageal fistula, renal. limb)
- foetal alcohol syndrome
CHD complications
Complications of Every Boys Heart
- infective endocarditis (IE)
- infection of heart chambers/ valves
- vegetation of the TV = tricuspid valve - bacterial endocarditis
- brain abscess
- hemiplegia
- heart failure
complications of infective endocarditis
brain: stroke, mycotic aneurysm
eye: roth spots
skin: petechiae, red nodules/osler’s nodes, purpura/ janeway lesions
heart: infected embolus, infected clot
spleen: infarction, abscess
kidney: infarction, hematuria
fingernail bed: splinter haemorrhages
heart failure def
Is a disorder in which the heart pumps blood inadequately (not enough to support the metabolic demands of the body), leading to reduced blood flow, back-up (congestion) of blood in the veins & the lungs.
Can occur at any age, even young children especially those born with a heart defect
left sided heart failure
Impaired left ventricle function results in blood going backwards into the lungs, impairing lung function & making breathing difficult.
right sided heart failure
Accumulation of blood coming into the right ventricle (from the rest of the body ) causes congestion of fluid in the legs (oedema) and enlargement of organs e.g. liver
heart function & failure
- heart beats 60-80 x per minute & pumps approximately 5 liters per minute.
- activity the heart may pump as much as 25 liters per minute.
- In heart failure the heart is unable to increase the amount of blood with exercise.
= SOB & tiredness is experienced with walking long distances or climbing stairs
causes of heart failure in children
MAtCH
myocarditis
cardiomyopathy
heart valve disorders
abnormal connections
Myocarditis – inflammation of heart muscle caused by bacterial, viral or other infection damages heart muscle.
Cardiomyopathy – weak heart muscle due to many causes e.g. myocarditis, muscular dystrophies. Most causes are not apparent.
Heart Valve disorders – narrowing (stenosis) of a valve reduces flow through the heart, or leakage of blood backward (regurgitation) through a valve.
Abnormal connections between heart chambers e.g. VSD, PDA allow blood to recirculate within the heart, increasing the workload of the heart.
Myocarditis - HF cause
– inflammation of heart muscle caused by bacterial, viral or other infection damages heart muscle.
Cardiomyopathy - HF cause
– weak heart muscle due to many causes e.g. myocarditis, muscular dystrophies. Most causes are not apparent.
