Cardiac Lecture 15 AO Lex

7/25/2019 Cardiac Lecture 15 AO Lex

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Congenital Heart Dz.(C!t."#$

%&' in ))) li*e +irts Maor cause of deat oter tan

!re-aturit in te st

ear of life /)0 etiolog is un1no2n 3N4W fetal circulation Pressure canges Flo2 canges Fora-en o*ale5PDA CHF


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Pediatric 6ndicators of CardiacDsfunction

Poor feeding

7ac!nea5 7accardia

Failure to tri*e5!oor 2eigtgain5acti*it intolerance

De*elo!-ental delas

8 Prenatal istor

8 Fa-il istor of cardiac disease


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9nderstanding HeartDefects

:lood flo2s +5c !ressure of gradients indifferent !arts of te +od ; te eartHi to lo, ta1ing !at of least resis. :lood rate>i !ressure>fast *ice *ersa i

resistance>slo2 (not al2as$ Nor-al>Rt sided !ressure?tan Lt Aorta (circ$>i ; PA (lung$>lo


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9nderstanding HeartDefects

6f tis directional flo is interru!ted 2it ase!tal defect ten te !ressure cangesand s2itces te flo +ac12ards e.g. @leftto rigt sunting

:lood returning to eart *ia SBC ; 6BCas lo2est sat lea*ing *enous +lood desat

Sats are > in RA,RB, and PA :lood entering Lt fro- lungs is full sat. Sat ; desat +lood sould not -i=


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Defects of 6ncreased

Pul-onar :lood Flo2

All a*e CHF

Canosis, clu++ing !ossi+le

ASDBSD

ABC

PDACoarct. 4f Aorta

AS,PS

74F


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Defects of 6ncreasedPul-onar :lood Flo2&ASD

ASD&a+nor-al o!ening +52atria, allo2ing +lood fro- te i

left to enter te lo rt

Re!air Surgical !atc5o!enre!air +efore scool age


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ABC defect

6nco-!lete fusion of endocardialcusions

Lo ASD and clefts of te -itral andtricus!id *al*es, creating a large AB*al*e tat allo2s +lood to flo +52 allfour ca-+ers

Most co--on ano-al in DS Re!air +anding, !atc ; reconstruct


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PDA

Failure of te fetal ductus arteriosusto close 2itin te first 2ee1s of life

Re!air 6ndo-eticin (!rostaglandinini+itor$, ligation *ia Lttoracoto-, or BA7S&*isual assisted

torasco!ic surger, coils *ia cat,full surger


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4+structed Defects

C4AAS

PS


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Coarctation of Aorta

Localized narro2ing near teinsertion of te DA, resulting in

increased !ressure !ro=i-al to tedefect (ead and 9G$ and decreased!ressure distal to te o+struction

(+od and LG$ Re!air Rese= and end to end anas.

4f aorta, +alloon angio!last


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Aortic5Pul-onic Stenosis

Narro2ed entrance at res!ecti*e*al*es

AS surgical re!air rarel results in anor-al *al*e e.g. li-it !sicalacti*it

Re!air +alloon angio


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Defects of DecreasedPul-onar :lood Flo2

74F7ricus!id Atresia


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7etralog of Fallot

Four defects BSD, PS, 4*erridingAorta, Rt. Bentricular H!ertro!

7et S!ells (!.#''$, !an sstolic-ur-ur

Aorta recei*es +lood fro- +ot*entricles

Re!air:7 sunt, -edian sternoto-and CP +!ass


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Mi=ed :lood Flo2Defects

7rans!osition of reat

Bessels7otal ano-alous!ul-onar *enousconnection

7runcus Arteriosus

H!o !lastic Lt. HeartSndro-e


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7rans!osition of te great*essels

7e PA lea*es te LB 2it noco--unication +52 te sste-ic

and !ul-onar circulations Need BSD and ASD in order to

sur*i*e

Co-!le= surgical !roceduresarterial s2itc !erfor-ed in te st2ee1s of life, creating a ne2 aorta


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H!o !lastic Lt.HeartSndro-e

9nderde*elo!-ent of te Lt. Sideresulting in a !o !lastic Lt.

Bentricle and aortic atresia. Surgical re!air ststageNor2ood

!rocedure Endstage +idirectionallenn sunt I&/ -. to relie*e

canosis and reduce te *olu-e loadon te rt. Bentricle "rdstage-odified Fontan !rocedure.


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Medications Procedures & Diagnostics

Prostaglandins Cardiac Cateterization

Digo=in 4=gen

Lasi= CP7

He!arin Cest 7u+es

6ndocin (6ndo-etacin$ Pacing

Aldactone (S!ironolactone$ G3

Anti+iotics (PCN, GGS$ Gco (GC$

Anti!ertensi*es G=ercise Stress 7est

ACG ini+itors He-oglo+in

:eta :loc1ers He-atocrit

A!resoline C: (!4E$

Co--on Medical 7reat-ent


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Reu-atic Fe*er (RF$

RF 6nfla--ator disease occurs after

grou! AJ&e-oltic stre!tococcal !arngitis

Self&li-iting

Affects oints, s1in, +rain, serous surfaces,and eart


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Clinical Manifestation of RF

Clinical -anifestation Carditis Polartritis Grte-a -arginatu-

7ransitor ras on trun1 and !ro=i-al e=tre-ities Non!ruritic

Su+cutaneous nodules 4ccur in cro!s o*er +on !ro-inences

Artralgia, fe*er, e!ista=is, a+do-inal !ain@St. Bitus Dance

%t Manifestation


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RF Manage-ent

Pri-ar !re*ention(cure grou! A +etastre!$ troat

c=5PCN Pre*ent cardiac

da-age Palliation of oter

s-!to-s (ASA,!rednisone$

Pre*ent recurrence

Gncourageco-!liance of A:Kes!. long ter-

:ed rest&el!s2it eart load

Nutrition

Corea&!ro*idesafet


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3a2asa1i Disease Acute sste-ic *asculitis, un1no2n

cause

Duration &' 2ee1s, self&li-iting

Witout treat-ent of 3D, E)0&E%0a*e cardiac co-!lications Dilation of coronar arteries (ectasia$

Coronar arter aneurs-s (giantaneurs-s ' --$

Acute, su+acute, con*alescent !ases

9suall ounger tan age % (toddlers$


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Clinical Manifestations

Hig fe*erunres!onsi*e to anti!retics5 anti+iotics

#5% signs (ras, redness5s2elling of ands and feet,crac1ed li!s5stra2+err tongue, red ees, unilaterall-!adeno!at, irrita+ilit$

A+do-inal !ain

C:C ane-ia, W:C, Platelets, GSR, CRP&ele*ation

.% c- cer*ical l-!adeno!at


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A Four-year-old boy

with the typical

features of Kawasakis

disease:+ilateral

none=udati*e

conuncti*itis (A$

dr, fissured,

erte-atous li!s

and a @stra2+errtongue ( A and :$

erte-atous and

ede-atous ands

and feet (C and

D$

an erte-atous

truncal ras (G$

a desOua-ating

!erineal ras (F$.

222. nei-.org


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Manage-ent

Gcocardiogra-

As!irin and 6--unoglo+ulin ad-inistration

Monitor Cardiac status, !ro-ote co-fort, and education

Assess eart for tac, gallo!, uo, res!. distress, andte-!erature

ASA to=icit HA, confusion, dizziness, tinnitus (Ree


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A Fall in seru- 38enances te effects ofDigo=in, increasing digo=into=icit

Digo=in to=icit *o-iting,

letarg 4=gen a drug

ad-inistered 25 a!!ro!riateorder, can +e detri-ental

6nfants rarel recei*e -ore

tan -l in one dose Hold Digo=in if eart rate6 ?/) , C ?), A ?)

7ings to 3no2

Cardiac Lecture 15 AO Lex

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