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Cardiovascular Dysfunction By Shahzad Bashir

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Fetal Circulation Structures • Umbilical vein; umbilical arteries

• Foramen ovale

• Ductus arteriosus

• Ductus venosus

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Changes at Birth

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Pediatric Indicators of Cardiac Dysfunction• Poor feeding

• Tachypnea/ tachycardia

• Failure to thrive/poor weight gain/activity intolerance

• Developmental delays

• + Prenatal history

• + Family history of cardiac disease

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Two Types of Cardiac Defects• Congenital

– Anatomic>abnormal function

• Acquired

– Disease process • Infection• Autoimmune response• Environmental factors• Familial tendencies

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CHD• Incidence: 5-8 per 1000 live births

– About 2-3 of these are symptomatic in first year of life

– Major cause of death in first year of life (after prematurity)

– Most common anomaly is VSD– 28% of kids with CHD have another

recognized anomaly (trisomy 21, 13, 18, +++ )

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Older Classifications of CHD• Acyanotic

– May become cyanotic

• Cyanotic

– May be pink

– May develop CHF

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Newer Classification of CHD• Hemodynamic characteristics

– Increased pulmonary blood flow

– Decreased pulmonary blood flow

– Obstruction of blood flow out of the heart

– Mixed blood flow

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Increased Pulmonary Blood Flow Defects• Abnormal connection between two sides

of heart

– Either the septum or the great vessels

• Increased blood volume on right side of heart

• Increased pulmonary blood flow

• Decreased systemic blood flow

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Increased Pulmonary Blood Flow Defects• Atrial septal defect

• Ventricular septal defect

• Patent ductus arteriosus

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ASD

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VSD

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PDA

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Obstructive Defects• Coarctation of the aorta

• Aortic stenosis

• Pulmonic stenosis

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Coarctation of the Aorta

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Aortic Stenosis

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Pulmonic Stenosis and Catheter Placement

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Decreased Pulmonary Blood Flow Defects

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Tetralogy of Fallot

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Tricuspid Atresia

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Mixed Defects• Transposition of great vessels

• Total anomalous pulmonary venous connection

• Hypoplastic heart syndrome

– Right

– Left

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Transposition of Great Vessels

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Totally Anomalous Pulmonary Venous Connection

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Hypoplastic Left Heart

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CHF in Children• Impaired myocardial function

– Tachycardia, fatigue, weakness, restless, pale, cool extremities, decreased BP, decreased urine output

• Pulmonary congestion– Tachypnea, dyspnea, respiratory distress,

exercise intolerance, cyanosis• Systemic venous congestion

– Peripheral and periorbital edema, weight gain, ascites, hepatomegaly, neck vein distention

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Interventional Cardiac Catheter Procedures in Children • Transposition of great vessels

• Some complex single-ventricle defects

• ASD

• Pulmonary artery stenosis

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INTERVENTION

Balloon dilation

Balloon dilation

Balloon dilation

DIAGNOSIS

Valvular pulmonic stenosis

Recurrent coarctation of aorta

Congenital mitral stenosis

Interventional Cardiac Catheter Procedures in Children (cont’d)

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Surgical Interventions• Open heart

• Closed heart procedures

• Staged procedures

• Prepare child and family for procedures

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Acquired CardiovascularDisorders

Infectious and Inflammatory Cardiac Disorders

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Endocarditis

• Subacute bacterial endocarditis

• Infective endocarditis

• Strep

• Staph

• Fungal infections

• PROPHYLAXIS: 1 hr before procedures (IV) or may use PO in some cases

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Rheumatic FeverRheumatic Heart Disease• RF

– Inflammatory disease occurs after Group A – ß-hemolytic streptococcal pharyngitis

• Affects joints, skin, brain, serous surfaces, and heart

• Rheumatic heart disease– Most common complication of RF– Damage to valves as result of RF

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Prevention of RHD • Treatment of streptococcal tonsillitis/pharyngitis

– Penicillin G—IM X 1

– Penicillin V—Oral X 10 days

– Sulfa—Oral X 10 days

– Erythromycin (if allergic to above)—Oral X 10 days

• Treatment of recurrent RF

– Same as above

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Thanks