Upload
gyles-farmer
View
223
Download
0
Embed Size (px)
Citation preview
Disorders of cardiovascular function
R Pulmonary Artery
Congenital heart disease an abnormality or anomaly of the heart,
present at birth Consequences include CHF, predisposition to
infection, alterations in growthAcquired heart disorders Abnormalities occurring after birth that
compromise the heart’s function
Congenital heart disease
Etiology/pathophysiologyEnvironmental
intrauterine rubella exposure, maternal alcoholism, DM, advanced maternal age, maternal drug ingestion
Geneticsibling or parent with heart disease, chromosomal anomalies, presence of other noncardiac congenital anomalies
Principals of fetal and postnatal circulation Types of defects- (CHD) based on
physiologic characterisitics Increased pulmonary blood flow Decreased pulmonary blood flow Obstruction to systemic blood flow Mixed blood flow
Clinical manifestations Cyanosis, pallor, cardiomegaly, pericardial rubs,
murmurs, additional heart sounds, discrepancies between apical and radial pulses, tachypnea, dyspnea, grunting, digital clubbing, hepatomegaly, splenomegaly, discrepancies between upper and lower extremity blood pressures, crackles and wheezing
Diagnostic tests Urine culture, arterial blood gases,
electrocardiogram, echocardiogram, fluoroscopy, angiography, cardiac catheterization, and cardiac mri
Defects with increased pulmonary blood flow
Communication of some type between right and left side of the heart, pressure on left side of heart pushes blood back into right side of heart and then into the lungs
Patent ductus arteriosus Can be asymptomatic or show s/s of heart failure Give indomethacin or surgery
Atrial septal defect Asymptomatic or s/s of heart failure Surgical correction- purse string stitches or
Dacron patch
Ventricular septal defect Initially asymptomatic but eventually s/s of heart
failure 50% close spontaneously, others require banding
then complete surgical repair with Dacron patch
Defects with decreased pulmonary blood flow Tetralogy of Fallot
Combination of 4 defects Pulmonary stenosis, VSD, right ventricular
hypertrophy and overriding aorta Cyanotic at birth Blalock-Taussig shunt
Mixed defects
Transposition of the great vessels Profound cyanosis if no other defects Less cyanosis if large septal defect is present
Temporary defect is created until open heart surgery to switch vessels into their proper positions
http://www.thic.com/transposition.htm
Defects with obstruction to systemic blood flow Coarctation of the aorta
Narrowing of the lumen of the aorta Increased pressure in head and upper extremities
and decreased pressure in body and lower extremities
Surgical correction