507870
Description
Mind Map by v.djabatey, updated more than 1 year ago
|
Created by v.djabatey
almost 11 years ago
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|
Presentation of congenital heart disease
- ultrasound diagnosis
- routine fetal scan btw 18-20 weeks gestation
- includes checking fetal heart anatomy
- if abnormality detected
- detailed fetal echo by paed cardiologist
- also done for fetus at increased risk
- e.g. suspected Down syn
- e.g.
sibling/mum
has
congenital
heart disease
- e.g. suspected Down syn
- also done for fetus at increased risk
- detailed fetal echo by paed cardiologist
- if abnormality detected
- 70% of
infants
needing
surgery in 1st
6 months of
life diag
antenatally
- early
diagnosis
allows for
parental
counselling
- parents' choice
- continue w/ pregnancy
- child's mx planned antenatally
- if child has duct dependet lesions mum may be offered Rx at or close to cardiac centre
- if child has duct dependet lesions mum may be offered Rx at or close to cardiac centre
- child's mx planned antenatally
- termination of pregancy
- continue w/ pregnancy
- parents' choice
- includes checking fetal heart anatomy
- routine fetal scan btw 18-20 weeks gestation
- detection of a heart murmur
- commonest
presentation of
congenital heart
disease
- innocent murmur
- most kids w/ murmurs have normal heart
- heard in 30% of kids
- hallmarks (Ss)
- aSymptomatic pt
- Soft blowing murmur
- Systolic
murmur only
(NEVER
DIASTOLIC)
- left Sternal edge
- Also
- HS I+II+0 (normal
heart sounds + no
added sounds)
- no
parasternal
thrill
- no radiation
- HS I+II+0 (normal
heart sounds + no
added sounds)
- aSymptomatic pt
- often heard
during febrile
illness or
anaemia
- due to increased cardiac output
- need to
re-examine kid
when these are
corrected
- due to increased cardiac output
- most kids w/ murmurs have normal heart
- if uncertain whether innocent or pathological
- refer to paed cardiology
- for ECHO
- for ECHO
- if older than neonate
- CXR & ECG may help
- CXR & ECG may help
- refer to paed cardiology
- pathological may not be detected till baby weeks old
- at birth pulmonary vasc res still high
- only when pul vasc res falls
may baby be symptomatic
or murmur heard (baby
several weeks old)
- at birth pulmonary vasc res still high
- commonest
presentation of
congenital heart
disease
- heart failure
- symptoms
- breathlessness
- esp on feeding or exertion
- esp on feeding or exertion
- sweating
- poor feeding
- recurrent chest infections
- breathlessness
- signs
- poor weight gain or faltering growth
- tachypnoea
- heart murmur: gallop rhythm
- heart failure-> poor quality heart sounds
- heart failure-> poor quality heart sounds
- enlarged heart
- hepatomegaly
- liver
rapidly
reflects
heart failure
- liver
rapidly
reflects
heart failure
- cool
peripheries
- poor weight gain or faltering growth
- right heart failure
- signs rare in
developed
countries
- oedema
- ankle
- sacral
- ankle
- ascites
- oedema
- seen in
- long
standing
rheumatic
fever
- pulmonary hypertension
- long
standing
rheumatic
fever
- tricuspid regurg
- right atrial dilatation
- signs rare in
developed
countries
- causes
- neonate- obstructed
(duct-dependent)
systemic circulation
[likely cause 1st week
of life]
- hypoplastic left heart syn
- critical aortic valve stenosis
- severe coarctation of aorta
- interruption
of aortic
arch
- closure of duct->
- severe acidosis
- collapse
- death unless patency of duct restored
- severe acidosis
- hypoplastic left heart syn
- infants
(high
pulmonary
blood flow
due to L to R
shunt)
- VSD
- AVSD
- large
persistent
ductus
arteriosus
- as pulmonary res falls
- pulmonary oedema
- breathlessness
- pulmonary oedema
- VSD
- older kids or
teens (R or L
heart failure)
- Eisenmenger syn
- right heart failure only
- irreversibly raised pul vasc resistance
- due to chronically raised pulmonary arterial Pa and flow
- due to chronically raised pulmonary arterial Pa and flow
- shunt is R to L
- blue teen
- heart lung transplant needed
- right heart failure only
- rheumatic heart disease
- cardiomyopathy
- Eisenmenger syn
- neonate- obstructed
(duct-dependent)
systemic circulation
[likely cause 1st week
of life]
- symptoms
- shock
- cyanosis
- peripheral
(blueness of
hands & feet)
- cold
- unwell from any cause
- polycythaemia
- cold
- central cyanosis
- slate blue tongue
- assoc w/ fall in arterial blood O2 tension
- clinically recognisable only if conc of reduced Hb > 5g/dl
- hence less pronounced if child anaemic
- hence less pronounced if child anaemic
- slate blue tongue
- check infant O2 sats
- normal = 94%+
- normal = 94%+
- persistent
cyanosis in
otherwise well
infant is
usually sign of
structural heart
disease
- causes of
cyanosis in infant
w/ resp distress
(RR> 60 b/min)
- cardiac
- cyanotic congenital heart disease
- cyanotic congenital heart disease
- resp disorders
- surfactant deficiency
- meconium aspiration
- pulmonary hypoplasia
- surfactant deficiency
- persistent pulmonary HTN of newborn
- failure of pul vasc res to fall after birth
- failure of pul vasc res to fall after birth
- infection
- septicaemia from GBS and other orgs
- septicaemia from GBS and other orgs
- metabolic disease
- metabolic acidosis
- shock
- metabolic acidosis
- cardiac
- peripheral
(blueness of
hands & feet)
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