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Mosby items and derived items 2005, 2001 by Mosby, Inc.

Cardiovascular
Dysfunction
By
Shahzad Bashir
Mosby items and derived items 2005, 2001 by Mosby, Inc.
Fetal Circulation Structures
Umbilical vein; umbilical arteries
Foramen ovale
Ductus arteriosus
Ductus venosus

Mosby items and derived items 2005, 2001 by Mosby, Inc.
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, +++ )

Mosby items and derived items 2005, 2001 by Mosby, Inc.
Older Classifications of CHD
Acyanotic
May become cyanotic
Cyanotic
May be pink
May develop CHF
Mosby items and derived items 2005, 2001 by Mosby, Inc.
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
Mosby items and derived items 2005, 2001 by Mosby, Inc.
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
Mosby items and derived items 2005, 2001 by Mosby, Inc.
Increased Pulmonary
Blood Flow Defects
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Mosby items and derived items 2005, 2001 by Mosby, Inc.
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
Mosby items and derived items 2005, 2001 by Mosby, Inc.
Pulmonic Stenosis and
Catheter Placement


Mosby items and derived items 2005, 2001 by Mosby, Inc.
Decreased Pulmonary
Blood Flow Defects
Mosby items and derived items 2005, 2001 by Mosby, Inc.
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
Mosby items and derived items 2005, 2001 by Mosby, Inc.
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 (contd)
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Surgical Interventions
Open heart
Closed heart procedures
Staged procedures
Prepare child and family for procedures
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Acquired Cardiovascular
Disorders
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 Fever
Rheumatic Heart Disease
RF
Inflammatory disease occurs after Group A
-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

Mosby items and derived items 2005, 2001 by Mosby, Inc.
Prevention of RHD
Treatment of streptococcal tonsillitis/pharyngitis
Penicillin GIM X 1
Penicillin VOral X 10 days
SulfaOral X 10 days
Erythromycin (if allergic to above)Oral X
10 days
Treatment of recurrent RF
Same as above
Mosby items and derived items 2005, 2001 by Mosby, Inc.

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