Heart defects
1. Defintion
2. Etiology
3. Classification
4. Pathogensis
5. Leading symptoms and syndromes
6. Diagnosis
7. Treatment
VSD
1. birth defect of the heart in which there is a hole in the septum that separates the two lower
ventricles
2. impaired organogenesis at 3-8 weeks of fetal development,
Hereditary
Chromosomal abnormalities, mutation of single genes
Environment factor which includes the drugs mother takes, pollution.
3. Depending on size
Small <3mm or large.
4.
5. Cardiomegaly: heart hump
Right ventricular heart failure most often develops with nonspecific lung diseases. It is
accompanied by shortness of breath (increased breathing depth), rapid progression of cyanosis,
swelling of the cervical veins, enlargement of the liver and its densification, enlargement of the
spleen, anorexia, abdominal and chest pain, stool disorders, disorders of blood supply to the
brain (sleep disorders, headache), the development of oligo- and anuria.
Pulmonary hypertension
Eisenmeneger syndrome: Bluish lips, fingers, toes, and skin (cyanosis)
Rounded fingernails and toenails (clubbing), Coughing up blood. Dizziness or faintin
Cardiovascular (cardiovascular) syndrome can be manifested by cardiac arrhythmias
(tachycardia)
6. Chest x ray: shows cardiomegaly and increased pulmonary vascular pattern
ECG: right ventricular hypertrophy or combined ventricular hypertrophy and sometimes left
atrial enlargement
Echocardiography:, Defect in the septum: This is the most important finding and is usually seen
in the apical four-chamber view. PASP >50mmgh
Increased blood flow through the defect: This can be seen as a turbulent jet of blood flowing
from the left ventricle to the right ventricle.
Enlargement of the right ventricle and right atrium: This can occur due to the increased blood
flow through the defect.
Pulmonary hypertension: This can be seen as increased blood pressure in the lungs.
Increased flow across the mitral and tricuspid valves: This can occur due to the increased blood
flow through the defect.
Abnormalities of the aortic valve
pulse oximetry:
At
auscultation There is a splitting of the second tone in the second intercostal space on the left at
the sternum, its accentuation may be observed. A rough systolic murmur is heard along the left
edge of the sternum with a maximum sound in the third intercostal space on the left and a large
distribution area.
In some children, diastolic murmurs of relative pulmonary valve insufficiency are also heard:
- Graham-Still murmur - appears as a result of increased pulmonary circulation in the pulmonary
artery and with an increase in pulmonary hypertension; is heard in the 2-3 intercostal space to
the left of the sternum and is well carried up to the base of the heart;
- Flint's murmur - occurs as a result of relative mitral stenosis, which appears with a large cavity
of the left atrium, due to a large arteriovenous discharge of blood through the defect; better
defined in Botkin point and is carried out to the apex of the heart.
7. Severe cases, surgery
ASD
1. a hole in the wall between the heart's two upper chambers
2. impaired organogenesis at 3-8 weeks of fetal development,
Hereditary
Chromosomal abnormalities, mutation of single genes
Environment factor which includes the drugs mother takes, pollution.
3. Ostium secundum, ostium primum: defect on the anterior side of the septum
4. underdevelopment of the primary and secondary interatrial septum and endocardial ridges in
the embryonic period. From hole blood is shunted from the LA to RA during the systole 2. Lung
plethora: increased pulmonary blood flow 3. Rtight ventricular hypertrophy.
5. large shunts may cause slow weight gain in early childhood, exercise intolerance,
shortness of breath on exertion, fatigue
6.
7.
Tetralogy of fallot
1. a large ventricular septal defect, right ventricular outflow tract obstruction (pulmonary valve
stenosis) , right ventricular hypertrophy and aortic dextraposition.
2. Causes environmental factor, family history, genetic effect, infection of mother by rubella….
3.
4. Cyanosis may come in sudden spells, called tet spells, when a baby is
crying or feeding. It happens when a baby's blood oxygen level drops
quickly. During the spell, babies may have a hard time breathing. In the
most extreme circumstances, they may go limp or lose consciousness.
Other symptoms of tetralogy of Fallot at birth may include: Difficult or rapid
breathing Fatigue Fussiness Heart murmur Trouble feeding or gaining
weight delayed metal development, and physical development in severe
cases, shortness of breath at rest, “drumsticks” and “watch glasses” occur in
older children.
5.
Pulse oximetery
Heart rate
6.
propranolol 1 mg/kg/day in 3 divided doses
patent ductus arteriosus
1. persistence of the fetal connection (ductus arteriosus) between the aorta and pulmonary artery
after birth.
2. Premature birth, family history, presence of other congential heart diseases,infection of rubella
during preganacy.
3. The large duct causes a strong left-to-right shunt . If uncorrected, over time a large shunt leads
to left heart enlargement, pulmonary artery hypertension, and increased pulmonary vascular
resistance, ultimately leading to Eisenmenger syndrome.
4. Usallya asymptomatic, symptoms increased fatigue and shortness of
breath. However, the most characteristic of the defect are frequent respiratory
diseases and pneumonia in the first and second years of life, and retardation in
physical development,cyanosis of lower extremities. systole-diastolic murmur is
detected above the heart with the epicenter above the pulmonary artery
(anatomical definition of projection). The nature of the noise is often compared to
“the noise of a top,” “the noise of a mill wheel,” “machine noise,” “the noise of a
train passing through a tunnel.” With the development of pulmonary
hypertension, an accent of the second tone appears at the same point.
5. F
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