Congenital Heart Disease Year 4 Paediatrics Notes OmpathStudy

Congenital Heart Disease Year 4 · Paediatrics Collection: 4TH YEAR ALL NOTES / PAEDS / OTHER NOTES -- SMLE essential topic!\n\n Pediatrics Tea\nmWor\n43\nK\n7\nCongenital Heart\nDiseases\nDone by: Balqes Alrajhi Marwah Alkhalil\n\n Revised by: Aseel Badukhon\n\nTeam Leader: Aseel Badukhon\n\n Notes Previous Notes Book Important! \n\n Overview\n\n Epidemiology Congenital heart disease (CHD) ~ 1% of live births:\n\n Ventricular septal Pulmonary valve\ndefect (VSD)\n30%\nMost common stenosis (PS)\n7%\nPatent ductus Coarctation of aorta\narteriosus (PDA)\n12% (CoA)\n5%\nAtrial septal defect Tetralogy of fallot\n(ASD)\n7% (TOF)\n5%\n\n Aortic valve stenosis\n(AS)\n5%\nAtrioventricular septal\ndefect (AVSD)\n2%\nD-transposition of\ngreat arteries (D-TGA)\n5%\n\n Etiology Etiology: Mostly unknown \n● Chromosomal abnormalities (10%)\n- Trisomy 21: AVSD\n- Trisomy 18: complex\n- Trisomy 13: complex\n- DiGeorge Syndrome: interrupted aortic arch, conotruncal abnormalities\n- Turner syndrome: Coarctation of Aorta, Bicuspid aortic valve\n- Williams Syndrome: Supra-aortic stenosis, Pulmonary branches stenosis\n- Noonan Syndrome: Dysplastic pulmonary valve stenosis, hypertrophic cardiomyopathy\nFrom the book! \n\n Overview\n\nKey concepts \nBlood flow easier to low resistant Pulmonary vascular resistance\nResistance organs Systemic vascular resistance\n\n Blood flow from high pressure to low\nBlood flow Pressure Gradient pressure chambers\nsystemic is high pressure\npulmonary is low pressure\n\n Blood flow away from site of\nFlow Obstruction obstruction if alternative path exist\n\n Congenital heart Pulmonary duct dependent\ncirculation\nExamples: critical pulmonary stenosis\nor pulmonary atresia\nDuct Dependent diseases that need\nCHD patency of ductus Example: critical aortic valve stenosis,\narteriosus for survival Systemic duct dependent circulation critical coarctation of aorta,\nInterrupted aortic arch, HLHS\n\n1.CVS Flow and Resistance\n\n Flow Resistance\n\n little change in diameter cause\nsignificant change in flow by\npower of 4\n\n - we advise the mother to not take\nibuprofen or NSAID in late pregnancy\nbecause it can close ducts arterioles\nin utrolife and end up with severe right\nside heart failure.\n- prostaglandin is IV meds that keep\nductus open \n\n1.CVS Flow and Resistance\n\n Serial Circuit Parallel Circuit\n\n 1/R total = 1/R1 + 1/R2 + 1/R3\n= 1/5 + 1/25 + 1/100\nR total = R1 + R2 + R3 R total = 5 + = 20/100 +4/100+1/100 = 25/100 = 1/4 R total = 4\n25 + 100 R total = 130\n- if you add more R the R total will be low\n- ‫اﻟﻧﺎﺗﺞ ھﻧﺎ ﺑﯾﻛون اﻗل ﻣن اﻗل ﻗﯾﻣﺔ ﻣﻘﺎوﻣﺔ ﻣوﺟودة ﻓﻲ اﻟداﺋرة‬\n\n 2.CVS Circulation\n\n - any obstruction will\ncause increase in the\npressure before\nobstruction.\n- if the patient have pump\nproblem the blood will\naccumulate in LV and\ngos backward to the LA\nthan to lungs and it will\ncause right said heart\nfailure.\n- the resistance difference\nbetween the organs it\ndetermined according to\nits function and needs.\n\n 3.CVS driving pressure\n\n - LV has capacity to go from (low pressure to accommodate LA\nflow ) to (high pressure to overcome aortic pressure). \n\n 4.Cardiac Cycle\n\n - 1st: closer of mitral\nand tricuspid valve\n- 2nd: close of aortic\nvalve\n- 3rd: raped filling of LV\nin the early diastole\n- 4th: atrial contraction\n- 3rd + 4th are called\ngalob rep and they are\nsign of heart failure.\n\n 5.Cardiac Systemic Output\n\n ● Cardiac and Venous\nFunction Curve\n● Cardiac Output Increase\nduring Exercise due to:\n- Increase contractility\n- Increase preload\n- Reduce afterload\n\n 6.Fetal vs Postnatal Circulation\n\n FETAL CIRCULATION POSTNATAL CIRCULATION CVS Changes after birth\n\n ● Closure of ductus\narteriosus. placenta secret\nprostaglandin to keep it\nopen after removing\nplacenta and exposure to\noxygen it will go on\nphysiological constriction\nin 24h and anatomical\ncloser in 2 weeks foramen ovale is essential for life - once the baby cry after ● Closure of ductus venosus\nin fetus which is allow blood go delivery the alveoli will open ● Closure of Foramen Ovale.\nfrom RA to LA directly. because and the lung resistance will\nRA in fetal life is higher pressure drop and by clamping the because of the change in\nthan postnatal and LA in fetal life umbilical cord the systemic pressure that happened\nis lower than postnatal circulation resistant will go up postnatally in RA and LA pulmonary resistance is high in so the blood in the RV will ● Increase of systemic\nfetal life so 10% of the blood will favor going to lungs.\nvascular resistance\ngo to the pulmonary artery and - After removing placenta the\n90% will go to systemic venous return to RA will ● Decrease of pulmonary\ncirculation through ductus depend on SVC and IVC so the vascular resistance\narterioles RA pressure will go down. \n\n CHD\n\nClassification of CHD \nCyanotic Heart Disease Acyanotic Heart Disease \nDecreased pulmonary flow: Left – Right shunt lesions: \n– Tetralogy of Fallot – Ventricular septal d