s
***Aortic Stenosis:
^^Gx:
-Narrowing of Aortic (Bicuspid Valve)
-most common Cause OF Aortic Valve Pathology Obstruction
^^Px:
LV will have to pump harder to override the blockage
—-> Leading to LV hypertrophy
^^CF:
1 Systolic Murmur in Right Precordium can be Heard!
( RIght NOT LEFT)
( above 2nd IC space)
2-Late: dizzines/ Syncope/Excercise Intolerance!
3-Suprasternal Notch =We Feel systolci thrilll!
4-In Severe Cases Can Lad to HypoPerfusion( Weakperipheral Pulse/ Pale/RF)
^^DX:
1-ECG LVH!
2-Xray : Heart Size Normal or Dialated LV
Dialated Ascending aorta
3-US (Diagnostic):
Can help find the Cause , Assesment of Valve Function!
^^Tx:
-Surgery:
1-In case of Supravalvar Aortic stenosis
(pressure betwen Arota+LV60-80mmHg)
———> Membrane is resected
2-In case of Valvar Aortic stenosis——>Balloon Valvoplasty !
***ASD
^^Gx:
-Hole Btwn RA and LA
-Less seere then VSD
( the Pressure in Atria is Not As High + Different In PRessure is Not as Greats,
Around 4 mmgHg!)
-History of Frequent Colds And Productive Cough
…. Due to Slightly Increase PRessure in Pul artery which Can Cause Slight Pul Edema!
Which makes the PTs at Risk of having Getting Viral Infections!
^^Sx:
-Systolic Mumor( Heard Left upper Sternal Border 2nd -3rd IC)
-Fixed S2 Split Sound Split!
^^Dx:
I-Best Initial Test is ECG!,:
– To Also Rule out the Presence of Subclinical Atrial Stenosis!
-Show partial RBBB(RVH)
II-XRAY:
? Transverse Diameter with pul Plethora!
III-US: is Diagnostic!
^^Tx:
-No NECC Needed, It Is Based on Presence of Sx & Patients Wishes!
-Surgery Closure Can be Done By Percutaneously or Openly!
***Tetralogy of Fallot:
^^Gx:
-Cyanotic Heart Defect
-Component :VSD+Overring Aorta!
-OUTCOME Which Result in Pul Stenosis +Pulmonary HBP + RVH
-Most Common Cyanotic CHD
^^PX( READ)
-It is basically 4 Problems Caused By initial 2 Problems!
Sum up :
1- Overriding Aorta(Aorta Very close to Septum)
2- Pul Stenosis!(Valves are Very Thick and closed
3-RVH
4-VSD
^^CF:
1- Acutely Cyanotic<—> ”SQUATTING”
2-Chromosome 22 Gene Deletion!
3-Chronic Cyanosis(Finger CLubbing)
4-Low Height Percentile
5-Systolic Murmur
6-Loud S2
7-Hypoix Spell
( Epidosdes of Severe Cyanosis ith Finger clubbing+ Possible Growth Retardation)
^^Dx :
1-ECG: RVH
1-US (Echocardiogram) is Best, Will probably Show RVH
3-Xray : Cardiomegaly /Hypovolemia
^^Tx:
Surgical Repair!(Not Emergent but must be Done):
1-Palliatie Surgery if Severe hypocia!
2-Radical , at 1 year of Live
^^Complication:
1-Cerebral thrombosis
2-Fe Deficit
3-Cerebral Abscess
4-Infective endocarditis
***IE Prophylaxis:
^ High Risk Condition:(L)
1-Denitity
2-Invasive Resp Procedrue
3-Prosthetic Cardiac Valves/Material
4-Hx of Infective endocaridtic
5-CHD
( Cyanotic Heart Defects without Surgery)
(CHD Repaired with Prosthetic Material)
(Defect Remains at the Site or Adjacent to the site)
6-Defect corrected prosthetic Material 6M from operation!
7-after implant (prsothetic/device)
^^Ax Used:
-Dental :IV amoxiciclin 50mg/Kg 30-60 min prior
-Invasive Procedure: Oxacillin & Caphlosporin!
-GI Tract & Urinary Procedure : Ampiccilin , amoxicillin ,Vancomyicn!
-Surgeries: Oxacillin or caphalosporine
**PDA:
^^Gx:
1-Non cyanotic Defect(
2-DA faiil to close(Should close during infancy)
3-Fail to close we will have shunting
(LV to RV shunt)
(Blood Moves From Aorta ——–> Pulmonary Trunk, Moving O2(+) into Pulmonary Circulation!)
^^CD
1-many Asx)Depend on Size)
2 -Loud Constant ” Machine like” Murmour Heard in Upper LEft Sternal Border During Systole + Diastole
3-S2 is Hard to Hear
^^Dx:
1-ECG=LVH
2-Xray = Normal Heart Size/ Cardiomegaly (sometimes)
3- -US(Echocardiogram) , Diagnostic
^^Complication:
-Pul HBP
-Infective Endocarditis
^^Tx:
A- No Sign of congestive HF /Premature———-> Give Indomethacin!
B- Sign of Congestive HF/not PRematrue————–>Surgical Closure!
^^XRAY + US!
***VSD(most common CHD)
^^Gx:
-Congenital,
-Non-Cyanotic Heart Defect
(Where the wall between LV & RV is incompletely Closed)
-More Dangerous then ASD because the pressure in Ventricles is Much Higher!
The difference is 116mm HG( Very Big)
-Typically present in infants With Failure To thrive (due to Hypoxia)
^^Sx:
1-Systolic Murmur+Thrill
(Heard best around left upper Sternal Border)
2-Tachypnea
3-Sweating
^^Dx:
1-ECG: BiVentricular Hypertrophy!!
2-Chest Xray : Cardiomegaly
3-US (DX) Best Initial Test
^^Tx:
-50% spontaneous close
-Surgical Closure(Qp:Qs>2:1)
^^indication!
-Small defect with No Sx =No Danger!
-VSD >50% Diameter of Aorta!+ HF Not Correct By medication
^^Indication:
I-Operation before 1 Y:
1-VSD >50% of Diameter of aorta
2-Pressure in Pul Artery >50 mm HG!
3-HF is nto corrected by X
***SVT:
^^Gx:
Arrythmia From Ventricles
^^Types:
A Fib
A flutter
Wolf parkinson
^^Sx:
Palipation
-Anxiety
-Chest pain
^^Dx:
ECG
^^TX(SVT)
1-Conversion Therapy is Adenosine IV
2-Vagal Maneuver are Effect
3-For Tx: Propaphenone/Amiodarone/Intracardiac1
***VT
^^RF:
-RF ( MI /Long QT/ V Hypertrophy)
^^Sx:
Palpitation
Cardiac arrest
HF(Shortness of breath/syncope)
^^Cause Of Ventricular Tachycardia In CHildren(VT)
-Myocarditis
-Cardiomyopathy
-Ventricular Tumours!
-CHD!
^^Tx:
I-Many VT areNo Cause for worry
II-the Ones to worry :Hypotension/yncope/Cardiac arrest!
A- Central Pulse is Palpate
———–>synchronized Cardioaversion!
———>Or give amiodorone
B-if central Pulse is Not Palpable
————->Tx if as V Fib( Defibrillation ,NE , Resuscitation)
***Coarctation of Aorta(Narrowing of aorta)
^^Gx:
-Congenital Narrowing of Aorta ( ussually Descending)
-14% of CHD , more common for Boys
-Associated with : Bicuspid aortic Valves/ VSD/PDA
-RISK : Cardiac Failure(2-3 W) + Arterial HBP!
^^CF:
I-EARLY:
-Tachcardia/Tachypnea/Shock
-Femoral Pulse is Abscent
-Systolic murmur Not heard or between shoulder!
II-Late:
-Hypetension
– Murmour
^^Dx:
1-ECG : Shows LVH!
2-Xray : CARDIOMEGALY+Pul congestion
(Dialation of Left Ventricle!, Dialated Asecnding Aorta )
3-Echo(US) =Diagnostic
( Narrowing of aorta Change in BF pattern at the site)
^^Tx:
Sugery :
– For infants Aorta is operated on in Firsst few Month of Life
-, For adult type at Years 3-10 of life!
without surgery Life expentacy is 30-40 years
Palnned surgery—>3-10 years
^^Complication in No Surgery(L)
^^Coarcitation of Aorta : LVH(ECG) + MRI!
***HBP
^^Indication And Assesment of BP measurement in Children:???
-Ussually we start routinely measuring at age 3
-But in Some cases We need to MEasure Before 3 Years:
1-Premature, Low Birth Weight
2-CHD
3-UTI
4-Kidney disease(Hx)
5-Organ ranplant
6- Malignanat process
7- Sign of icnrease Intracranial pressure
***Essential Hypertension:
^^Gx:
-Child DBP/DBP >95%
->3 occasion!
”The Smaller the child & the Higher the BP , the More Likely it is to be 2nd”
-if 2nd/sx/Damge otorgan.DM ithout Tx
-TX: Ca Channel block