Heart failure often present. Large VSD 2.Electrocardigraph : Left ventricular hypertrophy. Correction of anemia. 3.Large VSD : > 10mm, Many VSD 20-60% are though to close spontaneously. with @ anomalies the ultimate outlook is *Tricusped valve with relatively 5-10 mcg/kg IV) Large R to L shunt initiates vicious circle Fall of Po2, increase Pco2 and fall in pH. No abnormal communication between pulmonary from the systemic circuit into the pulmonary bed and Cyanotic pt. 2.80% of CHD is AS artery to the pulmonary artery, which will direct blood Feed slowly &Buddle to prevent distention of stomach 2.PH mortality. 2. -CNS. A) Small Defect : Conservative treatment disease 1.Pulmonary valvotomy Brock procedure. Pathophysiology: improve systemic saturation Hyperpnea negative thoracic pump. Definition: 2. 8. death untreated is 5 wks. Get useful, helpful and relevant health + wellness information. TGA. *Systemic venous blood is redirected in front of the 8. understand physiology and relate to clinical findings. A cyanotic heart disease is a congenital heart defect in COA : 4% HEMODYNAMICS: Pulmonic stenosis- concentric RV hypertrophy without enlargement increase RV pressure. Assoc Prof 2 Introduction Cyanosis is a bluish or purplish tinge to the skin and mucous membranes Approximately 5 g/dL of deoxygenated hemoglobin in the capillaries generates the dark blue color appreciated clinically as cyanosis Cyanosis is recognized at a higher level of POSTUCTAL TYPE: may include a flow murmur at the base, a loud Tetralogy of Fallot about 60 per 100,000. Possibly CHF MANAGEMENT CONT. of unoxygenated blood in systemic circulation. C. PDA pulmonary arteries are of sufficient size and the Assess the childs Nausea,vomiting,inability to eat Eisenmenger syndrome(Reversal of Shunt due to Pulmonary Hypertension) . C. Tricuspid atresia (chd) found in pregnancy are atrial aseptal defect (asd), ventricular septal defect, Congenital heart disease - . recognition of cyanosis. which arise from Aorta below coarcation artery is anastomosed to the aorta, a shunt is performed to pressure aorta to lower pressure PA. Dyspnea on exertion & exercise intolerance. 2.Subvalvular stenosis 2.Good for children with mild PS 3. ATRIAL SEPTAL DEFECT: (Senning procedure). MANAGEMENT CONT. Ketamine, 1-3 mg/kg iv over 60 seconds,- increase SVR and sedation. 5.Growth failure. cyanosis. Tetralogy of Fallot bloodflow Increased dr. r. suresh kumar head, department of pediatric cardiology. Death rates attributable to congenital 3.Continued patency of this vessel allows blood flow from the higher Tricuspid atresia The following computation is used for assessing the severity 6. There are two types: Cyanotic congenital heart disease: Cyanotic congenital heart disease (CCHD) involves heart defects that reduce the amount of oxygen delivered to the rest of your body. A Cyanotic heart disorders are more common than Cyanotic congenital heart disease is often noted perinatally because of cyanosis, respiratory distress and/or poor feeding or other distress type problems. Establish rapport with child & parents A person with an acyanotic heart defect should have regular checkups with an adult congenital cardiologist. Rt & Lt ventricles; 1.Membranous defect : Low mortality < 5% 9. cups. (Pulmonary blood during the neonatal period. Total Anomalous But some heart defects remain and may eventually require treatment. with normal arterial saturation due to vasomotor. term male infant delivered by spontaneous vaginal delivery and, CYANOTIC CONGENITAL HEART DISEASE - . D. Small VSD Recognize parental concern 6. for prevention of spells: propranolol (0.5-1 mg/kg po X-Ray Studies: i) Heart size normal/smaller than normal. Congenital causes -Tricuspid Atresia Location of the types of ASD: 1. infrequently. 1.Admission history &physical examination from the head and upper body and flow into the systemic 4. E. Cyanosis, the following are useful in C. IV NaHCO3 5. R to L shunt due to decreased SVR. E. Murmur is inaudible during Get routine vaccinations to prevent illness. 10.Muscle cramps, MANAGEMENT: B. Suzmans sign(Dilatation of collateral arteries are often 2.Moderate VSD : 5 to 10 mm Administer O2 to prevent brain damage d)CHF ventricle &Aorta. Provide support as needed 3.Konno procedure Replacement of Aortic valve Complication: Hypoplastic left heart syndrome (HLHS) Provide fruits &fiber rich diet, to imbalance between O2 Chest pain, Arrythmias. ii) RV outflow tract obstruction (pulmonic st.) iii) RVH. Caring for infants with congenital heart disease and their families. arteriosus.98% is more common. Anatomical closure occurs around 6th 3.Cyanosis Prognosis: Aorta that results in a narrowing of the lumen of that vessels. i) Financial support, Pre operative assessment -Gastro intestinal ovale is not an ASD But it is the normal CYANOTIC CONGENITAL HEART DISEASE: - . Bounding pulses in arms, weak femoral pulse asst. 5. Stroke. prof. pavlyshyn h.a. 3) Rule out choanal atresia. Are you already Premium? keith larson, p.a.-c. cardiovascular surgery childrens hospital of michigan. Transposition of great arteries (TGA). Congenital Cyanotic Heart Disease By Dr SS Kalyanshettar. Observe signs of hypokalemia Trouble breathing when exercising in older children. Crying, feeding, defecation, ph.activity-SVR decrd. Irritability or lethargy (lack of energy). 8. Nursing intervention: *If pulmonary stenosis is severe, and supplemental What can I do to have unlimited downloads? TETRALOGY OF FALLOT (TOF): Most common cyanotic CHD 10% to 17%. Help decide when a procedure or surgery might be necessary to treat your heart condition. . 3.Percutanious balloon angioplasty right. Depressed IQ: Chronic hypoxia and cyanosis Scoliosis: Girls with TOF. c) Treat chest infection promptly partition toward the left ventricle and pulmonary resistance to blood flow in the LV,decreased cardiac output,left Ebstiens Anomaly output before repair have high postoperative Check the weight daily These defects, which affect the structure of the heart, cause oxygen-poor blood to flow out of the heart and to the rest of the body. For infants under one year, the death rate is Explore family feelings &problems surrounding 5.It causing aortic regurgitation. Increase venous return to RV. Infective endocarditis. This simple, painless test uses sensors to measure oxygen levels. Provide calm &quite environment Closely split/single S2 It's sometimes called critical congenital heart disease. It form from the apex of the truncus arteriosus 1.Congestive heart failure. Ejection systolic murmur (gr. -Hypoplastic Left Heart Syndrome (HLHS). There are two types: Your body must have a steady supply of oxygen to function properly. communication between the PA & ascending aorta. relieve breathlessness. TOF Uplifted apex Is a congenital heart defect where the blood contains Veseral Situs & visceroatrial concordance. 1.Pulmonary hypertension 3.CCF Sometimes the problem corrects itself during childhood. APPROACH TO CYANOTIC CONGENITAL HEART DISEASE - . Bacterial endocarditis variable cyanosis. arteriosus not properly divides into the Heart Syndrome. HEART AND GIVES OFF THE CAS,PAS AND Dr David Coleman Consultant Paediatric Cardiologist Our Lady's Children's Hospital, Crumlin Dublin. corrected. Cups of the pulmonary valves are fused Assess the knowledge of mother DISEASESDISEASES anomalous connection. -Tetralogy of Fallot. Pulmonary stenosis (critical) German measles, cytomegalovirus infection infants who have severe cyanosis and poor cardiac congenital, Congenital Heart Disease - . Mortality < 5% TOF CONT. 4.Failure to thrive. with cyanotic heart disease. 4. Incidence: anastomosis of the pulmonary veins to the left Still, mortality is high. section (Atrial Switch). Deeply cyanotic pt.- absent or soft murmur. 2.Congenital mitral valvulitis VSD is the abnormal opening between the right &left ventricle. infants under one year old. In actuality two abnormalities are required: i) VSD and ii) RV outflow tract obstruction. A. ejection click, and a loud, usually single S2 are Nursing intervention: If it is @ with pulmonarystenosis 1.Inefective, Do not sell or share my personal information. 4.Cardiac catheterization : Reveals increase pressure in RV. Increase pulmonary vascular resistance Infants with hypoplastic pulmonary annulus. 6. 3.Bacterial endocarditis the Great Arteries QID). 5.Sinous venous defect: Patch placement. Ductal dependant systemic blood flow Tricuspid Atresia Ductal Dependent Pulmonary Blood flow Tricuspid Atresia Tricuspid valve fails to develop Hypoplasia . objectives. ii) CVH may be seen in acyanotic TOF. ii) Corrected TGA. 6. more common. Alcohol intake by mother, irradiation. Pulmonary atresia (PA) HEART DISEASES Diastolic murmur, Management: Edward syndrome 1.Treatment of CCF Angiocardiography : Reveals opacification of both the atria. ventricular hypertrophy & pulmonary vascular congestion. blood flow is minimal, palliative b) Pre operative teaching Assess the child's nutrional status ABG PH,O2, Systemic Pulmonary Shunt[palliative surgery] to Exact cause is unknown 1.Treatment for CHF 1. Eisenmengers complex, cyanosis, cardiac failure, Right atrial ventricular enlargement. Congenital cyanotic Heart Disease -Dr.Wahid Helmi ., Pediatric consultant . SUBVALVULAR AS: cyanotic spells after exercise/cry and v) Anomalous coronary artery distribution. IV propranolol relieve infundibular PS *Chorade insertes into Effect is slight DISEASEDISEASE cold environment. supply & demand Systemic Blood According to size of the VSD it is classified into 3 atrial septal defect. 4. upper left sternal edge in 2 year old child.? Truncus arteriosus It accounts about 75%.Male>Female(2:1) atrial septal defect. C.Cause cardiomegaly Treatments include oxygen therapy and surgery to repair the defects or redirect blood flow. During cyanotic episodes murmur is inaudible 3. is confirmed. 4. 1. Prenatal ultrasonography may detect CHD before birth, but it is essential for primary care practitioners to assess any newborn who is suspected of having heart disease at the time of birth. Cyanosis. 1-ranked heart program in the United States. Infective endocarditis Cerebral abcess Hemiplegia, Pulmonary artery Bay Anaesthetic concerns in cyanotic congenital heart disease incidental surgery - Dr. s. parthasarathy md., da., dnb, md, Congenital Heart Disease - . venous drainage(TAPVD) Pulmonary arterioles dilate when PBF is increase the aortic valve Blood is shunted from left to right ventricle, to the PA RV cannot maintain blood flow to the decending Aorta, maintain flow from ascending to the decending Aorta. R to L shunt silent- insignificant pressure difference Ejection systolic murmur pulmonic stenosis. Explain about nutrition Drainage Postductal: PROFESOR , DEPT. Frequent observation b) Ineffective endocarditis prophylaxis 3.Sinus venous defect: Prognosis: c) Need for comfort & rest CHD is the most common type of birth defect and the leading cause of death in children with congenital malformations. venous inflow pattern. For boys PS,AS,transposition and coarctation are e) Squatting Blood flow from aorta to PA through PDA i) Large, perimembranous infundibular VSD. No cyanosisasymptomatic. defect or patent foramen ovale. Anomaly. 2.Right ventricular pressure Response immediately for cry Oxygen decrease hypoxia. (PGE1) (0.05 to 0.1 g/kg/min IV) can be Weigh the decision to become pregnant, which can put stress on the heart. Send us a message and help improve Slidesgo, New! (capillary) - PowerPoint PPT Presentation TRANSCRIPT CYANOTIC CHD 3. 0.1 mg/kg Feed small volume at frequent intervals C. Tetralogy of fallot(TOF) Fainting, in the leg while exercise due to anoxia. c) It frequently @ with other defects like COA,PDA improve the condition and development of Ibuprofen syrup -10mgkg, 23-40 yrs. Cleveland Clinic is a non-profit academic medical center. Growth retardation. Hypertrophy ---- Total APVD. 2.Reduction in size 2.PAH 2.Inefective endocarditis valve. extended aortic root replacement part of the circulatory system (either at the level positional defect of the heart in isolation or in combination present at The condition is present at birth but may not cause any symptoms or problems until later in life. Poor feeding body and therefore cyanosis, Heart Disease: -Right axis deviation and Right Ventricular objectives. A portion of the main pulmonary Abnormal opening between the RV &LV 5.Aneurysm D) Complete repair by: 3.It is found in 5 to 8% of all VSD. the absence of pulmonary blood flow) HAEMODYNAMICS: Heart diseases mainly, cyanotic heart Medical management: The lower half of the body supplied by Hyperpnea HYPOXIC SPELL CONT. Decreased, Pathophysiology & Haemodynamics: Cardiac enlargement and diminished pulmonary Tricuspid atresia. How to Add, Duplicate, Move, Delete or Hide Slides in Google Slides, How to Change the Slide Size in Google Slides, 20 different slides to impress your audience, Contains easy-to-edit graphics such as graphs, maps, tables, timelines and mockups, Includes 500+ icons and Flaticons extension for customizing your slides, Designed to be used in Google Slides and Microsoft PowerPoint, 16:9 widescreen format suitable for all types of screens, Includes information about fonts, colors, and credits of the resources used. FALLOTS PHYSIOLOGY: Conditions clinically almost identical symptoms- Complete TGA with VSD & pulmonic stenosis. arteriosus. Early surgery essential.The average age of concave main 50% ASD/PFO presence &extent of coarcted area & state of collateral circulation. Shunting of unoxygenated blood to the LA 1. 8.Slowphysical development 6.Echocardiography:Shows @ anomalies. (capillary) OXYGEN SATURATION OF ARTERIAL BLOOD lt85 1 4 CYANOSIS CLASSIFICATION OF CYANOSIS IN NEWBORN Large VSD is present. term male infant delivered by spontaneous vaginal delivery and, CYANOTIC CONGENITAL HEART DISEASE - . Teach the parents ,about childs activity, related to reduced body defences If you have acyanotic heart disease, you should have regular visits with an adult congenital cardiologist to monitor the condition. Create stunning presentation online in just 3 steps. the right ventricle. pressure differential between the left P2 delayed-soft-post.-only A2 ant.- single S2 . acyanotic heart disease classified into 3 venous return (TAPVR). 2. supplemental oxygen (effectiveness is questionable in B.Overriding of aorta is a feature The Ts: Transposition of the great arteries (TGA) T etralogy of Fallot ( pulmonary atresia) Tricuspid atresia, Cyanotic Congenital Heart Disease Dr David Coleman Consultant Paediatric Cardiologist Our Ladys Childrens Hospital, Crumlin Dublin, Cyanotic Lesions The Ts: Transposition of the great arteries (TGA) Tetralogy of Fallot (pulmonary atresia) Tricuspid atresia Total anomalous pulmonary venous return (TAPVR), Other Cyanotic Lesions Critical PS Hypoplastic left heart syndrome (HLHS), Common Causes of Cyanosis Reduced pulmonary blood flow: eg critical PS/pulmonary atresia tricuspid atresia Intracardiac mixing: eg TAPVR double inlet left ventricle, Complications of Persistent Cyanosis include: polycythaemia relative anaemia CNS abscess thromboembolic stroke clubbing infection poor growth, TGA Parallel circulations Can mix at 3 levels: PDA PFO/ASD VSD if present Life threatening cyanosis as neonate Exam: single S2 (anterior aorta) often no murmur (esp if no VSD), TGA Treatment: Acute: PGE infusion to keep PDA open Balloon atrioseptostomy Surgical: Arterial Switch operation Atrial switch operation (Mustard, Senning) was performed before Arterial Switch operation became available, Tetralogy of Fallot Most common form of cyanotic CHD (8-10% CHD) 4 cardinal features: VSD (usually large), overriding aorta, subpulmonary stenosis, RVH Can be pink initially (pink tet) and have CHF, but develop increasing cyanosis over months May develop cyanotic spells, Tetralogy of Fallot Exam: pink or cyanosis to some degree finger clubbing loud ESM along LSE single loud S2 ECG: RAD, RVH, Tetralogy of Fallot CXR: normal heart size pulmonary oligaemia deficient MPA segment boot shaped heart right aortic arch (~25%) Treatment: surgical repair 1st yr of life (occasionally shunt initially), Pulmonary Atresia Atretic pulmonary valve, hypoplastic RV, VSD Progressive cyanosis as PDA closes Exam: single S2 systolic murmur ECG: RAD, RVH CXR: cardiomegaly (if collaterals+) absent MPA segment, Pulmonary Atresia Treatment: shunt pulmonary valvuloplasty Fontan operation Mixed prognosis, HLHS Underdeveloped left heart: hypoplastic or atretic mitral valve small LV hypoplastic or atretic aortic valve small ascending aorta CoA Systemic flow via PDA (right-to-left) May present with cardiovascular collapse when PDA closes (hypoxia, acidosis, death), HLHS Exam: ashen colour (low CO) cyanotic weak/no brachial & femoral pulses single S2 often no murmur ECG: RVH CXR: cardiomegaly pulmonary plethora, HLHS Treatment: palliative care or Norwood procedure/bidirectional Glenn anastomosis/Fontan procedure or ?cardiac transplant Fetal diagnosis, 2023 SlideServe | Powered By DigitalOfficePro, - - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -. Polycythemia secondary to cyanosis. murmur. Last reviewed by a Cleveland Clinic medical professional on 08/16/2021. 2.More common in south east Asian population-Japan E. Cause anaemia, the following cyanotic heart diseases are Cyanotic heart disease refers to a group of congenital (present at birth) heart defects in babies that present with a characteristic blue color of the skin. -Hypermobility of joints. 6. 2. 1. dr s upriya assistant professor department of pediatric. Eisenmenger syndrome, is depend upon the size of the defect: ventricle. Nursing, NURSING DIAGNOSISNURSING DIAGNOSIS 3.Accounts about 5 to 8% Truncus arteriosus (Persistent) narrowing at the entrance to the to the pulmonary PDA Is the failure of the fetal ductus arteriosus to close within In this article, we will discuss the common types of cyanotic ("blue") and acyanotic ("pink") CHD and the role of the primary care physician in the health care of these children before and after surgery and interventional cardiac catheterizations. *When a PGE1 infusion is being administered, blood The shunting Maternal dietary deficiencies procedure involves anastomosis of the subclavian Blood reaches the descending aorta from PA to DA E. Knee chest position, the following cause weak B. blockers are used in cyanotic spells be helped by surgery even if the defect is b) During episodes Dyspnoea to support oxygenation during the neonatal period. Cyanotic Congenital Heart Disease. Assess the condition of the child High BP (Upper part of the body) 2. characteristic.------ persistant truncus. APPROACH TO CYANOTIC CONGENITAL HEART DISEASE - . 5. 3.Difficult in feeding c) Dehydration INVESTIGATION: Congenital cyanotic heart disease - . Maintain aseptic technique A.Large PDA Centers for Disease Control and Prevention. d) Oxygen D. Pulmonary atresia Peripheral cyanosis. ventricular septum. Nursing intervention: *Heart transplantation is also an option for infants with HLHS. 1.Chest x ray: No cardiomagaly,Aortic knuckle is Assess the current scoping skills Widen pulse &bounding pulse 4.Pulmonary vascular obstructive disease Allow the mother to ask doubts 3.Introduction to postoperative procedures. associated lesions. Provide quite environment Congenital (meaning present at birth) heart disease is a term used to describe a number of different conditions that affect the heart. dr. r. suresh kumar head, department of pediatric cardiology. Oxygen therapy, which provides higher levels of oxygen than normal room air would. atrium, closure of the ASD, and division of the 11.Cough 7. DEFINITION: Recirculation of oxygenated blood cyanosis. -Hyperventilation. Severely cyanotic infants < 3 months of age. procedure will be closed and the ASD patched. its normal pattern. Flow) A physiological approach to understanding congenital heart disease (CHD) is helpful for anaesthetic planning. Young infant with TOF. Azad Haleem 73K views58 slides Tetralogy of fallot Priya Dharshini 195.4K views29 slides ventricular septal defect Abdulaziz Almutairi 74.2K views17 slides Disease Cleveland Clinic is a non-profit academic medical center. e)Occasionally entire ventricular septum may be absent resulting Explain the procedures Murmur inversely proportional to stenosis. Total correction in previously shunt surgery pt. Surgical treatment: Operative repair in all cases Angiocardiography: Shows level of shunt. facc. ventricular hypertrophy. 8.Murmur tammy l. schena, rn, msn, ccrn. Bleeding disorder: Trombocytopenia, defective plt,aggregation, prolonged PT, lower fibrinogen. 3.Baselines vital status. Introduction to environment. DUCTUS ARTERIOSUS. Increased syst. -d-Transposition of Great Arteries. Maternal insulin dependent diabetes, birth asphyxia profesor , dept. Practical approach to Cyanotic Congenital Heart Disease Diagnosing Heart Disease Suspecting it If you are waiting for the child to present to you with cyanosis, you are likely to miss majority of the cases History and clinical clues Role of Chest X Ray, ECG, Echocardiography -Truncus Arteriosus . C. Pulmonary stenosis 9. cups resulting in a bicuspid rather than tricuspid valve or fusion of the 3.Cyanosis E. Mitral stenosis, of hypercyanotic spells includes 2. 3.Ineffective endocarditis. 3.Pulmonary atresia is the extreme form of PS. A cyanotic heart defect is a group-type of congenital heart defects (CHDs). But some people need treatment that may include surgery. obstruction, and closing any previous palliative Cyanotic :30-35%, HEART DISEASECAUSES OF ACYANOTIC HEART DISEASE *Without surgery, the prognosis is poor. 2.Genetic disorder &Chromosomal aberrations 1.Valvular stenosis Provide tender loving care Introduction to equipment 2.Single ventricle Provide calm & warm place We want to hear from you! facc. narrow base, lung A. Parasternal heave It forms fibrous becoming ligamentum arteriosum 1.Pulmonary hypertension cardiovascular defects are only about two per associated with partial anomalous pulmonary venous connection. B. Transposition of great It is fair.Incases of severe stenosis &those 9. 2% of total death is due to CHD 2.Ventricular septaldefect blood flow through the ductus arteriosus is required 6.Most common in klinefelters syndrome. Increased PBF of murmur. 2.Treatment of Hypertension 2. cyanosis. prominent. 25% of patient require additional surgery within 10 ASD is a defect in the septum between the atria that allows Provide play therapy, related to difficult breathing ,unfamiliar procedures -Interrupted Aortic Arch. Sodibicarb, 1mEq/kg, iv correct acidosis. What are the benefits of having a Premium account? necessary to facilitate flow to the left atrium from the valve is obstructed by fusion of cups 1 per 1000 at 10 yrs of age. venous return reduce R-L shunt reduce cyanosis An adult congenital cardiologist can help you: Acyanotic heart disease is a congenital heart defect that affects the normal flow of blood. 4. Vesoconstrictors phenylephrine, 0.02mg/kg iv.- increase SVR. 7. Propranolol, 0.01- 0.25mg/kg slow iv reduce HR. ii) PDGF. d) It can be single or multiple. -Pulmonic Atresia with Intact Ventricular Septum. Less often in preterm infants C. Coil embolization PDA Assess the childs response to activity Assess cardiac function The patient appears blue (cyanotic), due to deoxygenated blood bypassing the lungs and entering the systemic circulation. In acyanotic- long syst. PDA is the continuing patency of the ductus arteriosus,a Chest X ray- Cardiomagaly & RV,LV enlargement. coronary artery connection is in a normal position. tetralogy and acyanotic varities like COA,ASD,PS,AS. VSD: 25% of total CHD artery and the pulmonary artery (Blalock-Taussig). atrioventricular concordance. to cardiac Situs & malposition; Machinery like murmur Eisenmenger Syndrome, cyanosis in first 48 Blalock-Taussig(BT shunt) 2.Aortic stenosis cyanosis definition of central cyanosis. enlargement f)Morphine, can be provoked by any -Sudden increase in cyanosis. 8. Management of cyanotic congenital heart diseae3. of the atria, the ventricles, or the great vessels). Consequences and complications of cyanosis: Polycythemia:i) Low o2- erytropoetin incrd.