Cardiovascular system

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Cardiovascular system ??????????

• 1. ?????
• 1.1 Right side pump
• 1.2 Left side pump
• 2. ?????
• 2.1 Fluid
• 2.2 Blood vessel

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Assessing the child with a cardiovascular disorder

• History
• Fatigue
• Cyanosis
• Frequent of URI
• Feeding difficulty
• Poor weight gain
• Growth Failure

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Assessing the child with a cardiovascular
disorder ( cont. )

• Physical exam
• Decrease height weight
• Easily fatigue
• Cyanosis, Polycythemia
• Tachypnea, Murmur
• Clubbing of fingers
• Absent of femoral pulse

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Diagnostic Test

• Electrocardiogram
• Radiography
• Echocardiography
• Magnetic Resonance Imaging
• Exercise Testing
• Laboratory Test

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Risk management

• For congenital Heart Disease
• ?????????
• ???????????????????????

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Risk management ( cont. )

• For Acquired Heart Disease
• Rheumatic Fever
• Hypertension
• Hyperlipidemia

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Ventricular Septal Defect (VSD)
There is a hole within the membranous or muscular
portions of the intraventricular septum that
produces a left-to-right shunt, more severe with
larger defects
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Ventricular septal defect (VSD). Oxygenated blood
from the left ventricle shunts via the hole into
the right ventricle. This volume load causes
enlargement of both ventricles and the pulmonary
artery, and exposes the right ventricle and
pulmonary arteries to abnormally high pressures.
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Ventricular Septal Defect ( VSD )

• Right ventricular hypertrophy
• Pulmonary artery dilatation
• ????? systolic murmur ??? Lt. Sternal border ???
  3-4
• ????????? thrill
• 60 ??????
• Important post op. Complication Arrhythmia

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Patch closure of ventricular septal defect. When
a large VSD requires surgical closure a patch is
typically used. Common materials for patches
include Dacron, or pericardium.
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Atrial Septal Defect (ASD)
A hole from a septum secundum or septum primum
defect in the interatrial septum produces a
modest left-to-right shunt
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Atrial septal defect ( ASD )

• ??????????????
• Rt. Ventricular hypertrophy
• Systolic murmur ??? 2-3 interspace
• Split ??? second heart sound

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Patent Ductus Arteriosus (PDA)
The ductus arteriosus, which normally closes soon
after birth, remains open, and a left-to-right
shunt develops
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Atrial septal defect (ASD). Oxygenated blood from
the left atrium shunts via this hole into the
right atrium. This volume load causes enlargement
of both atria, the right ventricle and the
pulmonary artery.
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Patch closure of atrial septal defect. Many
defects may be closed using a primary suture
technique. Patches are used in larger defects.
Catheter delivered device closure is currently
being evaluated investigationally.
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Patent ductus arteriosus

• DA ?????????????????????????? ???????? complete
  ????????? 3 ?????
• ?? Rt.ventricular hypertrophy
• wide pulse pressure
• systolic and diastolic murmur
• Treatment Indomethacin, Operation

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Patent ductus arteriosus shunting blood from the
aorta to the pulmonary artery.
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PDA ligated
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Coarctation of Aorta
Either just proximal (infantile form) or just
distal (adult form) to the ductus is a narrowing
of the aortic lumen, leading to outflow
obstruction
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Coarctation of the Aorta

• ??????????????????? subclavion artery
• Increase blood pressure of the upper part
• Blood pressure ?????? gt 20 mmHg ?????
• Lt. Heart hypertrophy
• Rib notch
• Systolic murmur

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Severe narrowing of the aorta in the region of
the ductus arteriosus, just beyond the take-off
of the vessels to the head and arms.
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The coarctation segment has been resected and an
oblique, end-to-end reconstruction of the aorta
is performed.
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Tetralogy of Fallot
Pulmonic stenosis results in right ventricular
hypertrophy and a right-to-left shunt across a
VSD, which also has an overriding aorta
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5.Muscular right ventricular outflow obstruction
has been cut away as part of the repair.6.Patch
closure of the VSD.
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Tetralogy of Follot

• Pulmonary stenosis
• Ventricular septal defect
• Overiding of the Aorta
• Rt. Ventricular hypertrophy

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TOF

• Cyanosis , Polycythemia
• ????? clot ?? blood vessel
• severe dyspnea , Growth retardation
• Clubbing of fingers, squatting
• Hypoxic spell
• systolic murmur
• Rt. Heart hypertrophy

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Transposition of the Great Arteries

• The "great arteries" in this anomaly refer to the
  Aorta and the Pulmonary Artery, the two major
  arteries carrying blood away from the heart.
• In cases of Transposition of the Great Arteries,
  these vessels arise from the wrong ventricle.
  They are "transposed" from their normal position
  so that the aorta arises from the right ventricle
  and the pulmonary artery from the left ventricle.

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TGA - Arterial Switch Operation
TGA - Completed repair
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Heart Failure

• ??????????????????????????????????????????????????
  ?????????? ?????????????????????????
• decrease renal blood flow
• 1st sign tachycardia, tachypnea

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• Right heart failure
• Increase venous pressure
• Hepatomegaly
• Edema ???? late sign ??????

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• Left heart failure
• - Dyspnea
• - Rale
• - ????????????

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Theraputic

• ?? work load ????????
• ?? preload Lasix, Aldactone
• ????? cardiac function Digoxin
• ?? afterload Vasodilater

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Rheumatic fever

• Beta hemolytic streptococcus Gr.A
• ???????? 6-15 ??
• ??????????? Jones criteria

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Jones criteria

• Major criteria
• Carditis
• Polyarthritis
• Chorea
• Erythema
• Subcutaneous nodule

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Jones criteria

• Minor criteria
• Fever
• Polyarthralgia
• ASO titer gt 333 TODD Unit
• Cardiomegaly
• ??????????????????????

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????????

• ???????????????????????????????
  ??????????????????????? Penicillin ??????
  Benzathine Penicillin G IM ???????????? ????
  ????????? Penicillin ??????

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Kawasaki disease

• ??????????????????????????????????????
  ?????????????????????????? ?????????????
  ???????????????????????
• ????????????????????????????? ? ??????????????
  ????????????????????????????? ? ????????????? 5-7
  ??????????????????????????? ??????????????????????
  ??????????? ??????????????????????????????????????
  ??????? ???????????? ??????????????????????
  ??????????????????????????????????????????????????
  ????? ??????????

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• ?????? ??????????
• ???  ??????????????? ??????????????????????????
  ???  
• ????    ???????? ???????????????????? 8 ??
  ???????????????? 1-2 ??

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????? ??????????????????

• 1.  ??? ????????????????? ????????????????????????
  ???????? 1-2 ??????? ???????????? 3-4 ???????
• 2.  ????? ?????????? 2 ???? ??????????
  ?????????????????????? 1-2 ??? ???????????????????
  ? 1-2 ???????

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• 3.  ?????????????????????????????????????
  ??????????????????? ??????????????????????????????
  ????????????????? ???????????????????????????????
  ? (Strawbery tongue)

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• 4.  ??????????????????????????????????? 
  ??????????? ??????? ??????????????????????????????
  ?????????????????? ??????????? (?????? 10-20
  ????????????) ????????????????????????
  ????????????????????  ????????????????? 1-2
  ??????????????????????? (Beau's line)

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• 5.  ?????????????????? ???????????????? 1-2 ???
  ??????????????? ?????????????? 1-2 ???????

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• 6.  ????????????????????  ?????????????? 50-70
  ?????????? ?????????? 1.5 ?.?. ???????
• 7.  ????????????? ? ??????????????????  ??????
  ????????? ??????????????????? ????????????????????
  ?????????????? ???????? ???????

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• ??????????????????? ??? ???????????????????????
  ??????????????????????? (Coronary Artery)
  ?????????????? 20-30 ????????????????????
• ??????????? ???????? ???????????? ??????
  ????????????????????????? ???????????????
  ?????????????????? ???????????????????????????????
  ?????????? (Coronary Artery) ?????????????????????
  ???????????? (Aneurysm) ??????????????????????????
  ?????? ???????????? ?????????????????????
  ??????????????????? ??????????????????????????????
  ??? 10-28 ????????? ?????????????????????
  ????????? ???????????????????????????
  (???????????? 1-2)

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???????????

• ???????????? ?????????????????????????????????????
  ???????????????????????????????????????
  ???????????????????????????????????????
  ?????????????? ???????????????????????????????????
  ?? 4-6 ????????? ????????????? Echocardiogram
  ???????????????????????????????????
  ???????????????????

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????????

• ??????????????????????????????? ????????????????
  Immunoglobulin ??????? (2 ????/??. ???? 400
  ??./??./??? ??? 4 ???) ???????????????
  ???????????????? 9 ?????????????????????????
  ????????????????????????????????????????
• ??????????????????????????????????????????????????
  ?? ???????????????????????? (3-5 ??./??./???)
  ????????????????????? ????????????????????????????
  ?????????????? 8 ?.?. ????????????????????????????
  ?????????????????????? ???????????????????????????
  ?????????????????????????????????????????
  ??????????????????????????????????????

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????????????? ???????????????

• ????????????????????????????????????????????
  ??????????????????????????????????????????
  ??????? 5-7 ?????????????????????????????????
  ?????????????????? ???????????????????????????????
  ? ?????????? 8 ??. ???????????????????????????????
  ???????????? ?????????????????????????????????????
  ????????? ?????????????????????? exercise test
  ?????????????? ???????????????????????????????????
  ????????????