儿科学课件：Congenital Heart Disease

1、Congenital Heart Disease And Heart Failure Objective Part one: Case Discussion Part two: Heart Failure diagnostic criteria principles of management Part one: Case Discussion General information: male, 1Y11M, Chief complaints: heart murmur for more than one-year, cough for six days, fever for two day

2、s. Past history: susceptible to colds, twice pneumonia, feeding difficulties, excessive sweating, labored respiration while eating. Physical examination: body weight: 10Kg, no cyanosis; chest abdominal breathing, three depressions sign, crackles in the lungs; protrusion of precordium, /6 grade pansy

3、stolic murmur in the third and fourth left intercostal spaces, palpable thrill, accentuation of P2; liver enlarged with its lower edge 2cm below the right costal margin. Case Discussion Assistant examination: Chest X-ray: increased lung markings, cardiac enlargement, C/T(cardiothoracic ratio): 0.56

4、Electrocardiogram (ECG): high left ventricular voltage（left ventricular hypertrophy） Ultrasonic Cardiogram (UCG): v Case Discussion Clues of Diagnosis 1. Involved organs? Lungs； heart 2. Etiological Factor ? Infection； congenital 3. Function of organs? Heart failure Diagnosis 1. acute pneumonia 2. c

5、ongenital heart disease: ventricular septal defect pulmonary hypertension chronic cardiac insufficiency (heart failure ) Principles of Treatment 1. symptomatic treatment: oxygen, nutritional support, physical or medical cooling, nebulization, suck sputum, etc. 2. treatment for pneumonia: anti-infect

6、ive agents (antibiotics), acording to the pathogens Principles of Treatment 3. treatment for heart failure : cardiotonic agents (digoxin); treatment for VSD surgery Part two: Heart Failure CLINICAL MANIFESTATIONS often atypical, biventricular failure Chronic: feeding difficulties, excessive perspira

7、tion ，poor weight gain ，irritability，tachypnea while sucking, dyspnea, hepatomegaly Acute: sudden dyspnea, dysphoria, paleness or cyanosis, tachycardia and gallop rhythm, wheezes and crackles in lungs, hepatomegaly CLINICAL MANIFESTATIONS Silmilar to adults Fatigue, effort intolerance, anorexia, abd

8、ominal pain and cough, increased heart rate (at rest)，tachypnea but shallow breath Left heart failure (haemostasis in pulmonary circulation): cough, tachypnea, dyspnea, wheezes and crackles in lungs, gallop rhythm haemostasis inanorexia, abdominal pain, j hepatomegaly with tenderness, Chest X-ray ca

9、rdiomegaly, diminution of cardiac impulse increased lung markings, pulmonary plethora, haemostasis in Pulmonary vein, acute pulmonary edema Electrocardiogram (ECG) Echocardiogram congenital heart defects Treatment 1、 Rest： bed rest, in a semi-upright position keep quiet, avoid crying and irritating

10、use sedatives when necessary 2、Diet： eat more frequently but smaller meals light diet but nutritious food nasogastric feeding when nesessary Treatment 3、Fluid restriction： totle intravenous fluid volume Treatment Treatment 4、 oxygen: tachypnea and cyanosis: give oxygen, keep airway unobstructed Seve

11、re pulmonary edema: positive pressure ventilation Treatment 5、Digitalis： mechanism： enhance myocardial contractility and systolic velocity，increase CO, excite vagus nerve, slow heart rate and atrioventricular conduction ，diminish myocardial oxygen consumption, inhibit vasoconstriction caused by symp

12、athetic nerve system, improve systemic and pulmonary circulations Treatment Instructions： Critically ill Ordinary patient: Treatment Attention： 1、Note the use of digitalis recently, avoid overdose 2、Reduce 1/3 dosage in patients with myocarditis, in premature infants or neonates (less than 2 weeks o

13、ld) 3、avoid giving calcium 4、measure serum electrolyte levels, avoid hypokalemia Treatment clinical manifestations of digitalis toxicity Treatment 6、Diuretics： in conjunction with digitalis in severe heart failure interfere with reabsorption of water and sodium by the kidneys, reduce circulating blo

14、od volume， reduce pulmonary fluid overload and ventricular filling pressure Treatment 7、ACE Inhibitors: Treatment Treatment Treatment 8、Phosphodiesterase Inhibitors Inhibit Phosphodiesterase, prevent the degradation of intracellular cyclic adenosine monophosphate, intracellular 9、- and -Adrenergic Agonists Used in patients refractory to digitalis or having digitalis contraindications Dopamine, Dobutamine