Please enable JavaScript.
Coggle requires JavaScript to display documents.
Congenital Heart Disease - Coggle Diagram
Congenital Heart Disease
Pathogenesis
VSD
two systolic pathways
blood flow through the VSD to the outflow tract of the ventricle
outflow tract of ventricle
ASD
defects occur in both the systole and diastole
isometric strain
transient right-to-left shunt occurs are common
During diastole, the bulk flow of the shunt occurs
blood flow occurs in each atrium through two alternate pathways
through AV to the ventricle passes through the ASD and fills the opposite ventricle
difference in the compliance and capacity of the two ventricles determines the flow across the ASD
Reversible pulmonary hypertension
discontinuation of the left to right shunt
return to normal PVR so the elevated PVR is secondary to increased pulmonary blood flow (Qp).
left atrial pressure is elevated as in mitral stenosis in the face of a normal Qp
relief of the mitral stenosis decreases the trans-pulmonary gradient and PVR returns to normal
Normal Heart
heart acts as the pump that, through coordinated muscle activity, supplies the organs and tissues of the body with oxygenated blood
proper relaxation to aid appropriate filling of blood during diastole, and have coordinated contraction dependent on a functional heart muscle (or myocardium) during systole
Heart Failure
heart is unable to pump enough blood to meet the body’s needs; this may be due to abnormalities of the heart muscle after a myocardial infarction, or problems with heart valves or heart rhythm
Sympathetic compensatory mechanism
baroreceptors sense a decrease in blood pressure (BP)
release of catecholamine (noradrenaline)
stimulates beta-1 adrenoceptor cells in the heart
Increased Stroke Volume
Increased Contraction
Increased Heart Rate
Increased Cardiac output
Short term helps to maintain cardiac output
Long term it can be damaging and actually exacerbate HF
Renin-angiotensin-aldosterone (RAA) compensatory mechanism
underperfusion due to reduced BP is detected by the kidneys
activates the RAA pathway
controls BP and electrolyte balance
Vasoconstriction, salt and fluid retention are some of the consequences
Short term helps with organ perfusion
Long term it exacerbates cardiac dysfunction and remodeling
Sources
Stringer, H., & 9, R. (2019, July 24). IOM Future of Nursing Report Card: Progress after 10 Years . Retrieved November 16, 2020, from
https://www.nurse.com/blog/2019/07/01/iom-future-of-nursing-report-card-progress-after-10-years/
Chowdhury, D. (2007). Pathophysiology of congenital heart diseases. Retrieved November 20, 2020, from
https://www.annals.in/article.asp?issn=0971-9784;year=2007;volume=10;issue=1;spage=19;epage=26;aulast=Chowdhury
Watson, R., Gibbs, C., & Lip, G. (2000, January 22). ABC of heart failure. Clinical features and complications. Retrieved November 20, 2020, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117436/
Stringer, H., & 9, R. (2019, July 24). IOM Future of Nursing Report Card: Progress after 10 Years . Retrieved November 16, 2020, from
https://www.nurse.com/blog/2019/07/01/iom-future-of-nursing-report-card-progress-after-10-years/
Watson, R., Gibbs, C., & Lip, G. (2000, January 22). ABC of heart failure. Clinical features and complications. Retrieved November 20, 2020, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117436/
Tips for starting ENTRESTO. (2020). Retrieved November 20, 2020, from
https://www.entresto.com/info/starting-entresto.jsp?utm_source=google
Environmental Hazards Weigh Heavy on the Heart Information for Older Adults and Their Caregivers. (2009, August). Retrieved November 20, 2020, from
https://www.airnow.gov/sites/default/files/2020-02/ehwhh_english_100-f-09-043.pdf
Contributor, N. (2019, August 05). Heart failure 1: Pathogenesis, presentation and diagnosis. Retrieved November 20, 2020, from
https://www.nursingtimes.net/clinical-archive/cardiovascular-clinical-archive/heart-failure-1-pathogenesis-presentation-and-diagnosis-21-08-2017/
Clinical manifestations
Signs
Displaced apex beat
Right ventricular heave
Elevated jugular venous pressure
Crepitation or wheeze
Pulsus alternans
Third heart sound
Tachycardia
Oedemic
Cachexia and muscle wasting
Ascites
Hepatomegaly (tender)
Angina Pectoris
Symptoms
Reduced exercise tolerance, lethargy, fatigue
Nocturnal cough
Paroxysmal nocturnal dyspnea
Wheeze
Orthopnea
Ankle swelling
Dyspnea
Anorexia
Weight Gain
Pink, frothy Phlegm
Diagnostics
Blood tests
N-terminal pro-B-type natriuretic peptide (NT-proBNP)
signs of diseases that can affect the heart
Chest X-ray
condition of your lungs and heart
Echocardiogram
Use of sound waves
size and shape of your heart
abnormalities
Ejection Fraction
how well your heart is pumping
Electrocardiogram (ECG)
heart rhythm problems and damage to your heart
Stress test
receive a drug intravenously that stimulates your heart similar to exercise
walk on a treadmill while attached to an ECG machine
health of your heart by how it responds to exertion
Cardiac computerized tomography (CT) scan
X-ray tube inside the machine rotates around your body
images of your heart and chest
Magnetic resonance imaging (MRI)
Radio waves are broadcast toward aligned particles
create images of your heart
Coronary angiogram
a thin, flexible tube (catheter) is inserted into a blood vessel at your groin or in your arm
guided through the aorta into your coronary arteries
A dye injected through the catheter
arteries supplying your heart visible on an X-ray
helping doctors spot blockages
Myocardial biopsy
Incidence/Prevalence
8 children for every 1000 liveborns
11.89 per 1000 children
4.09 per 1000 adults
5.78 per 1000 in the general population
Severe CHD
1.45 per 1000 children
0.38 per 1000 adults
Environmental factors
Indoor Air Pollution
Smoke
House hold products
Carbon Monoxide
Outdoor Air Pollution
Particle Pollution
Traffic
The stress causes a heart attack
Pollutant Gases
Ozone
Sulfur Dioxide
Nitrogen Dioxide
Drinking Tap water
Lead
Increases Blood Pressure
Arsenic
Directly harms the heart
Excessive Heat
Temp reaches 10 Degrees higher than normal
It is hard to cool down the body, so organs fail
Risk Factors
Heart attack
Damage to your heart muscle from a heart attack
Cannot pump as well
Diabetes
increases your risk of high blood pressure and coronary artery disease
Coronary artery disease
Narrowed arteries may limit your heart's supply of oxygen-rich blood
leads to a weaker heart
High blood pressure
heart works harder than it has to if your blood pressure is high
Certain medications
nonsteroidal anti-inflammatory drugs (NSAIDs)
Diabetic medications
rosiglitazone (Avandia) and pioglitazone (Actos)
increase the risk of heart failure
certain anesthesia medications
some anti-arrhythmic medications
certain medications used to treat high blood pressure, cancer, blood conditions, neurological conditions, psychiatric conditions, lung conditions, urological conditions, inflammatory conditions and infections
Congenital heart defects
some that develop heart failure were born with structural heart defects
Sleep apnea
inability to breathe properly
Results in low blood oxygen levels and increased risk of abnormal heart rhythms
Valvular heart disease
Viruses
may have damaged your heart muscle
Irregular heartbeats
frequent and fast
weaken the heart muscle
Alcohol use
Drinking too much alcohol can weaken heart muscle
Tobacco use
Obesity
Treatment
ENTRESTO
Stage A
Treat High Blood Pressure
Treat Lipid disorders
Quit Smoking
Discontinue alcohol and illegal drug use
Beta Blockers
Only if these are present
Previous heart attack
High Blood Pressure
Prescribe ACE inhibitor and ARB
Only if these are present
High Blood Pressure
Other vascular and cardiac conditions
Diabetes
coronary artery disease
Stage B
All Stage A treatments
All patients should take ACE or ARB
Beta blockers should be prescribed after heart attack
Surgery
Artery Repair/Replacement
Valve Repair/Replacement
Stage D
All Stage A,B, and C apply
Be evaluated for:
Heart Transplant
Ventricular assist devices
surgery options
Research Therapies
continuous infusion of IV inotropic drugs and end-of-life care
Stage C
All Stage A treatments
African-American patients
prescribed hydralazine/nitrate combination
All patients should take ACE or ARB
Prescribe Diuretics and Digoxin
Severe symptoms
Aldosterone Inhibitor
Restrict dietary Sodium
Monitor Weight
Restrict Fluids
Discontinue drugs that worsen condition
Cardiac resynchronization therapy
Biventricular pacemaker
implantable cardiac defibrillator(ICD)
Treatment for VSD and ASD
Transcatheter device closure
Cardiac catheterization
place a mesh patch or plug to close the hole
Open-heart surgery
Through an incision in the chest, surgeons use patches to close the hole
Reversible pulmonary Hypertensions
Guanylate cyclase (GSC) stimulators
Riociguat (Adempas) increases nitric oxide in the body, which relaxes the pulmonary arteries and lowers pressure
vasodilators
Most common: epoprostenol (Flolan, Veletri)
treprostinil (Tyvaso, Remodulin, Orenitram)
Endothelin receptor antagonists :
reverse the effect of endothelin, a substance in the walls of blood vessels that causes them to narrow
Sildenafil and tadalafil
open the blood vessels in the lungs
High-dose calcium channel blockers
Warfarin
Digoxin
Diuretics
Oxygen therapy
Atrial septostomy
surgeon creates an opening between the upper left and right chambers of your heart (atria) to relieve the pressure on the right side of your heart