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PROBLEM 1: “Achy breaky heart”, image, image, image, image, image, image, …
PROBLEM 1: “Achy breaky heart”
Development of the
Heart
Splanchnic Mesoderm
blood islands
cardiogenic region
angioblastic cords
two heart tubes
single heart tube
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Ventricular septal formation
primordial interventricular septum grows from the floor of the primitive ventricle towards the fused endocardial cushions.
Neural Crest Cells
Birth Defects & Epidemliology
include
Heart defects
such as
ventricular septal defect
atrial septal defect
pulmonary stenosis
aortic stenosis
coarctation of aorta
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if untreated, can cause
Eisenmenger Syndrome
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caused by
Genes or Chromosomes
Smoking & alcohol abuse
Drugs (eg. Warfarin)
Infectious diseases (eg. Rubella)
Diabetes
Neural tube defects
Down syndrome
0.8% to 1.2% of live births worldwide
(2020)
Clinical presentation of Congenital heart defects
signs
include
▸ Heart Murmur
▸ Other Abnormal Heart Sounds.
▸ Tachycardia
▸ Congested Lungs
symptoms
include
Sweating
▸ Difficult Feedings
Tachypnea
Growth Retardation
Clubbing
involve
a bulging enlargement of the distal ends of the fingers/toes
can be associated with
Congenital heart diseases
Lung cancer
Chronic pulmonary diseases
Cyanosis
happens due to
low Oxygen levels in the blood
has 2 types
Central
associated with low oxygen level in the blood
Peripheral
associated with poor blood circulation
result in
bluish lips, fingers and toes
Study Designs
Descriptive Studies
generates hypothesis
Describe characteristics of disease (outcome) or exposure (risk factors)
3 types
Case Series
Cross-sectional ecologic study
Case Report
Analytic Studies
Hypothesis testing with comparator groups
2 Types
Experimental Study
Non-RCT
RCT
Obsevational Study
Case control
Outcome first
Cross-section
Both together
Cohort
Exposure first
Investigations for patients with CHD.
History taking
Which includes
Perinatal history
Like
Apgar score
Family medical history
Current symptoms
Including
Skin color
clubbing
Edema
Child’s physical development
Insufficient Weight gain
Feeding behavior
Reduced exercise capacity
Gestational history
Were there any
Indications of CHD in fetal ultrasound
Chromosome anomalies
Did the mother take any medications or drugs?
Echocardiogram
The purpose is to
Diagnose heart problems
Including
CHD
Cardiomyopathy
It works by
Looking at how the blood moves through the heart chambers and valves
Assessment
Normal EF = 55-65 per beat
Anything below 40 EF is abnormal
Tests that are done
Pulse oximetery
ECG
Chest X ray
Blood tests
Including
Full blood count
Levels of RBC, WBC, platelets and hemoglobin
Urea and electrolytes
Electrolytes stabilizes heart rhythm
fetal circulation
Unique features of fetal circulation
include
The placenta is the "fetal lung“
There are three blood vessels connected to placenta
Umbilical vein
Left and right umbilical arteries
There are three shunts or bypass channels
Four major pathways:
Placenta
Ductus venosus
bypass the liver
Foramen ovale
help in right to left shunt
Ductus arteriosus
link the pulmonary artery with the aorta
Congenital Heart Defects
Include
Septal Defects
involve
Atrial Septal defects
caused by
Ostium primum
Ostium Secundum
Ventricular Septal defects
Caused by
Defect in the membraneous part
Defect in the Mascular Part
Shunting
Divided into
Right to left shunting
Includes
Eisenmenger syndrome
Teratology of Fallot
Left to right shunting
Includes
Ventricular Septal Defects
Atrial Septal Defects
Patent Ductus Arteriosus
Divided into
Acyanotic Congenital Heart Defects
Includes
Pulmonic stenosis
Coarctation of Aorta
Aortic stenosis
Atrial Septal Defects , Ventricular Septal Defects and Patent Ductus Arteriosus
Cyanotic Congenital Heart Defects
Includes
Transposition of Great Arteries
Persistent Truncus Arteriosus
Teratology of Fallot
Eisenmenger syndrome
Cardiac Cycle & Murmurs
Cardiac Cycle
the process includes
Atrial Systole, Isovolumetric Ventricle Systole, Ventricle Ejection, Isovolumetric Ventricle Diastole
Heart Sounds
S3
Produced by
Fast to slow ventricle filling
S4
Produced by
Osculation of Ventricles during Atrial Contraction
S1
Lound & Long
Produced by
AV Valve closure
S2
Produced by
SemiLunar
Short & Sharp
Can split due to inspiration
Murmurs
Types
SYSTOLIC
CONTINOUS
Associated with
PDA
DIASTOLIC
Caused by
Blood Regurgitation
Narrowing of the valves
Turbulence flow of blood
A Thrill is
a Pulpable Murmur