Congenital Heart Disease
These
defects the result of faulty intrauterine development of the fetus. If the
defect is very severe, the child mat be dead at the time of birth or may die
soon after birth. If it is moderately severe, the child may look normal at the
time of birth ,but will start developing features of the cardiac disease soon
after. Mild types of lesions may not be symptomatic until the child has grown.
Classification
Congenital Heart Disease
|
Type |
Examples |
|
Noncyanotic |
.Atrial septal
defect. .Ventricular
septal defect. .Patent ductus
arteriosus. .Pulmonary
stenosis. |
|
Cyanotic |
.Tetralogy of
Fallot. .Transposition of
great vessels. .Total anomalous
pulmonary venous return. .Tricuspid
atresia. |
Causes
1.Rubella
infection of the mother.
2.Genetic
factor.
3.Hypoxia
during pregnancy.
4.Radiation
during pregnancy.
5.Corticosteroid
therapy during pregnancy.
6.Diabetes
mellitus.
7.Vitamin
deficiency.
Dextrocardia
1.Normally
the heart is deviated to the left. In this condition it is deviated to the
right.
2.Abdominal
structures are also on the opposite side as of normal.
3.The
patient is usually symptomatic and the condition is diagnosed coincidentally.
4.Chest
X-ray shows mirror image of the normal.
5.There
is no treatment for this condition.
Congenital heart disease.
A. Atrial
septal defect;
B. Ventricular
septal defect;
C. patent
ductus arteriosus;
D. Tetralogy
of Fallot.
Coarctation of Aorta
1.There
is a constriction of the arch of the aorta, so that the resistance to the flow
of blood across the constricted part is increased.
2.The
constriction may be before or after the site of the attachment of the ductus
arteriosus.
3.The
intercostal and other arteries enlarge as a result of this.
4.Systemic
blood pressure is very high, more so in the upper limb than in the lower limb.
5.There
is a radio femoral delay in the pulse.
6.The
treatment of the condition is to control the hypertension with drugs and then
surgically excise the constricted segment of the arch of aorta and replace it
with a vascular graft.
Pulmonary Stenosis
1.The
orifice of the pulmonary valve is narrowed.
2.There
is obstruction to flow of blood from the right ventricle to the lungs.
3.The
treatment is any of the following:
-Balloon pulmonary valvotomy.
-Surgical replacement of the stenotic
pulmonary valve.
Tetralogy of Fallot
1.It is
characterised by occurrence of the following abnormalities:-
.Ventricular septal defect.
.Right ventricular hypertrophy.
.Dextroposition of the aorta.
.Pulmonary stenosis.
2.It is a congenital cyanotic heart disease, and
unless treated in time, the baby can die
3.The
treatment is surgical. The pulmonary stenosis is treated first, and the other
anomalies are treated as the child grows older, and fit for further surgery.
Transposition of Great Vessels
1.It is
sometimes found in newborn babies.
2.The
aorta originates from the right ventricle instead of the left ventricle, and the
pulmonary artery originates from the left ventricle instead of the right
ventricle.
Clinical Features of Congenital
Cyanotic Heart Disease
1.Age
:< 5years.
2.The
physical and mental growth of the child may be less than normal.
3.Cyanosis:It
is of central type. It is due mixture of the blood on the left and the right
sides of the heart, so that nonoxygenated blood mixes with oxygenated blood and
gets pumped into the systemic circulation. It is seen in the tongue and oral
mucous membrane, nose, etc.
4.Clubbing
of fingers: The distal phalanxes of the fingers are swollen.
5.The
dyspnea of the patient is relieved at least partially by squatting.
6.There
is ventricular hypertrophy.
7.Murmur
is heard on cardiac auscultation.
Complication
1.Cyanotic
spells.
2.Embolic
phenomena.
3.Retardation
of growth.
4.Infective
endocarditis.
5.Left
ventricular failure.
6.Congestive
cardiac failure.
Treatment of Congenital cyanotic
Heart Disease
1.Rest,
especially if there is dyspnoea on exertion.
2.Antibiotics
for all infections.
3.Dehydration
is avoided if the patient has polycythemia, so as to prevent cerebral venous
thrombosis.
4.If the
haematocrit is more than 80%,100 ml to 200ml blood is removed.
5.Knee-chest
position is given in a cyanotic spell.
6.At
appropriate age, corrective cardiac surgery is done.
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