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pediatric cardiology

pediatric cardiology. Aortic stenosis Heart failure Dr.Aso faeq salih. Aortic stenosis. a narrowing of the valve that opens to allow blood to flow from the left ventricle into the aorta and then to the body. Valvular, subvalvular or supravulvalar – 5% Failure of :

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pediatric cardiology

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  1. pediatric cardiology • Aortic stenosis • Heart failure • Dr.Aso faeq salih

  2. Aortic stenosis a narrowing of the valve that opens to allow blood to flow from the left ventricle into the aorta and then to the body.

  3. Valvular, subvalvular or supravulvalar – 5% • Failure of : • development of the three leaflets • Resorption of tissue around the valve

  4. Clinical manifestation • Depend on degree of stenosis • Mild to moderate : asymptomatic • Severe: • easy fatigability, exertional chest pain, syncope • In infant with severe stenosis can survive only if: • PDA permits flow to the aorta and coronary arteries

  5. Physical sign: • Small volume, slow rising pulse • Sys ejection murmur at Rt 2nd IS and radiating to neck • ejection click • Thrill at RUS border/suprasternal notch/carotid • Cong bicuspid aortic valve: • Prone to calcific degeneration in middle age • Increased risk of infective endocarditis

  6. (a) Aortic stenosis. (b) Murmur. (c) Chest X-ray. (d) ECG.

  7. Treatment • Ballon valvulopasty • Symptoms on exercise/ high resting pressure gradient(>64mmHg) • High risk of significant valvular insufficiency • Surgical mx • When BV unsuccesful or significant valvular insufficiency develops • Subacute bacterial endocarditis prophylaxis

  8. Heart Failure( HF )

  9. State in which the heart cannot deliver adequate C . O to meet the metabolic needs of the body

  10. Compensatory mechanisms : • Salt &water retention by kidney  increase pre load . • Vasoconstriction , through Renin / Angiotensin  increase after load . • Increased circulating Catecholamine  increase C.O . • Increase R.R to promote excretion of Co2 . • Increase renal excretion of H- ion & retention of HCO3 to maintain a normal PH .

  11. C.O = HR X SV • The primary determinants of SV : • Pre load (volume work ). • After load ( pressure work ) . • Contractility (intrinsic myocardial function )

  12. Causes of cardiac failure • Cardiac rhythm disorders may be caused by the following: Complete heart block , Supraventricular tachycardia , Ventricular tachycardia , Sinus node dysfunction • Volume overload may be caused by the following: 1.Structural heart disease (eg, ventricular septal defect,[3] patent ductus arteriosus, aortic or mitral valve regurgitation, complex cardiac lesions) 2.Anemia 3.Sepsis

  13. Pressure overload may be caused by the following: Structural heart disease (eg, aortic or pulmonary stenosis, aortic coarctation) Hypertension • Systolic ventricular dysfunction or failure may be caused by the following: Myocarditis , Dilated cardiomyopathy Malnutrition , Ischemia • Diastolic ventricular dysfunction or failure may be caused by the following: Hypertrophic cardiomyopathy , Restrictive cardiomyopathy , Pericarditis , Cardiac tamponade (pericardial effusion)

  14. Clinical Manifestations : Depends on the degree of cardiac reserve . • Infants : • Feeding difficulties & sweating . • Poor weight gain . • Irritability & weak cry . • Respiratory distress .

  15. Children : • Fatigue . • Effort intolerance . • Anorexia , abdominal pain . • Dyspnea . • Cough . • Orthopnea .

  16. Signs : • Respiratory distress . • Increased JVP . • Hepatomegally . • Edema . • Basal crepitation . • Cardiomegaly . • Gallop rhythm . • Holosystolic murmur of mitral , tricuspid insufficiency .

  17. Investigations : • CXR  cardiac enlargement , pul. vascularity. • ECG : chamber hypertrophy , ischemic changes , rhythm disorders . • Echo : assess ventricular function . • Doppler ; calculate C . O . • Arterial O2 : may be decreased ( pul. Edema ) . • Blood gas analysis : metabolic & respiratory acidosis . • Electrolyte disturbances : hypo Na , hypo glycemia .

  18. Treatment : • Underlying cause must be removed or alleviated if possible . • General measures : • Adequate sleep & rest . • Position : older children  semi upright position infants  infant chair . • Modification of activities . • Diet : • increase no. of calories / feeding up to 24 cal/oz, or supplementing breast feeding .

  19. NG feeding . • Low Na formula is not recommended . • Older children : diet with (no added salt ) & abstinence from food containing high concentration of salts . • Respiratory distress : • Semi upright position . • Continuous O2 , +ve pressure ventilation . • _ ve inotropic factors should be corrected : hypoglycemia , hypo Ca , acidosis . • Sedation for irritability & excessive crying . • Treatment of associating pul. Infection . • Temperature control .

  20. Medication : ( inotropic agents & after load reducing agents ) . • Medications used in treating HF : • Diuretics . • Inotropic agents . • After load reducing agents .

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