Cardiovascular Disorders PDF

Cardiovascular disorders  What Is Congestive Heart Failure? Congestive heart failure (CHF) is a term used by cardiologists to describe a patient whose heart out to the rest of the body to meet the body's...

Cardiovascular disorders  What Is Congestive Heart Failure? Congestive heart failure (CHF) is a term used by cardiologists to describe a patient whose heart out to the rest of the body to meet the body's demand for energy  This can be due to either a heart that pumps well but is very insufficient ( ), or it can be a result of a weak heart muscle that does not pump a normal amount of blood to the body. Either situation will lead to backup of blood and fluid into the lungs if the left side of the heart is the problem, or backup of blood and fluid into the liver and veins leading into the heart if the right side of the heart is problem.  It is not uncommon for of the heart to fail at the same time and cause backup into both systems simultaneously. Causes There are of congestive heart failure. The first category is more common in babies and younger children. In this situation, the heart muscle pumps well, but the route that blood takes is very inefficient. It occurs when , which the lungs and eventually the heart find difficult to handle. This happens with certain or connections with which some  With these connections (also known as shunts) , blood that has already returned from the lungs filled with oxygen to the heart actually ends up back in the lungs then back in the heart again. Examples of these types of lesions include: ①  A patent ductus arteriosus(PDA) is a blood vessel between the aorta and main pulmonary artery that but which If it is large and does not close, the baby will have an excessive amount of blood flow to the lungs. This is a very common problem in premature infants. ②  Another problem that leads to excessive blood flow to the lungs is or a hole between the two lower pumping chambers of the heart. These will cause congestive heart failure only if the hole is big enough to allow so much extra blood flow to the lungs that the heart has to work a lot harder to pump blood out to the body. ③  Some babies are born with other connections between the two main arteries leaving the heart, i.e., aortopulmonary window or truncus arteriosus. These babies are also at  Holes between the two upper chambers of the heart (atrial septal defects) rarely cause problems with no matter how large.  The second cause for congestive heart failure is when the heart muscle is not strong enough to This is usually seen in older children but can be seen in babies.  A major cause of this type of congestive heart failure in babies is when structures on the left side of the heart are so small or that blood has a difficult time ejecting from the heart leading to This can be seen in critical aortic stenosis, critical coarctation of the aorta, or  In older children where the structure of the heart is normal, it is usually due to a weakening of the heart muscle, or cardiomyopathy, (myocarditis) or Kawasaki disease, which all can lead to congestive heart failure. Kawasaki disease (KD) is an illness that causes inflammation in the blood vessels throughout the body.  Cardiomyopathy can also be seen in babies and can be due to a number of problems such as rhythm disturbances or infections Signs & Symptoms Signs and symptoms are different for children of different ages. Potential ones are listed below for babies as well as older Signs & Symptoms in Babies Poor growth because a significant amount of energy is used up by the heart as it works harder to do its job. Difficulty breathing because lungs fill with fluid and they will use more of the muscles of their chest and belly to compensate. With significant congestive heart failure, the heart is pumping so hard that one can feel or even see the heart impulse on the surface of the chest.  Faster breathing and heart rate Difficulty eating or may not eat as fast or as well as other babies. They can become very sweaty with feedings because of the extra work needed to eat. Sleep more or have less energy than other babies because their heart has to work harder Small and wasted appearance The liver may also be enlarged due to congestion on the right sid of the heart and may be more easily palpated (felt). There may be puffiness of the eyes or feet as the right heart fails. Delays in reaching developmental Signs & Symptoms in Older Children Inability to tolerate exercise. They become short of breath more quickly compared to their peers and need to rest more often. Shortness of breath can occur even with minimal exertion, such as climbing. Lack of energy when compared to their friends, although this may be harder to determine because all children have different levels of energy.  Passing out during exercise Poor appetite Weight loss or lack of weight gain can be seen even in older children. Fluid retention and weight gain, causing a puffy appearance Extra sound when listening to the heart (called a gallop) Enlargement of the liver due to congestion on the right side of the heart, and it may be more easily felt  Eyes or feet may be puffy as the right heart fails Chest pain Palpitations (irregular heartbeat) Dizziness Syncope (fainting)  As it is harder to determine parameters for heart failure in older children, it is important to look for change in exercise capabilities or progression of symptoms with time. Diagnosis Congestive heart failure is a clinical diagnosis. The symptoms described above are important clues to the problem. A good physical examination is of major importance. An electrocardiogram may be helpful to indicate if the chambers of the heart are enlarged and can point to specific congenital heart diseases or rhythm disturbances that can cause heart failure. An electrocardiogram  A chest Xray -can be very useful to determine if the heart is enlarged and if there is extra blood flow or fluid in the lungs. This can be ver y impor tant in determining the progression of congestive heart failure A chest Xray  A graded exercise test can also be used to follow progression of heart failure in some instances for older children. An echocardiogram confirms the diagnosis of structural problems of the heart, and can be used in evaluating the function of the heart muscle. A graded exercise test An echocardiogram An echocardiogram  A cardiac cath ete ri zati on sometimes must be performed to further investigate the function of the heart. A cardiac MRI , for some older children and adolescents, provides a useful means to evaluate heart function. A cardiac MRI Treatment Treatment can vary with age and type of disease. A treatable cause, such as a rhythm problem, may require specific medications or procedures. In babies with ventricular septal defects, medical therapy can be used as a temporary solution to allow the hole to get on its own, or to give the baby a little time to grow prior to heart surgery.  In more complex problems such as aortopulmonary window, , or hypoplastic left heart syndrome, when it is known that surgery will be needed, it is currently the practice in most centers to perform surgery in the first weeks of life. Some heart disease cannot undergo surgery and a heart transplant is the only option. In older children with weak heart muscles, can help to give it time to , though some of these children will also eventually require.  Treatment can also include devices, such as or the SynCardia Total Artificial Heart. These devices can help stabilize and support patients while they wait for a donor heart to become available for transplantation (bridge-to-transplant therapy), or to support patients who are not eligible for transplant (destination therapy). Destination therapy may be an alternative to heart transplant for. the SynCardia Total Artificial Heart.  There are several types of medications used to treat congestive heart failure. A diuretic like furosemide (Lasix), which helps the kidneys to eliminate extra fluid in the lungs, is often the first medicine given both in babies and older children. Sometimes medicines to lower the blood pressure like an ACE inhibitor (Captopril), or more recently, beta blockers (Propranolol) are used. Theoretically, lowering the blood pressure will decrease the workload of the heart by decreasing the amount of pressure against which it has to pump.  Sometimes a medication called Digoxin is used to help make the heart squeeze better, and help pump blood more efficiently. Since weight gain is a major challenge for infants with congestive heart failure, giving babies high calorie formula or fortified breast milk can help give the extra nutrition they require  Sometimes babies will need to have extra nutrition given to them via a tube that goes directly from the nose to the stomach, a nasogastric feeding tube. This is good for babies who work hard or get very tired from feeding in order to prevent them from using up all the extra calories needed for growth.  Older children with significant heart failure can also benefit from nasogastric feeding to give them more calories and energy to do their usual activities. Oxygen can worsen blood flow to the lungs in babies with large ventricular septal defects but may be helpful as a buffer to children with weak hearts. Some kids with cardiomyopathy may also need restriction of certain kinds of exercise and competitive sports, although they may benefit from light activity like swimming Rheumatic heart disease What is rheumatic heart disease? Rheumatic heart disease is a condition in which rheumatic fever damaged the heart. Typically, this long-term damage happens to the mitral valve, aortic valve or both. This damage may cause a valve to “ ” or become narrow over time. The mitral valve (between the left atrium and left ventricle) is usually more affected than the aortic valve (between the left ventricle and aorta).  Rheumatic heart disease can be prevented by preventing rheumatic fever. (acute rheumatic fever) is a disease that can affect the heart, joints, brain, and skin. Rheumatic fever can develop if and scarlet fever infections are not treated properly. Early diagnosis of these infections and treatment with antibiotics are key to preventing rheumatic fever. Causes Rheumatic heart disease is a direct result of rheumatic fever, an inflammator y disease caused by infection with group A streptococcus bacteria, which are responsible for illnesses such as strep throat and scarlet fever. Rheumatic fever affects connective tissue throughout the body, particularly in the heart, joints, skin.  When the heart is involved, inflammation can develop on the surface (pericarditis), within the valves (endocarditis), or in the heart muscle itself (myocarditis). Over time, people who develop endocarditis can experience permanent damage to one or more of the four heart valves, causing them to become narrow or leaky. Children between 6 and 16 who get repeated strep infections are at highest risk for rheumatic fever and, consequently, rheumatic heart disease. Genetics Genetics may play a role in rheumatic heart disease, as there appears to be a genetic link that makes some people more susceptible to rheumatic heart disease. But little is known about the genetic factors that increase or decrease the risk of developing RHD. Children Most Often Affected Although anyone can get rheumatic fever, it is more common in school- age children (5 through 15 years old). Rheumatic fever is and adults. Infectious illnesses, including group A strep, tend to spread wherever large groups of people gather together. Crowded conditions can or , and thus rheumatic fever. These settings include:  Schools Daycare centers Military training facilities Someone who had rheumatic fever in the past is more likely to n if they get strep throat or. Symptoms of Rheumatic Heart Disease Children with rheumatic heart disease may not have any clear symptoms. Usually, symptoms show up 10 to 20 years after the original illness. If your child has aortic or mitral valve abnormalities due to rheumatic fever, they may have symptoms, like being mainly with or when. Children with myocarditis or pericarditis may have chest pain or swelling. Your child may also have other effects of rheumatic fever, like joint pain and inflammation. Diagnosis To diagnose this condition, the doctor will ask about any recent strep infections (like strep throat) or sore throat episodes, examine your child and use In children with rheumatic heart disease, doctors can often hear a heart murmur. During the exam, your child’s doctor will look for signs of inflammation in your child’s joints. The doctor will ask for details about your , their health history and your family health history.  The doctor may order or or signs of a recent strep infection or other blood tests. The child will also need These may include: Chest X-ray Echocardiography Electrocardiogram MRI (magnetic resonance imaging) of the hear Treatment Children with rheumatic fever need medicine (antibiotics) to fight their strep infection. Your child’s doctor may also prescribe to treat They may recommend for 2 to 12 weeks, based on how serious your child’s illness is. After treatment, your child may still need to take medicine (prophylactic antibiotics) to make sure the infection does not  If your child had rheumatic fever, they need follow-up care with a heart doctor (pediatric cardiologist) to check for long-term heart damage. We provide care to prevent problems and to treat any problems that arise. Once a child gets rheumatic heart disease, they may have to take antibiotics for many years to Having rheumatic fever again can further damage their heart valves.  If your child has a damaged heart valve that is narrow or leaks enough blood to strain their heart, they may need surgery to repair the valve or it with an artificial valve. In some cases, if the valve is too narrow, doctors can use a catheter procedure ( ) to try to open the valve without surgery. Prevention of rheumatic fever Primary prevention can be achieved by educating the people to avoid streptococcal sore throat and Treatment of streptococcal with penicillin or other medications can be a useful measure to prevent Secondary prevention of the disease can be done by early detection, , and  Long-acting penicillin therapy should be every 15 days OR for at least five years. Parents should be made aware of the continuation of treatment, medical help, and follow –up Complications Rheumatic heart disease is generally latent or until Infective endocarditis, an embolic event, heart failure, pulmonary hypertension, and atrial fibrillation from untreated severe valvular disease are the most common complications. THANK YOU Dr/ Doaa Galal