Congenital Heart Disease PPT PDF

Congenital heart disease (CHD) Dr Talaat Saeed, MD Lecturer of cardiology 1  Dating since birth. Can continue to adult if mild disease or repaired at childhood. It can be either due to genetic defects or environmental factors (e.g. mater...

Congenital heart disease (CHD) Dr Talaat Saeed, MD Lecturer of cardiology 1  Dating since birth. Can continue to adult if mild disease or repaired at childhood. It can be either due to genetic defects or environmental factors (e.g. maternal rubella and maternal chronic alcohol abuse). Either acyanotic or cyanotic or 2 Effects of congenital heart diseases  Congestive heart failure: failure to gain weight, feeding difficulties, tachycardia, tachypnea and tender liver.  Cyanosis: reduced HB in cutaneous vessels in excess of 5g\dl. Hypoxia leads to renal production of erythropoietien that in turn stimulates bone marrow to produce more RBCs enhancing O2 carrying capacity. This erythrocytosis leads to hyperviscosity syndrome ; headache, fatigue, visual disturbances, tinnitus.  Pulmonary hypertension: increase pulmonary blood flow leads to pulmonary vascular endothelium injury → release of activation factors→ enhance hypertrophy, excess CT synthesis, proliferation of vascular smooth muscle cells→ reduce diameter of small pulmonary vessels. If pulmonary hypertension became severe, it cause shunt reversal ; Eisenmenger syndrome. 3  Common features of acyanotic heart disease Usually discovered accidently as a murmur during early childhood. Usually survives to adulthood as age matched populations. Usually of benign course with good prognosis unless of severe degree. Anatomically: Either : 1- Left to right shunt e.g: Atrial Septal defect (ASD), Ventricular Septal defect (VSD) or patent ductus arteriosus (PDA) 2- Obstructive pathology e.g: Aortic Stenosis (AS) , Pulmonary Stenosis (PS) or coarctation of aorta. 4  Spontaneous closure of left to right shunt can occur without intervention in majority of them. It may be asymptomatic if small or present with heart failure if significant left to right shunt due to volume overload. Patient may develop Eisenminger syndrome (severe pulmonary hypertension with reversal of shunt to become right to left i.e becomes cyanotic) if there is significant left to right shunt without treatment. Can easily be diagnosed by echocardiography and rarely needs other investigations Can be easily treated by: a- percutaneous intervention (closure of the shunt by device or balloon dilatation for obstructive lesions or b- surgical repair if not feasible for percutaneous intervention. Usually pregnancy is safe and can practice exercise. Low risk for infective endocarditis. 5 Atrial septal defect (ASD). 6 Ventricular septal defect (VSD). 7 Patent ductus arteriosus (PDA). 8 Aortic valve stenosis (Bicuspid aortic valve) 9 Coarcatation of aorta (COA). 10 Cyanotic congenital heart disease (CCHD): 11  Common features of cyanotic heart disease Usually discovered during neanatorum due to heart failure or cyanosis. Usually of aggressive course due to complex anatomy with high mortality especially if untreated (poor prognosis). Anatomically : Usually there is A- significant right to left shunt of blood or B- markedly diminished or absent pulmonary blood flow with subsequent necessary ASD VSD or PDA to maintain life. Patient may have symptoms of heart failure or complications of cyanosis eg: hyperviscosity syndrome (haedach, blurring of vision, fatigue or thrombosis) or pulmonary hypertension. 12  Can be diagnosed easily by echo but usually needs other investigations e.g multislice CT, cardiac MRI or right heart catheterization. Usually needs surgical intervention at early stages with common need for staged correction Usually of unfavorable outcomes with high mortality if untreated and if treated most of them die at 3rd or 4th decade. Pregnancy is usually contraindicated and if got pregnant is of high risk for complications including death. High risk for exercise and infective endocarditis 13 Tetraology of fallot (TOF ) 14 Transposition of great arteries ( TGA): D- TGA , L-TGA 15 16 Ebstein anomaly. 17 Systemic hypertension (HTN) Dr. Talaat Saeed, MD Lecturer of cardiology 18  Systemic HTN - BP ≥ 140 or 90 in person not talking anti-HTN medications or controlled BP in patient already on treatment. 1) Normal BP BP < 120 and < 80 2) Pre-HTN: BP 120-139 or 80-90 3) HTN: BP ≥ 140 and/or 90. - Stage 1 : SBP 140-159 DBP 90-99. - Stage 2 : SBP 160- 179 DBP 100-109 - Stage 3 : SBP ≥ 180 DBP ≥110mmhg. 19 Precautions of measurement 20 Measurement in different situations 21  Types and causes  Essential: due to neither secondary cause nor monogenic disorder.  Secondary: caused by identifiable and potentially curable disorder, e.g. -Renal parenchymal disease as polycystic kidney. -Renal artery stenosis. -hypothyroidism and hyperthyroidism. -Cushing disease. -Primary aldosteronism. -Coarctaion of aorta. -Drugs; steroids, NSAIDs, appetite suppressants, decongestants, TCAs…. 22  Complications of HTN 1- Cardiac complications: heart failure, arrythmia as atrial fibrillation, coronary artery disease. 2- Brain: stroke, intracranial heamorage. 3- Renal failure; nephropathy 4- Retinal haemorrhage; retinopathy. 5- Aortic aneurysm and / or aortic dissection. 23  Treatment of HTN A- Lifestyle modifcations: salt restriction, stop smoking, weight reduction, moderation of alcohol consumption, healthy diet and regular exercise. B- Pharmaholgical therapy includes different drugs categories: 1- Angiotensine converting enzyme (ACE ) inhibitors: e.g: captopril or enlapril 2- Angiotensin Receptors Blockers (ARBs) eg: vlasartan or olmesartan. 3- Beta blockers (BBs): eg:bisoprolol, metoprolol, nebivolol or carvidolol. 4-Calcium channel blockers (CCBs): e.g:verapamil or amlodipine. 5-Thiazide diuretics eg: hydrochlorothiazide or chlorothalidone. 6- Others (alpha adrenergic blockers as prazoscin, central adrenergic agonist as alpha methyl Dopa…….) C- Search for secondary cause that is potentially curable. Aim is to achieve systolic blood pressure between 120 and 130 (not less than 110), and diastolic blood pressure between 70 and 80 (not less than 70). 24 Thank You 25