Anatomic stenosis causes obstruction to blood flow Pressure load on the

Anatomic stenosis causes obstruction to blood flow

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Anatomic stenosis – causes obstruction to blood flow Pressure load on the ventricle Decreased cardiac output Clinical manifestations – associated with low cardiac output TX: Aortic stenosis and coarcation – treated the same as defects that increase pulmonary blood flow Hypoplastic left heart syndrome – treated the same as defects that decrease pulmonary blood flow and mixed defects Defects that ↓ Pulmonary Blood Flow ( Pulmonary Stenosis, Tetralogy of Fallot, Pulmonary Atresia) Common causes Obstruction of pulmonary blood flow to lungs No connection of the right-sided blood flow to lungs Common manifestations Cyanosis Hypercyanotic spells Poor weight gain Polycythemia Treatment - depends upon defect Cyanosis: Hgb reduced by 5 g/100ml in veins Anemia: O2 sat very low before cyanosis is observed Polycythemia: cyanosis is obvious at a higher O2 sat Crying: cyanosis worse. Prolonged crying should be avoided Cyanotic spells require immediate treatment.
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Managing Hypercyanotic Episodes: Goal -to decrease pulmonary resistance Calm the child Oxygen Morphine and propranolol intravenously PRBC Goal – to increase systemic vascular resistance knee-chest position IV fluids to exand circulatory volume Dopamine (sympathomimetic agent) Immediate palliative or corrective surgery Mixed Defects: Complex defects Transposition of the great arteries Truncus arteriosus Cyanosis and congestive heart failure If the pulmonary blood flow is increased –– then what symptoms???? If pulmonary blood flow is decreased – then what symptoms?? TX: Early intervention to prevent secondary damage Surgical repair - See Table 26-7 Palliative surgery initially Antibiotic prophylaxis for infective endocarditis Prostoglandin E 1 (PGE 1 ) to reopen the ductus arteriosus Aggressive treatment of hypercyanotic episodes Cardiomyopathy: Etiology – primary or no known cause Symptoms: CHF Approx. 40% die within 2 years or receive a heart transplant These diseases enlarge your heart muscle or make it thicker and more rigid than normal. In rare cases, scar tissue replaces the muscle tissue. Some people live long, healthy lives with cardiomyopathy. Some people don't even realize they have it. In others, however, it can make the heart less able to pump blood through the body. This can cause serious complications, including Heart failure Abnormal heart rhythms Fluid buildup in your lungs or legs Endocarditis , an inflammation of the heart lining Heart attacks , high blood pressure or infections can all cause cardiomyopathy. Etiology – primary or no known cause, Viruses-myocarditis
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Dilated (and hypertrophic) cardiomyopathy presents with signs and symptoms of congestive heart failure (CHF) . Infants with this disease may demonstrate fast and heavy breathing with feedings, sweating with feedings, lethargy or inactivity, or poor weight gain. Older children may have difficulty
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