CARDIOVASUCULAR PROBLEMS IN

CHILDREN
NIRANJANA SHALINI. M.Sc (N)
Assistant professor
CONGENITAL HEART DEFECTS
 Congenital Heart Defect
Anomalies of the heart structure which is
present from birth itself

Heart structure- Chambers, valves, vessels

 Shunt
Abnormal communication between
chambers or blood vessels that results in
mixing of oxygenated blood with
de oxygenated blood
ACYNOTIC HEART DISEASES
ATRIAL SEPTAL DEFECT
 TYPES OF ASD

or primum
P/P
LA PRESS is than RA PRESS

O2 blood moves from LA to RA

RA & RV ENLARGEMENT (MILD)

ACYANOSIS & CHF( UNUSUAL IN UNCOMPLICATED ASD)

C/M
DEPENDS UPON SIZE & LOCATION

MAY BE ASYMPTOMATIC

DYSPNEA & EXERCISE INTOLERANCE& EASY FATIGABILITY

SYSTOLIC MURMUR & WIDE SPLIT S2

DIAGNOSIS

CARDIAC EXAMINATION:
❖ SOFT SYSTOLIC EJECTION MURMUR
❖ SPLIT OF II HEART SOUND
❖ IF LARGE SHUNT: DIASTOLIC MURMUR

ECHO:
❖ LOCATION & SIZE OF THE ASD
❖ DILATATION OF ATRIA& SIZE. WALL THICKNESS OF RV

CHEST RADIOGRAPH:
❖ ENLARGEMENT OF RT HEART & SEGMENT OF PUL. ARTERY

CARDIAC CATH: INCREASED OXYGEN CONTENT & PRESSURE IN

RT SIDE OF THE HEART
MANAGEMENT

SMALL ASD CLOSES SPONTANEOUSLY, REQUIRING NO

INTERVENTOIN

SURGICAL: 2-4 YEARS

: SMALL ASD- PURSUE STRING SUTURE
:MODERATE – LARGE- PERICARDIAL/ DACRON PATCH

NON SURGICAL: IMPLANTABLE UMBERLLA VIA CARDIAC CATH

COMPLICATION

❑ ATRIAL ARRYTHMIAS
❑ PULMONARY HT
❑ CHF
_________________________
 Pathophysiology
O2 blood return from lungs to LA enters into
LV through VSD – RV
Returns to Lungs through Pulm.Artery
(LT – RT SHUNT)
High PVR Increased right side pressure
Reversal of shunt from RT - LT
Cyanosis Eisenmenger syndrome
C/M

SMALL VSD : LITTLLE SHUNTING - ASYMPTOMATIC

PANSYSTOLIC MURMUR

LARGE VSD: DYSPONEA,TACHYPONEA,FEEDING DIFFICULTIES

FREQUENT PULMONARY INFECTION

MILD CYANOSIS IF INFANT CRIES

FAILURE TO THRIVE & CHF

DIAGNOSIS

C/E: SYSTOLIC MURMUR

ECG: LV&LA ENLARGEMENT--- RV HYPERTROPHY

RADIOGRAPH: HEART SIZE & SIZE OF PUL.ARTERY

ECHO: SIZE,LOCATION, DEGREE OF SHUNTING &PVR

CARDIAC CATH: ABNORMAL COMMUNICATION,

PRESSURE OF RV& OXYGEN IN RV & PUL.

HYPERTENSION
MANAGEMENT

SMALL: CLOSES SPONTANEOUSLY

LARGE: AS LIKE ASD- DIGOXIN & DIURETICS

PUL ARTERY BANDING AS PALLIATIVE

**********
 ALSO KNOWN AS
• Also known as atrioventricular canal defects
• Endocardial cushion defects
The structures that develop from the
endocardial cushions include the
lower part of the atrial septum and the
Ventricular septum
 treatment
• Lasix (furosemide)
• angiotensin converting enzyme (ACE)
inhibitors - enalapril.
• Surgery
___________
PATENT DUCTUS ATERIOSIS
•
Communication between
pulmonary artery
and
the aorta
•
Location – distal to left
subclavian
 C/M
IRRITABLE,
FEED POORLY,
FAIL TO GAIN WEIGHT
DYSOPNEA
RECURRENT UPPER RESPIRATORY
INFECTIONS
MURMUR
 DIAGNOSIS
• CHEST – XRAY
• Echocardiogram - Gold standard for
diagnosing PDA
• Cardiac catheterisation
 Treatment

•
Premature
Indomethacin
0.1mg/kg/dose
12 hourly 3 doses
•
Ibuprofen is as effective as
indomethacin in closing a PDA and
currently appears to be the drug of choice.
Ibuprofen reduces the risk of NEC and
transient renal insufficiency.

Ibuprofen for the treatment of

patent ductus arteriosus in
preterm or low birth weight (or
both) infants
•
Paracetamol appears to be a promising
new alternative to indomethacin and
ibuprofen for the closure of a PDA with possibly
fewer adverse effects.

Paracetamol (acetaminophen) for

patent ductus arteriosus in preterm
and low-birth- weight infants
 Treatment
•
All patients with PDA require surgical or
catheter closure.

•
 Cardiac catheterization –
Trans catheter closure

•
Small PDAs- closed with
intravascular coils.

•
Moderate to large – catheter introduced
sacs or umbrella like device
Intravascular coils - gianturco
Amplatzer patch
 Surgery
•
Left thoracotomy

___________________
• The coarctation or “constriction” may be distal
to
the ligamentum or ductus arteriosus or the
subclavian artery , or proximal to them
• distal to the coarctation is often dilated.
coarctation of aorta syndrome
 “preductal (infantile) type”,
• high load on the left ventricle causes elevation
in both systolic and diastolic pressures.
• congestive cardiac failure.
 “postductal (adult) type”

• collaterals connecting branches of the

subclavian artery to the arteries which arise
from aorta
 c/m preductal type
• congestive cardiac failure in first 1 to 3 weeks.
• feeding difficulty,
• dyspnea,
• failure to thrive,
• pitting edema,
• Heart murmurs. systolic murmur is usually
found over the interscapular area.
 c/m postductal type
• fatigue,
• intermittent claudication,
• headache, weakness
• exertional dyspnea.
• overgrowth of upper limbs and chest
• Weak, delayed and even absent femoral
arteries compared to the strong brachial
arteries.
• The blood pressure in the arms is much
higher than in the legs
• leg is cooler than arms
• left brachial pulse may be weaker and the
blood pressure in the left arm lower than
on the right side.
• Dilated and tortuous collaterals may be
seen over the interscapular area in older
children.
• It is called Suzman sign.
 DIAGNOSIS
• X-ray chest findings include some left
ventricular
• enlargement, notching of the ribs caused by
intercostal collaterals and “E/3” sign on
barium swallow. The first
• arch of the “E” is due to dilatation of aorta
before the coarctation,
• and the middle due to the coarctation
• the second due to poststenotic dilatation
• ECG.
• Echocardiography
• Cardiac catheterization
 TREATMENT
• constant infusion of prostaglandin E1
• Antibiotic prophylaxis
• Corrective surgery consists of resection of the
coarctated area and end-to-end anastomosis
• using a dacron graft or subclavian flap
________________
AORTIC STENOSIS
• Aortic valve stenosis — or aortic stenosis
occurs when the heart's aortic valve
narrows.
• This narrowing prevents the valve from
opening fully,
• which reduces or blocks blood flow from
heart into the aorta and to the rest of the
body.
TYPES

❖ VALVULAR STENOSIS
❖ SUBVALVULAR STENOSIS
❖ SUPRA VALVULAR STENOSIS
P/P

STRICTURE IN AORTIC OUTFLOW

EXTRA WORKLOAD OF LV

LV HYPERTROPHY & LVF

PULMONARY VASCULAR CONGESTION & PULMONARY

EDEMA
C/F

S/S OF EXERCISE INTOLERANCE,CHEST PAIN,

DIZZINESS ON STANDING FOR LONG TIME.
FAINT PERIPHERAL PULSE, ANGINAL PAIN
HYPOTENSION, TACHY CARDIA & POOR FEEDING
ENDOCARDITIS
VENTRICULAR DYSFUNCTION
SEVERE- SUDDEN DEATH
 TREATMENT
• The patient should have close follow-up.
• should be discouraged from overexertion, i.e.
competitive sports, atheletics and strenuous
exercise.
• Surgery - aortic valvotomy and aortic valve
replacement
__________________
PULMONIC STENOSIS
Pulmonary stenosis is a condition
characterized by obstruction to blood
flow from the right ventricle to the
pulmonary artery.
 Pathophysiology
Pulmonic stenosis restrict blood flow from Rt. V
to Pulm.artery
Rt.V Pressure increases

Thickening of Rt.V
Rt.A Pressure increases
Rt-Lt shunt through foramen ovale (ASD)
 C/M
• Murmur
• Dyspnea on exertion
• Easy fatigability
• Chest pain
• Epigastric pain
• Heart failure
 D/E
• History
• Physical assessment

• ECG
• ECHO
ELECTROCARDIOGRAPHY (ECG)
ECHOCARDIOGRAM (HEART
ULTRASOUND)
 TREATMENT

• 02 supplementation
• prostaglandin E1
• Surgery - Percutaneous balloon pulmonary
valvuloplasty (PBPV)& surgical valvuloplasty

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