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Congenital heart disease Understood PowerPoint Presentation

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Description : Check out this medical presentation on Congenital Heart Defect, which is titled "Congenital heart disease Understood", to understand the physiology Congenital Heart Disease (CHD) and relate to clinical findings.

Tags : Congenital Heart Defect, disease, chromosome defects, Downs syndrome, clinical findings

Published on : Jul 01, 2021 | Views : 2031 | Downloads : 14

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Slide 1-

Congenital heart disease understood
Slide 2-

Objectives Understand physiology and relate to clinical findings
Slide 3-

Facts and Figures Congenital Heart Disease (CHD) – incidence 8:1000 live births 4:1000 are symptomatic Up to 60% of neonates have a murmur at some stage Up to 1.6% have murmur at routine exam. 54% of babies with murmurs have CHD Routine neonatal examination fails to detect more than half of babies with CHD Normal examination does not exclude CHD
Slide 4-

Purpose of Screening for CHD Early identification before failure or hypoxia develop Prevention of irreversible damage Remember heart rate and rhythm
Slide 5-

ppt slide no 5 content not found
Slide 6-

Normal cardiac circulation
Slide 7-

Postnatal Anatomy and Function (picture from British Heart Foundation – www.bhf.org.uk)
Slide 8-

Congenital Heart Problems Cyanotic Congenital Heart Disease = blue Acyanotic Congenital Heart Disease = pink Cardiac Arrhythmias – fast or slow
Slide 9-

Why Cyanosis / blue? Low or no pulmonary blood flow - less oxygen picked up Transposition streaming Complete intra-cardiac mixing i.e mixed blue and pink
Slide 10-

Low pulmonary flow
Slide 11-

Separate streaming of blue and pink blood – transposition great arteries
Slide 12-

Tetralogy of fallots
Slide 13-

Cyanotic Congenital Heart Defects Tricuspid Atresia Pulmonary Atresia Transposition of the Great Arteries (7%) Tetralogy of Fallot (10%) Total Anomalous Pulmonary Venous Drainage
Slide 14-

Cyanotic summary Not pick up enough oxygen Mix blue and pink blood
Slide 15-

Acyanotic Congenital Heart Defects ie. pink Ventricular Septal Defect (25%) Atrial Septal Defect (7%) Atrio-ventricular Septal Defect Patent Ductus Arteriosus (12%) Coarctation of Aorta Aortic Stenosis (5%) Pulmonary Stenosis (5%)
Slide 16-

Ventricular septal defect
Slide 17-

Aortic stenosis
Slide 18-

Congenital Arrhythmias Irregular Rhythm – atrial or ventricular extrasystoles Bradycardia – sinus bradycardia, congenital heart block Tachycardia – supraventricular tachycardia
Slide 19-

Prior to Examination Note family history Note maternal drug/alcohol/illness history Note antenatal pointers to cardiac abnormality eg. Scan reports, high risk of Down’s Syndrome, irregular fetal heart Parents view of baby’s well being Ensure baby’s comfort
Slide 20-

Examination of Cardiovascular System Colour ( Dysmorphic features ) Respiratory rate and effort Palpation of apex beat Palpation for thrills and heave Heart rate and rhythm Heart sounds and murmurs Peripheral pulses
Slide 21-

Murmurs Timing – pan systolic, ejection systolic, continuous, diastolic Intensity – graded 1-6 Location – maximal intensity and radiation (May be innocent – quiet and short at left sternal edge with no accompanying symptoms or signs)
Slide 22-

Site of Murmurs
Slide 23-

Abnormal Symptoms Feeding difficulties Poor Colour Dyspnoea Restlessness Lethargy Sweating
Slide 24-

Abnormal Signs Poor colour or cyanosis Tachypnoea Displaced apex beat Hyperdynamic praecordium Thrill or heave present Abnormal cardiac rate or rhythm Added heart sounds or murmurs Poorly palpable or absent peripheral pulses Hepatomegaly
Slide 25-

Referral pathway Refer registrar or ANNP Assessment of well-being and saturations echo telelink? Seek feedback
Slide 26-

CONTROVERSIES Should saturation monitoring be part of routine assessment? Prevent Mortality and Morbidity Estimate MISS 50% Only Detect Hypoxia- Blue Duct Dependant Lesions more critical Routine antenatal screening picks up most and introduced to practise Multicentre UK study to assess benefits
Slide 27-

“pulseOx test accuracy study” Multi-centre study to recruit 20,055 Saturations before discharge or 24 hours If less than 95% - examine and repeat Access to reliable echo and follow up 53 major CHD with 24 critical. 34 known from antenatal screen Sensitivity= 75% for critical and 49% for major Miss low output e.g aortic stenosis WWW.HTA.AC.UK/1624 Lancet august 2011, issue 9793,p 785-794
Slide 28-

Summary Newborn examination is an opportunity to identify CHD early Normal examination does not exclude CHD Cardiac assessment includes consideration of family and antenatal factors as well as clinical examination Symptomatic babies may require urgent referral for further assessment If in doubt … ASK FOR HELP Do not be afraid to refer