儿科心脏病学先心病（32p）

《儿科心脏病学先心病（32p）》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、PaediatricCardiologyCongenitalHeartDefectsAmarpalS.Bilkhu5thYearMedicalStudentUniversityofGlasgow0705287b@student.gla.ac.ukLearningObjectivesUnderstandbasiccardiacphysiologyinthenewbornTodescribecommoncongenitalheartdefectsRecognisetheclinicalfeaturesof

2、congenitalheartdefectsUnderstandthemanagementoptionsavailableTobeabletoperformCVexaminationanddetectcongenitaldefectsinchildrenCaseScenario6weekoldbabygirlpresentsinA&Ewithdifficultyfeeding,wheezingandpoorweightgainforthepastcoupleofweeksShecanbecomebre

3、athless,criesalotandsweatswhilstfeedingandbecomesirritableRoutineneonatalexaminationwasnormalNoothersignificanthistoryCaseScenarioOnexamination:RR–55breaths/minHR–180beats/minRespiratory:SubcostalandintercostalrecessionsNocyanosis,butcoldperipheriesWhee

4、zethroughoutlungfieldsCVS:ThrillLoudpansystolicmurmuratthelowerleftsternaledge,accentuated2ndheartsoundPulsesnormal(femoralpulsespresent)CaseScenarioOnexamination:Abdomen:Liveredgepalpableabout2fingerbreadthsbelowthecostalmarginNoothermassesfeltClinical

5、featuressuggestiveofheartfailureCaseScenarioInvestigations:ECG–normalCXR–cardiomegaly,enlargedpulmonaryarteriesandincreasedpulmonaryvascularmarkingsEchocardiography–largeventricularseptaldefectUSSShowingVSD,andDopplershowinglefttorightshuntduringsystole

6、(blue)http://www.ultrasound-images.com/fetal-heart.htm#VSD_(Ventricular_Septal_Defect)CaseScenarioDiagnosis–heartfailureduetoVSDManagement:DiureticsforheartfailureOftencombinedwithACEinhibitors–captoprilSupportnutritionviaNGfeedstopreventweightfaltering

7、DefinitivemanagementisthroughsurgicalclosureoftheVSDNormallyperformedataround3-6monthsofagetomanageHF,encouragegrowthandpreventpulmonarycomplications(Eisenmenger’ssyndrome)CaseScenarioEisenmenger’ssyndromeIfVSDwithleftrightshuntsleftuntreatedChronicall

8、yraisedpulmonaryarterialpressureleadstoincreasedpulmonaryvascularresistanceMayleadtoheart-lungtransplantintheseconddecadeoflifeCongenitalHeartDefectsMostnowidentifiedonantenatalUSSFetalanomalyscanperformedat18-20weeksgestationUSS