1、Dr. Liu Chonghai Viral myocarditis Rheumatic heart disease Cardiomyopathy Kawasaki Disease Arrhythmia Congestive heart failure Pericarditis Infective endocarditis Etc. CHD accounts for nearly 1/3 of all major congenital anomalies. 25% are life threatening and require early intervention. The prevalen
2、ce of CHD in infancy is estimated at 6-8 per 1000 live births.(Indian) Prevalence 3 weeks of intrauterine life4 weeks of intrauterine life5-6 weeks of intrauterine life7-8 weeks of intrauterine life11 Differences between the fetal and postnatal circulation Presence of placental circulation, which pr
3、ovides gas exchange for the fetus. Absence of gas flow of blood to the lungs and thus little pulmonary venous return to left atrium Presence of ductus venosus, joining the portal vein with the inferior vena cava, providing a low resistance bypass for umbilical venous blood to reach the inferior vena
4、 cava Widely open foramen ovale to enable oxygenated blood (through umbilical veins) to reach the left atrium and ventricle for distribution to the coronaries and the brain Wide open ductus arteriosus to allow right ventricular blood to reach the descending aorta, since lungs are non-functioning.Cir
5、culatory adjustments at birth-transitional circulation Loss of placental circulation and clamping of the umbilical cord, after birth, results in a sudden increase in systemic vascular resistance with the exclusion of the low resistance placental circulation.Clinic features Cyanosis Difficult feeding
6、 and poor growth Difficult breathing Frequent respiratory infections Specific syndromesClinic features-Cyanosis Severe case Cry or exerts feedingClinic features-Difficult feeding and poor growth Parents complain that the child has difficulty with feeds. Slow feeding, small volumes consumed Growth ra
7、te is not appropriate for age. (growth retardation affects weight more than height.)Clinic features-Difficult breathing TachypneaRespiratory rates 60/min 50/min 2mon 40/min 12monClinic features- Frequent respiratory infections Frequent Severe Long duration Difficult to treatClinic features-Specific
8、syndromes Trisomy 21 Table 15-7 P401 Nadas Criteria One major or two minor One major or two minor creteriacreteriaMajor creteria Systolic murmur grate III or more in intensity Diastolic murmur Central cyanosis Congestive cardiac failureMinor creteria Systolic murmur less than grade III Abnormal seco
9、nd sound Abnormal electrocardiogram Abnormal X-ray Abnormal blood pressurePansystolic murmur A pansystolic murmur is always abnormal no matter what is its intensity. There are only three lesions that produce a pansystolic murmur VSD mitral reguragitation tricuspid regurgitationEjection systolic murmur May be due to an organic cause or it may be functional. Grade III ejection systolic murmur of a functional type may be heard in anemia or high fever.
