Presentation on theme: "Sanjay Gandhi Postgraduate Institute of Medical Sciences"— Presentation transcript:
1Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow
2Welcomes participants in this presentation Department of Cardiovascular & Thoracic Surgery and Telemedicine network at SGPGIMSWelcomes participants in this presentation
3"Birth defect of Heart, its Presentation and Treatment" Nirmal GuptaHeadDepartment of Cardiovascular and Thoracic SurgerySGPGIMS, Lucknow. U.P.
4Magnitude: Birth defects of Heart in India Every year 2 lakh children are born with congenital heart defectsAt least 60,000 of these need treatment in the 1st year of lifeOnly 5000 get treatment because of lack of awareness amongst public in general and GP’s: delayed diagnosisPoor socio-economic status of families: delayed treatment
5Current facilitiesRequires highly trained and dedicated team of diagnostic facilities, Surgeons and NursesPoor availability of facilities even in best hospitalsNot a financially viable option for private setupsLack of trained manpower in the country (only 5 dedicated units other than SGPGIMS)
6"Birth defects of Heart, its Presentation and Treatment" SYMPTOMS"Birth defects of Heart, its Presentation and Treatment"
7Neonatal HistoryCyanosisFailure to thriveExercise intoleranceShortness of breathSyncopePalpitationChest pain
8NEONATAL HISTORY Cyanosis, shortness of breath. Did the child need to stay in the hospital after maternal discharge?
9Neonatal historyCyanosisFailure to thriveExercise intoleranceShortness of breathSyncopePalpitationChest pain
10CYANOSIS > 5g/dl of deoxygenated Hb False positive polycythemiaFalse negative anemiaPathophysiology leading to cyanosis:Obstruction of systemic venous blood flow to the lungsShunting of deoxygenated blood to left heartDesaturation of systemic arterial blood
11Neonatal historyCyanosisFailure to thriveExercise intoleranceShortness of breathSyncopePalpitationChest pain
12FAILURE TO THRIVEPoor cardiac output and increased myocardial energy consumption coupled with poor feeding due to S.O.B.
13Neonatal historyCyanosisFailure to thriveShortness of breathExercise intoleranceSyncopePalpitationChest pain
14EXERCISE INTOLERANCEBaby poor ability to suck and feedChild sedentaryPathophysiology leading to exercise intolerance:Poor cardiac output.Increased energy consumption by an overworked heart.
15Neonatal historyCyanosisFailure to thriveExercise intoleranceShortness of breathSyncopePalpitationChest pain
16SHORTNESS OF BREATHSome children may be short of breath without appearing in distress "Happily tachypnoec"Pathophysiology of S.O.B.:Increase pulmonary blood flowInterstitial edemaDecreased oxygen diffusionHypoxemia
17Neonatal historyCyanosisFailure to thriveShortness of breathExercise intoleranceSyncopePalpitationChest pain
18SYNCOPE Pathophysiology: Inability to increase cardiac output suddenly due to restricted left ventricular outflow, e.g. severe aortic stenosis, IHSS.Abnormal vasomotor tone resulting in vasodilatation when vasoconstriction is needed to maintain adequate blood pressure.
19Neonatal historyCyanosisFailure to thriveExercise intoleranceShortness of breathSyncopePalpitationChest pain
20PALPITATION Pathophysiology: Irregular rhythm Tachycardia Awareness of normal rate and rhythm.
21Neonatal historyCyanosisFailure to thriveExercise intoleranceShortness of breathSyncopePalpitationChest pain
22CHEST PAIN Rarely cardiac in origin. Look for extra cardiac causes: Skin,Musculoskeletal,Costochondral joints,Pleural membranes,Pericardium,Referred pain
23"Birth defects of Heart, its Presentation and Treatment" SIGNS"Birth defects of Heart, its Presentation and Treatment"
25INSPECTION Does the child appear ill? Decreased tissue oxygenation due to poor cardiac output or severe cyanosisRespiratory distress due to pulmonary edema or hypoxemia.CyanosisEdemaDistended neck veins due to increased right heart pressure leading to systemic venous congestionClubbing of digitsChronic peripheral tissue hypoxemia
30AUSCULTATION LUNGS Pulmonary edema = rales, crackles HEART First heart sound (S1):Closure of atrio-ventricular valves.Second heart sound (S2):A2: closure of aortic valveP2: closure of pulmonary valveSingle S2 = absent pulmonary or aortic component or delayed closure of A2 superimposing P2inaudible P2 in TGADoes the splitting of S2 vary with respiration?Added sounds:Gallop rhythm: S3, S4
31AUSCULTATION (Contd.) Murmurs Grade: 1-6, one being the softest and six being the loudest.By definition grade four murmur is associated with a palpable thrill.Systolic murmur:Holosystolic:Shunting of blood between two structures , the pressure in one structure is higher than the other throughout systoleHarsh: VSDSoft: Atrio-ventricular valve regurgitation Ejection:Increase in blood flow turbulence as systole progresses due to an increasing amount of blood flow through a restricted orificeAortic stenosisPulmonary stenosisSmall VSD
32AUSCULTATION (Contd.) Mid-systolic: Diastolic murmur: Increase volume of blood flowing through normal valvesASDAnemiaDiastolic murmur:Early:Regurgitant blood flow from aorta or pulmonary artery into the ventriclesAortic insufficiencyPulmonary insufficiencyLate:Austin Flint murmurAortic regurgitation blood flow causes vibration of left ventricular free wall Systolic and diastolic murmur:Pressure difference between two structures during systole and diastole.PDA & Shunts and collaterals
33Congenital Heart Diseases and their Treatment "Birth defects of Heart, its presentation and treatment"
51General guidelines: At birth Blueness at birth or immediately after Murmur of the heartRapid breathingLow blood pressure
52General guidelines: At 2 – 6 months Difficulty in feeding- baby is unable to suck properly, sweats or starts rapid breathing while feedingBlue nails and toes and fainting spellsInadequate weight gainRecurrent chest infections
53General guidelines: In first 3 years of life Fainting spells Abnormal heart beatsChild avoids rigorous activitiesUnable to play with his mates
54General guidelines for couples Drugs to avoid during pregnancyStrict “NO” to Isoretinoin, Thalidomide, Estrogens, Oral contraceptives, ACE inhibitors, Chloramphenicol, Chlorpropamide, Erythromycin, Tetracycline and Haloperidol.Anti-cancer drugs and Phenytoin are harmful but benefits outweigh the side effects.Epinephrine, Ephedrine, B-blockers and Promethazine do not pose any significant risk, though the research is inadequate
55In the end…“There are a million times more patients in India with congenital heart diseases than polio, but the government’s budget for the treatment of congenital heart diseases is miniscule in comparison”