نارسایی مادرزادی قلب و عروق CHD،congenital cardio vascular anomalies
اسلاید 1: Powerpoint TemplatesCongenital Cardiovascular Anomalies Behnam Masmoui , CCNS , MSNHamadan University of Medical Sciences
اسلاید 2: بیماری های مادر زادی قلب در گذشته به 2 نوع سیانوتیک و غیر سیانوتیک دسته بندی میشد اما با توجه به علائم بالینی این دسته بندی اعتبار نداشت زیرا ممکن بود کودکی با نقص سیانوتیک دارای پوست صورتی رنگ باشد.در تقسیم بندی دیگری که بر مبنای خصوصیات همودینامیکی و جابجایی گردش خون صورت میگیرد گروه ها شامل:افزایش جریان خون ریویکاهش جریان خون ریویانسداد جریان خروجی خون از قلباختلاط جریان خونبیش از 35 نوع ناهنجاری مادرزادی قلب تا کنون شناخته شده که بعضی مثل قلب تک بطنی نادر هستند.
اسلاید 3: Classification of CHDsStructural heart defects —due to abnormal development of the heart during the first 2 months after conceptionFunctional heart defects– ex: congenital heart block3. Positional heart defects —ex: dextrocardia
اسلاید 4: DextrocardiaMay occur:With Situs Inversus: carries a slightly increased risk of heart defects (~ 5 – 10% associated with other CHDs)Without Situs Inversus: carries a greatly increased risk of associated heart defects (~95% associated with other CHDs)Both conditions are EXTREMELY rare Situs Inversus
اسلاید 5:
اسلاید 6: Classifications of Structural Congenital Heart Defects
اسلاید 7: ShuntsRight to Left vs. Left to RightRight to left shunt: un-oxygenated blood is shunted from the right side of the heart to the left side, and then enters the systemic circulation. Left to right shunt: a portion of the oxygenated blood is shunted from the left side of the heart to the right side and enters the pulmonary circulation, Increasing the work load for the right heart
اسلاید 8: Cyanotic vs. AcyanoticAcyanotic (usually left to right shunts):PDA, ASD, VSDCyanotic (right to left shunts): TOF, Transposition of the Great Arteries, Hypoplastic Left HeartO2 Sat less than 95%Child may have chronic hypoxiaCaused by:Decreased pulmonary blood flow –and/or--Right-to-left shunting: de-oxygenated blood is shunted from the right side of the heart to the left side without traveling though the pulmonary circulation, and blood ejected from the left side of the heart to the systemic circulation is only partly oxygenated
اسلاید 9: Most Common Congenital Heart Defects These account for 85% of all CHDs:
اسلاید 10: Etiology of CHDUnknown in most casesIncidence of CHD in children is slightly increased if a sibling or parent has CHDGender FactorsEnvironmental FactorsGenetic Factors
اسلاید 11: Gender FactorsOccur equally among males and females, but—More common in males: aortic stenosis, coarctation of the aortaMore common in females: PDAs, ASDs
اسلاید 12: Environmental FactorsMaternal Infections:Rubella: PDA, pulmonary stenosis, VSD, ASDMaternal Drugs:Lithium: Tricuspid valve abnormalities, Ebstein’s Anomaly ThalidomidePossibly related to CHDs: Dilantin & CocaineAlcohol abuse: VSDMaternal Disease:Diabetes: transportation of the great vessels, VSD, situs inversus, single ventricle, hypoplastic left ventricle SLE: Congenital heart block
اسلاید 13: Genetic FactorsTrisomy 21 (Down’s Syndrome): A-V canal defects, VSDXO (Turner’s Syndrome): coarctation of the aorta, aortic stenosisOsteogenesis Imperfecta:Aortic incompetenceMarfan Syndrome: Aortic dilatation, aortic & mitral incompetence
اسلاید 14: Prevention of CHDNot possible in most casesBut -- there are actions a woman can take to reduce her risk of having a child with CHD:Abstain from alcohol during pregnancyBe immunized against rubella before conceptionIf diabetic, maintain tight control of blood sugarsFolic acid 400 mcg/daily before conception may help to prevent CHD (unproven)If there is a family history of CHD seek genetic counseling prior to conception
اسلاید 15: Signs/Symptoms of CHDMurmursCyanosis –worsens with crying or other exertionRespiratory distressSigns of poor perfusion, such as slow capillary refill, diminished peripheral pulsesFatigue – commonly observed during feedings in newborns or during play in childrenFailure to thrive
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