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Transcript
Development of the Cardiovascular System.doc (81 KB) Pobierz Development of the Cardiovascular System. Clinical Manifestation of Congenital and Acquired heart Diseases in Childhood   •        Formation of the heart tube – 2nd-3rd week •        Bending of the heart tube and formation of the heart loop – 4th week •        Formation of primitive chambers  Anomalies of the heart loop formation •        Dextrocardia (heart tube bends to the left) •        Situs inversus viscerus •        Heterotaxia  Formation of heart septa and valves  4th-5th week –formation of main septa •        Atrial septa •        Ventricular septa •        Septum in truncus arteriosus and bulbus cordis (conus)  Congenital malformations •        Atrial septal defect (ASD) •        Ventricular septal defect (VSD) •        Aortopulmonary septal defect •        Common truncus arteriosus •        Transposition of great arteries •        Tetralogy of Fallot •        Aortic valve stenosis •        Pulmonary valve stenosis  Formation of arteries 4th-5th week of gestation  Arterial malformations •        Coarctation of the aorta •        Interrupted aortic arc •        Double aortic arc •        Aberrant subclavian artery   (vascular rings)  Circulatory changes after the birth •        Closure of umbilical arteries – constriction during several minutes after the birth, obliteration during 2-3 month (medial umbilical ligaments, superior vesicular artery) •        Closure of the umbilical vein and the ductus venosus – after closure of umbilical veins (ligamentum teres, ligamentum venosum) •        Closure of the ductus arteriosus – constriction after the birth, obliteration during 2-3 month (ligamentum arteriosum) •        Closure of the foramen ovale –stops to function after the first breath, anatomically during a year (in 20% of adults foramen ovale is not closed complitely)  Peculiarities of the heart in a newborn child •        Relatively big (0,8% of the body weight) •        Horizontal position, turned toward the anterior chest wall by the right ventricle •        Located higher •        Spherical shape •        Muscle fibers are thin, big number of nuclei •        Bad development of the interstitial tissue •        Good development of blood vessels •        Weight of ventricles is equal after the birth, later left ventricle growth faster (ratio between left and right ventricle at 2 years is 2:1, at 15 years – 3:1)  Peculiarities of blood vessels •        Arteries are better developed than veins •        Arteries are relatively broader (ratio between diameters of arteries and veins at birth is 1:1, in adult – 1:2) •        Muscle tone of arterial walls is lower (lower blood pressure) •        Pulmonary artery is bigger than aorta up to 12 years •        Great vessels grow more slowly than heart chambers  Location of the apical impulse •        Moves downward and to the right •        Up to the age of 2 years – the IV intercostal space, 1-2 cm to the left of the midclavicular line •        Preschoolers (3-7 years) – the V intercostal space, 1 cm to the left of the midclavicular line •        7-12 years – the V intercostal space, on the midclavicular line or 0,5-1 cm to the right  Borders of the relative heart dullness Border Age of child 0-2 years 3-7 years 7-12 years Upper ІІ rib ІІ intercostal space ІІІ rib Left     1-2 cm to the left of the l.medioclavicularis l.medioclavicularis Right     l.parasternalis dextra Between the l.parasternalis dextra and the sternum To the left of the l.parasternalis  Peculiarities of the auscultative picture •        First heart sound (S1) is associated with the closure of the mitral and tricuspid valves. It is best heard on the apex and lower left sternal border. Splitting of the S1 may be found in normal children (more frequently in early age – 1-3 years (9%). •        Second heart sound (S2) - semilunar valve closure, best heard at the 2nd intercostal space. Splitting of the S2 can be find in 19% of normal children. •        Third heart sound (S3) – is heard in 55-95% of children, at the beginning of the diastole, best heard on the apex in horizontal position of a child. •        Forth heart sound (S4) – just before the S1, best heard at the 3rd or 4th intercostal space (is rare in infants and children). •        Over 80 % of children have innocent (functional) heart murmurs.  The heart rate in children •        Neonate: 140 – 160 •        6 mo: 130 – 135 •        1 yr: 120 – 125 •        2 yr: 110 – 115 •        3-4 yr: 105 – 100 •        5 yr: 100 •        6-8 yr: 90 – 95 •        9-11 yr: 80 – 85 •        12 yr and older: 70 – 75  Blood pressure •        In neonates – 65-70 mmHg •        0-6mo – 80/50 mmHg •        6-12mo – 90/60 mmHg •        In infants – systolic BP – 75+2n (n – age in months), diastolic – 2/3 of it •        After 1 year – systolic – 90+2n, diastolic – 60+n (n – age in years)  Chief complaints •        Cyanosis or paleness of the skin (increases during feeding, crying) •        “cyanotic spells―, squatting •        Insufficient weight gain and growth retardation •        Edema (puffy eyelids and sacral edema in newborns) •        Tachypnea, dyspnea (increase during feeding, crying, exercises) •        Chest pain •        Palpitation (subjecive feeling of rapid heart beats)  Classifiscation of the congenital heart diseases •        Stenosis – aortic or pulmonary artery is stenotic. Increasing in the muscle mass of the affected ventricles •        R-to-L shunt – Fallot lesions, transposition of the great arteries. Cyanosis, dyspnea, diminished S2 over a.pulmonalis, enlargement of RA and RV, later enlargement of LA and LV •        L-to-R shunt – ASD, VSD, PDA. Pulmonary and RV hypertension cause pulmonary edema. Long-term presence of the large L-to-R shunt produces development of the Eisenmenger syndrome •        Mixing lesions (there are both L-to-R and R-to-L shunts without significant stenosis) – truncus arteriosus, total anomalous pulmonary venous return, hypoplastic left heart syndrome      In each group cyanotic and acyanotic conditions may be present  Classification of CHD, based on their physiology •        Increased blood flow through pulmonary circulation (PDA, ASD, VSD, transposition of the great vessels, common truncus arteriosus) •        Decreased blood flow through pulmonary circulation (isolated pulmonic stenosis, Fallot lesions, tricuspid atresia, Ebstein’s disease, Eisenmenger syndrome) •        Decreased blood flow through aorta (valvular aortic stenosis, coarctation of aorta, hypoplastic left heart syndrome)  Ventricle septal defect (VSD) •        Delayed growth and development decreased exercise tolerance, repeated pulmonary infections develop in moderate to large VSD •        Long-standing pulmonary hypertension leads to development of Eisenmenger syndrome (cyanosis, clubbing) •        A systolic thrill and systolic murmur may be present at the 3rd-4th intercostal space at the left sternal border •        Precordial bulge and hyperactivity are present with large-shunt VSD  Atrial septal defect (ASD) •        Three types of ASDs exist – secundum defect, primum defect, and sinus venosus defect (patent foramen ovale does not ordinarily produce intracardiac shunts) •        Clinical manifestation is almost the same as in VSD •        A systolic murmur may be present at the 2nd-3rd intercostal space over the left sternal border  Patent ductus arteriosus (PDA) •        Is a common problem in premature infants •        Diameter can vary from 3-4 mm to 2-3 cm •        The precordium is hyperactive •        A systolic thrill may be present at the upper left sternum border •        A continuous (“machinery―) murmur is best audible at the 2nd intracostal space over the left sternum border  Transposition of great arteries •        The aorta arises from right ventricle carrying desaturated blood to the body, and the pulmonary artery arises from the left ventricle carrying oxygenated blood to the lungs •        There is complete separation of the pulm... 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