Download Congenital heart diseases is a category of heart disease that

Lecture II
Congenital Heart Diseases
Dr. Aya M. Serry
2016
The Fetal Heart
• The heart is the first functioning organ in the embryo.
• Its first pulsatile movements begin during the third week
after conception.
• This early development of the heart is essential to the
rapidly growing embryo as a means of circulating
nutrients and removing waste products.
• Most of the development of the heart and blood vessels
occurs between the third and eighth weeks of embryonic
life.
Definition:
• Congenital
heart diseases is a category of heart disease
that includes abnormalities in cardiovascular structures
that occur before birth
• Approximately 8 out of every 1,000 newborns have
congenital heart defects, ranging from mild to severe
• Congenital heart defects may produce symptoms at birth,
during childhood, or not until adulthood. Other congenital
defects may cause no symptoms
Fetal Circulation
Fetal Circulation
https://www.youtube.com/watch?v=-IRkisEtzsk
https://www.youtube.com/watch?v=DC_wlkRPzw0
Congenital Heart Defects
• Pathophysiology:
• Abnormal Shunting of Blood
• P. 833 (Chapter 32 from textbook)
Symptoms:
The symptoms of congenital heart disease in infants and
children include:
• Cyanosis (a bluish tint to the skin, fingernails, and lips)
• Fast breathing and poor feeding
• Poor weight gain
• Recurrent lung infections
• Inability to exercise
In more severe cases, these
problems may develop
shortly after birth. However,
symptoms sometimes
don't develop until the
teenage years or early
adulthood.
Diagnosis:
 Congenital heart disease is often first detected when your
doctor hears an abnormal heart sound or heart murmur
when listening to your heart
Depending on the type of murmur your doctor hears, he or she
may order further testing such as:
•Echocardiogram
•Cardiac catheterization
•Chest X-ray
•Electrocardiogram (ECG or EKG)
Risk Factors
 In the majority of people, the cause of congenital heart
disease is unknown. However, there are some factors that
increase chance of having congenital heart disease. These
risk factors include:
• Genetic or chromosomal abnormalities in the child, such as Down
Syndrome
• Taking certain medications or alcohol or drug abuse during
pregnancy
Risk Factors Cont’d
• Maternal viral infections, such as (German measels) in the first
trimester of Pregnancy
• The risk of having a child with congenital heart disease may
double if a parent or a sibling has a congenital heart defect
Body
Right
Heart
Left
Heart
Lungs
CHD are classified into
Non-Cyanotic CHD
1) Atrial septal defects (ASD)
2) Ventricular septal defects (VSD)
3) Patent ductus arteriosus (PDA)
Cyanotic CHD
4- Tetralogy of Fallot
A) Non-Cyanotic CHD
1- Atrial septal defects (ASD)
• Normally, a small opening between the two atria
(foramen ovale) is present at child birth.
• Shortly after birth, the atrial septum gradually
grows and seals this opening
•In infants with atrial septal defects, the atrial
septum may not close properly or may be
malformed during fetal development.
• In these disorders, the opening between the atria
persists long after it should be closed, resulting in
an increase in the workload on the right side of the
heart and excessive blood flow to the lungs
A) Non-Cyanotic CHD
2- Ventricularl septal defects (VSD)
• Ventricular
septal defects can occur in any portion of the ventricular
septum.
•The size and location of the defect determine the severity of the
symptoms. Small ventricular septal defects can close on their own
(spontaneously) or become less significant as the child matures and
grows
• Moderately-sized defects can cause congestive Heart Failure, which
is characterized by an abnormally rapid rate of breathing (tachypnea),
wheezing, unusually fast heartbeat (tachycardia)
A) Non-Cyanotic CHD
2- Ventricularl septal defects (VSD)
• Large ventricular septal defects can cause
life-threatening complications during infancy
• Persistent elevation of the pressure within
the artery that carries blood away from the
heart and to the lungs (pulmonary artery)
can cause permanent damage to the lungs
A) Non-Cyanotic CHD
3- Patent Ductus Arteriosus
A) Non-Cyanotic CHD
3- Patent Ductus Arteriosus
• The
ductus arteriosus is a normal fetal blood vessel that closes soon
after birth.
•In a patent ductus arteriosus (PDA) the vessel does not close and
remains "patent" resulting in irregular transmission of blood between
two of the most important arteries close to the heart, the aorta and the
pulmonary artery
• A patent ductus arteriosus allows a portion of the oxygenated blood
from the left heart to flow back to the lungs by flowing from the aorta
(which has higher pressure) to the pulmonary artery
B) Cyanotic CHD
4-Tetralogy of Fallot
B) Cyanotic CHD
Tetralogy of Fallot
• Most
common form of cyanotic heart disease
• Cyanosis is the abnormal bluish discoloration of the skin that
occurs because of low levels of circulating oxygen in the blood
B) Cyanotic CHD
Tetralogy of Fallot consists of the combination of four different
heart defects:
1- a ventricular septal defect
2- obstructed outflow of blood from the right ventricle to
the lungs (pulmonary stenosis)
3- a displaced aorta, which causes blood to flow into the aorta
from both the right and left ventricles
4- abnormal enlargement of the right ventricle (right ventricular
hypertrophy)
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