cardio #4

incomplete closure b/w the two upper chambers of the heart
*blood flow b/w atria causing some heart chambers to pump extra blood

the heart can dialate, the muscle can become weak, and the pressures in the pulmonary arteries can increase due to increase in blood flow

the pressures in the right side of the heart are high enough that blood may begin to flow from the right to the left side of the heart

*most common 80%
*caused by failure of part of the atrial septum to close completely during development of the heart
*results in a "hole" b/w chambers

-junction of the superior vena cava and right atrium
-anomalous drainage of the pulmonary v.
-one or more of the pulmonary vv carries oxygenated blood from the lungs to the right atrium instead of the left

enlargement of the right atrium and ventricle due to the extra blood ==
increasing pulmonary blood flow

fatigue
shortness of breath

*F:M= 3:1
****Systolic murmur with FIXED SPLIT S2*** heard best at the 2nd LICS
*will increase pulmonary flow across pulm. valve
*a lg ASD can cause MID-DIASTOLIC RUMBLE (increase flow across the AV valve

PS will have an ejection click

easily heart over left shoulder (back)

echocardiogram- which visualizes the actual defect and estimates its size, as well as the conn. of the pulm. vv

inconclusiive echocardiographic examination or associated anomalies, that req further eval.

-50%; 100% if <3mm if < 3 months
-80% if small 5-8 mm
-most won't close; >8mm=rare
-3-5 yrs

b/c of pulmonary vascular obstructive disease
*the pulmonary arteries become thickened and obstructed due to increased flow, from left to right for many yeart

Open heart surgery

*b/c there is no chance of spontaneous closure and these pt's are not candidates for transcatheter closure b/c of location of ASD

-right ventricular overload
a shunt fraction >2.0 as est. by echo
(amount of blood going in2 pulm
circulation/amount going out to
the systemic circulation)
elective closure prior to a child start
ing school

*direct suture repair (small ASD)
*patch repair (more common)
-use pt's own pericardium, bovine periicardium, or synthetic mmaterial (Gore-Tex, Dacron)

-infants/children who become symptomatic
-moderate-lg ASDs remaining at 4-5 y/o
-small ASD in an older child or adult
-heart lung bypass (patch repair)
-catheter reapair

digitalis
diuretics
SBE prophylaxis
-d/c 6 months post-op
-not indicated for isolated ASDs

*balloon catheter (use ultrasound) est. size
*fabric-covered wire frame over ASD
*wedges the ASD b/c the two parts
*6-8wks normal tissues grows in and over the defect
*90% success
*faster recovery, no thoracotomy

*Ventricular septal defect (SYSTOLIC murmur along LSB)
*Pulmonary Stenosis
*aorta "overrides" the ventricular septal defect
*right ventricular hypertropy

-Palliative: Blalock-Taussig (aortopulmonary shunt)
-Definitive: VSD patch repair and pulmonary valvulotomy

*cyanosis dev. as ductus closes at birth (not able to circulate enough blood now)
*"Tet spells" (paroxysmal(sudden attacks) hypercyanotic episodes):
irritable to low 02 levels
sleepy or unresponsive
can be treated by comforting and
knee-ches position

>95% infants successfully in 1st yr of life

*closure of VSD; augmentation of outflow tract

repaiir can lead to pulmonary insufficiency

*CXR and EKG (USELESS)
*pediatric cardiology consult
*echoocardiograpy has replaced cath studies
*MRI occasionally

-"cuer en sabot" (wooden shoe)
-"egg-on-end"
-"snowman"
-"backwards 3 sign" ( and rib notching)