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Incidence
Etiology
Multifactorial inheritance pattern mostly :
Maternal diseases>
diseases> PKU-VSD,ASD
DM:left septal hypertrophy
Drugs>fetal
Drugs>fetal hydntoin syndrome- VSD
Valproate effect-co ao left heart hypoplasia
* Fetal alcohol syndrome>
syndrome> VSD,ASD,CO-AO.
-Advance maternal age.
Syndrome complexes
-VACTREL syndrome
Vertebral,Anorectal,Cardiac(VSD,TOF and
others),tracheal,Renal,Oesophageal and Limb abnormalities.
-CHARGE syndrome
Coloboma,Heart(VSD,TOF,A-V canal),
Atresia
choanal,Retardation,Gential,Ear abnormalties.
-Kartagener syndrome Dextrocardia
Majority of cases of the congenital heart diseases are unknown cause
Classification
Decreased flow
1. Tetralogy of Fallot
2. Tricuspid Atresia
3. Severe Pulmonic Stenosis
4. Ebsteins anamoly
Increased Flow
5. Transposition of great vessles
6. VSD with pulmonary atresia
7. Truncus Arteriosus
8. Hypoplastic left heart
9. Single ventricle
Prevalence
Cyanotic: 22%
Acyanotic: 68%
VSD
25%
ASD
6%
PDA
6%
TOF
5%
PS5%
PS5%
AS
5%
Diagnosis
History
-Convulsion.
-All may be manifest of congestive heart failure.
Physical examination
Auscultation
First heart sound (A-V valves closure)
Best heard at the Lt. lower sternal border or apex
Second heart sound (semilunar valve closure)
Best heard on the 1st and 2nd I.C.S , normally there
is normal splitting of the 2nd heart sound ,
Murmurs
Blood pressure
Investigation
Ventricular Defect
Small VSD
Asymptomatic
A loud, harsh, or blowing holosystolic murmur.
Large VSD
Tetralogy of Fallot
General measures-1
Special positions.
positions. (semisiting ,knee chest position (
IVF(again
VF(again depend on type of CHD , some need IVF as PDA and PS ,
OTHERS need IVF when ever there are pulmonary congestion or
volume overload).
Salt restriction.
restriction.
Exercise restriction.
restriction.
Rx of anemia.
anemia.
Digitalization 0.04mg/kg
Maintenance 0.01mg/kg
Rx of cardiac arrhythmias-3
Digoxin (be aware of toxicity nausia ,vomiting,AV block, K, ca).
Quinidine( hemolytic anemia.SLE,perodic paralysis)
Procainamide(agranulocytosis,+ve coombs hemolytic anemia)
Lidocaine (confusion, convulsion,respiratory failure,AV block).
Propranolol(bradycardia,bronchspasm,hypotensionetc).
Verapamil(bradycardia,PR interval prolongation,CHF).
Adenosine(chest pain,flushing,bronchospasm,bradycardia)
Preventive measures