1. Disorders of cardiovascular function

6. R Pulmonary Artery

7. Congenital heart disease an abnormality or anomaly of the heart, present at birth Consequences include CHF, predisposition to infection, alterations in growth Acquired heart disorders Abnormalities occurring after birth that compromise the heart’s function

8. Congenital heart disease Etiology/pathophysiology Environmental intrauterine rubella exposure, maternal alcoholism, DM, advanced maternal age, maternal drug ingestion Genetic sibling or parent with heart disease, chromosomal anomalies, presence of other noncardiac congenital anomalies

9. Principals of fetal and postnatal circulation Types of defects- (CHD) based on physiologic characterisitics Increased pulmonary blood flow Decreased pulmonary blood flow Obstruction to systemic blood flow Mixed blood flow

10. Clinical manifestations Cyanosis, pallor, cardiomegaly, pericardial rubs, murmurs, additional heart sounds, discrepancies between apical and radial pulses, tachypnea, dyspnea, grunting, digital clubbing, hepatomegaly, splenomegaly, discrepancies between upper and lower extremity blood pressures, crackles and wheezing

11. Diagnostic tests Urine culture, arterial blood gases, electrocardiogram, echocardiogram, fluoroscopy, angiography, cardiac catheterization, and cardiac mri

12. Defects with increased pulmonary blood flow Communication of some type between right and left side of the heart, pressure on left side of heart pushes blood back into right side of heart and then into the lungs

13. Patent ductus arteriosus Can be asymptomatic or show s/s of heart failure Give indomethacin or surgery

15. Atrial septal defect Asymptomatic or s/s of heart failure Surgical correction- purse string stitches or Dacron patch

19. Ventricular septal defect Initially asymptomatic but eventually s/s of heart failure 50% close spontaneously, others require banding then complete surgical repair with Dacron patch

23. Defects with decreased pulmonary blood flow Tetralogy of Fallot Combination of 4 defects Pulmonary stenosis, VSD, right ventricular hypertrophy and overriding aorta Cyanotic at birth Blalock-Taussig shunt

25. Mixed defects Transposition of the great vessels Profound cyanosis if no other defects Less cyanosis if large septal defect is present Temporary defect is created until open heart surgery to switch vessels into their proper positions http://www.thic.com/transposition.htmwww.thic.com/transposition.htm

27. Defects with obstruction to systemic blood flow Coarctation of the aorta Narrowing of the lumen of the aorta Increased pressure in head and upper extremities and decreased pressure in body and lower extremities Surgical correction