congenital heart disease
Introduction
Introduction to congenital heart disease Congenital cardiovascular disease is the most common type of congenital malformation. Light asymptomatic, when examined, found that severe cases may have difficulty breathing after breathing, purpura, syncope, etc., older children may have growth retardation. The presence or absence of symptoms is also related to the type of disease and the presence or absence of complications. Neonatal heart failure is considered an emergency, usually due to a more severe heart defect in the child. Its clinical manifestations are due to pulmonary circulation, systemic hyperemia, and decreased cardiac output. The treatment of congenital heart disease generally depends on the type and severity of the deformity, and is suitable for the surgical timing and preoperative cardiac function of the surgical correction, depending on the comorbidity. No shunt or left to right shunt, mild asymptomatic, electrocardiogram and X-ray no abnormalities, and moderate and severe can be corrected by surgery, the prognosis is better, if the bidirectional shunt of severe pulmonary hypertension has produced a poor prognosis Those who have a right-to-left shunt or a compound deformity, who are seriously ill, should seek early surgery. The lighter can choose the timing of surgery, preferably around 10 years old. In patients with congenital cardiovascular disease, ventricular septal defect, patent ductus arteriosus and tetralogy of Fallot are more likely to be complicated by infective endocarditis, affecting prognosis, and need to pay attention to prevention and treatment. basic knowledge The proportion of sickness: 0.01% Susceptible people: children Mode of infection: non-infectious Complications: heart failure
Cause
Congenital heart disease
Environmental factors (10%):
The incidence of patent ductus arteriosus and atrial septal defect in high altitude areas is high, and the occurrence of congenital heart disease may be related to hypoxia. Some congenital heart diseases are also gender-oriented.
Fetal environmental factors (28%):
Intrauterine viral infection in early pregnancy, more common after rubella virus infection, often cause patent ductus arteriosus and pulmonary stenosis, followed by Coxsackie infection (Coxsakie) can cause endocardial fibroelastosis, in addition to amniotic membrane disease, Mechanical compression around the fetus, maternal dystrophies, vitamin deficiency and metabolic diseases, maternal cytotoxic drugs or longer-term radiation exposure may be related to the occurrence of this disease.
Genetic factors (10%):
5% of patients with congenital heart disease occur in the same family, and the disease is the same or similar, possibly due to genetic abnormalities or chromosomal aberrations.
Prevention
Congenital heart disease prevention
1. In the early stage of pregnancy (before 3 months), try not to sit in front of the computer, microwave oven and other places where the magnetic field is strong. Because the fetus is still unstable, the organs are still forming, which may cause the child to be congenital. heart disease.
2, do not touch pets, because the bacteria and microbes in pets may also cause congenital heart disease in children.
3, should pay attention to the mother's pregnancy, especially in the early pregnancy, such as active prevention of rubella, influenza, mumps and other viral infections. Avoid contact with radiation and some harmful substances. Under the guidance of a doctor, avoid taking drugs that have an effect on fetal development, such as anticancer drugs, and carbosine. Active treatment of primary diseases such as diabetes. Pay attention to the diet and avoid nutrient deficiencies. Prevent local mechanical compression around the fetus. In short, to prevent congenital heart disease, all factors related to the disease should be avoided.
Complication
Congenital heart disease complications Complications heart failure
Room septal defect, ventricular septal defect and patent ductus arteriosus are often prone to pneumonia, prone to heart failure, Fallot's quadruple syndrome can often be complicated by cerebral thrombosis, brain abscess, the above congenital heart disease is easy to concurrent with atrial septal defect Bacterial endocarditis.
Symptom
Symptoms of congenital heart disease Common symptoms Purpura syncope dyspnea ventricular septal defect heart valve perforation palmprint atd angle large... Heart beat leakage in the atrium to form a mixed blood heart "stealing" pulse pressure difference is low
1, heart failure: neonatal heart failure is considered an emergency, usually because the child has a more serious heart defect. Its clinical manifestations are due to pulmonary circulation, systemic hyperemia, and decreased cardiac output. Children with pale, suffocating, difficulty breathing and tachycardia, heart rate can reach 160 times -190 times per minute, blood pressure is often low. You can hear the galloping horse. The liver is large, but peripheral edema is less common.
2, purpura: its production is due to right to left shunt to mix arteriovenous blood. The nail bed at the tip of the nose, lips, and toes is most noticeable.
3, : children with cyanotic congenital heart disease, especially children with tetralogy of Fallot, often appear after the activity of corpus callosum, which can increase the systemic vascular resistance and thus reduce the right of the septal defect Diverting to the left also increases venous return to the right heart, thereby improving pulmonary blood flow.
4, clubbing (toe) and polycythemia: purpura type congenital heart disease almost all with clubbing (toe) and polycythemia. The mechanism of the clubbing (toe) is unclear, but polycythemia is a physiological response of the body to arterial hypoxemia.
5, pulmonary hypertension: when the patient with septal defect or patent ductus arteriosus has severe pulmonary hypertension and cyanosis and other syndromes, known as Eisenmenger's syndrome. The clinical manifestations are purpura, polycythemia, clubbing (toe), signs of right heart failure, such as jugular vein engorgement, hepatomegaly, and surrounding tissue edema. At this time, the patient has lost the chance of surgery. The only waiting is heart and lung. transplant. Most patients die before the age of 40.
6, developmental disorders: children with congenital heart disease often develop abnormal, manifested as thin, malnourished, stunted and so on.
7, other: chest pain, syncope, sudden death.
Examine
Examination of congenital heart disease
Common typical congenital heart disease, through the symptoms, signs, electrocardiogram, X-ray and echocardiography can make a diagnosis, and can estimate its hemodynamic changes, extent and extent of the disease, to determine the treatment plan. For the combination of other malformations and complex congenital heart disease, combined with cardiac catheterization or cardiovascular angiography, to understand the extent, type and extent of abnormal lesions, comprehensive analysis, make a clear diagnosis, and develop a treatment plan.
Diagnosis
Diagnosis of congenital heart disease
Mainly identify which congenital heart disease belongs to:
(1) patent ductus arteriosus, ventricular septal defect, atrial septal defect: in the early stage of the disease, because the arterial blood is divided into veins, it belongs to the left-to-right shunt type, so there is no purpura; but in the advanced stage, the pressure on the left side of the heart exceeds On the right side, there is a purple cicada.
(2) Fallot's quadruple syndrome, transposition of the great arteries, pulmonary valve atresia: Since some or all of the venous blood is directly divided into the arteries, it belongs to the right-to-left shunt type, so there is purpura after birth.
(3) Pulmonary artery stenosis, aortic stenosis, and aortic coarctation: Despite the presence of a cardiac malformation, there is no abnormal passage between the left and right sides, which is a non-split type. Therefore, purpura does not occur for life.
