Unit V Cardiovascular System

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Unit V- Cardiovascular system Subheading:
1. Cyanotic Congenital Heart Diseases
2. Acyanotic Congenital Heart Diseases
3. Acute Rheumatic Fever
4. Rheumatic Heart Disease
5. Congestive Cardiac Failure
Keywords: Congenital, heart disease, cyanosis, oxygenated blood, deoxygenated blood, structural defects, systemic circulation, pulmonary circulation, Mottling, Pallor, Pulmonary Rales

1. CYANOTIC CONGENITAL HEART DISEASES (CCHD)
CCHD is a group of congenital heart diseases that occur due to deoxygenated blood bypassing the lungs and entering the systemic circulation or a mixture of oxygenated and deoxygenated blood entering systemic circulation which is caused by structural defects of the heart or any condition which increases pulmonary vascular
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This allow desaturated blood to shunt right to left side, causing desaturation in the left side of the heart and in the systemic circulation causing hypoxia and cyanosis.

PULMONARY ATRESIA / PULMONARY STENOSIS
Pulmonary Stenosis is the narrowing at the entrance to the pulmonary artery causing right ventricular hypertrophy. Pulmonary Atresia is the severe form of pulmonary stenosis.
Pathophysiology
When Pulmonary Stenosis is present, resistant to blood flow cause right ventricular hypertrophy – right atrial pressure will increase – reopening of the foramen ovale, shunting of unoxygenated blood into the left atrium, systemic circulation.
Clinical manifestation: Cyanosis, characteristic murmur , cardiomegaly .
Treatment: Baloon angioplasty (neonate). Surgical treatment:
In infant: Transventricular valvotomy procedure(Brock)
In children: Pulmonary valvotomy with cardiopulmonary
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Pathophysiology
The present of a patent foramen ovale is required to permit blood flow across the septum into the left atrium, the patent duct arteriosus allows blood to flow to the pulmonary artery into the lungs. VSD allows a modest amount of blood to enter the right ventricle &pulmonary artery. Thus pulmonary blood flow is diminished.
Clinical manifestation
- Cyanosis
- Tachycardia
- Dyspnea
- Hypoxia with clubbing
Management
For neonates whose pulmonary blood flow depends on the patency of the ductus arteriosus, a continuous infusion of Prostaglandin E1, is started until surgical intervention can be arranged.
Palliative treatment: A Bidirectional Clenn shunt can be performed at 6-9 month. Modified Fontan Procedure: systemic venous return is directed to the lungs without a ventricular pump through surgical connection between the right atrium and pulmonary

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