Page 1050 - TNFlipTest

P16 Pediatrics
Cardiology
Toronto Notes 2019
Presentation of Neglect
• FTT, developmental delay
• Inadequate or dirty clothing, poor hygiene • Child exhibits poor attachment to parents,
no stranger anxiety
Neglect
Definition
• omissionsincarebyparentsorcaregiverthatleadsinactualorpotentialharm
History
• fromchildandeachcaregiverseparately(ifpossible)
Physical Exam
• headtotoe(donotforce),growthparameters,nutritionstatus • dentalcare
• emotionalstate
Investigations
• bloodteststoruleoutmedicalconditions(e.g.thrombocytopeniaorcoagulopathy)
Cardiology
Congenital Heart Disease
PRENATAL CIRCULATION
oxygenated blood from placenta
umbilical vein
ductus venosus
IVC
R atrium
shunted through foramen ovale
L atrium
L ventricle
aorta
brain/myocardium/ upper extremities
deoxygenated blood returns via SVC to R atrium
1/3 of blood entering
R atrium does not flow through foramen ovale and flows to the R ventricle
pulmonary arteries
ductus arteriosus
aorta
systemic circulation
placenta for reoxygenation
Aorta
Ductus Arteriosus
Pulmonary Trunk
Descending Aorta
Umbilical Arteries © Bonnie Tang 2012
Superior Vena Cava
Foramen Ovale
Inferior Vena Cava
Liver Ductus Venosus
Placenta
• shuntingdeoxygenatedblood
■ ductus arteriosus: connection between pulmonary artery and aorta
• shuntingoxygenatedblood
■ foramen ovale: connection between right and left atria
■ ductus venosus: connection between umbilical vein and inferior vena cava
At Birth
Figure 1. Prenatal circulation
Before Birth
Fetal circulation is designed so that oxygenated blood is preferentially delivered to the brain and myocardium
• withfirstbreath,lungsopenup→pulmonaryresistancedecreases→pulmonicbloodflowincreases
• separationoflowresistanceplacenta→systemiccirculationbecomesahighresistancesystem→ductus
venosus closure
• increasedpulmonicflow→increasedleftatrialpressures→foramenovaleclosure
• increasedoxygenconcentrationinbloodafterfirstbreath→decreasedprostaglandins→ductus
arteriosus closure
• closureoffetalshuntsandchangesinvascularresistance→infantcirculationassumesnormaladultflow
Epidemiology
• 8/1,000livebirthshaveCHD,whichmaypresentasaheartmurmur,heartfailure,orcyanosis;VSDis the most common lesion