2. 2
• Dating since birth.
• Can continue to adulthood.
• If present search for other cardiac anomalies and
other systems congenital anomalies
• Either acyanotic or cyanotic or
3. Common features of acyanotic heart disease
3
• Usually discovered accidently as a murmur during early
childhood. If no murmur can be undiagnosed till elderly
• Usually survives to adulthood as age matched
populations (Simple defects).
• Anatomically: Either :
1 Left to right shunt e.g: Atrial Septal defect (ASD),
Ventricular Septal defect (VSD) or patent ductus arteriosus
(PDA)
2 Ostructive pathology e.g: Aortic Stenosis, Pulmonary
Stenosis or coarctation of aorta.
10. 10
• Spontaneous closure of left to right shunt can occur
without intervention in majority of cases.
• Usually asymptomatic or repeated chest infections.
• Patient may develop Eisenminger syndrome (severe
pulmonary hypertension with reversal of shunt to become
right to left i.e becomes cyanotic).
11. • Can easily be diagnosed by echocardiography and
rarely needs other investigations
• Can be easily treated by:
• a- Percutaneous intervention (closure of the shunt by
device or balloon dilatation for obstructive lesions
• b- Surgical repair if not feasible for percutaneous
intervention.
13. 13
Common features of cyanotic heart disease
• Usually discovered during neonatorum due to cyanosis.
• Usually of aggressive course due to complex anatomy with high
mortality especially if untreated (poor prognosis).
• Anatomically : Usually there is
A- Significant right to left shunt of blood &/or
B- Markedly diminished or absent pulmonary blood flow with
subsequent necessary ASD VSD or PDA to maintain life.
• Patient may have symptoms of heart failure or complications of
cyanosis eg: hyperviscosity syndrome (haedach, blurring of
vision, fatigue or thrombosis) or pulmonary hypertension.
14. 14
• Can be diagnosed easily by echo but usually needs other
investigations e.g multislice CT, cardiac MRI or right heart
catheterization.
• Usually needs surgical intervention at early stages with
common need for staged correction.
• Usulally of unfavorable outcomes with high mortality if
untreated and if treated most of them die at 3rd or 4th
decade.
18. 18
1) Normal BP BP < 120 & 80.
2) Pre-HTN: BP < 140 and/or 90
3) HTN: BP ≥ 140 and/or 90 or person not talking anti-HTN medications.
- Stage 1 (Mild): BP < 160 and/or 100.
- Stage 2 (Moderate) : BP ≥ 160 and/or 100.
- Stage 3 (Severe ) : BP ≥ 180 and or 110mmhg.
Systemic HTN
- BP ≥ 140 or 90 in person not talking anti-HTN medications or
controlled BP in patient already on ttt.
19. 19
Complications of HTN
1 Heart failure up to acute pulmonary
edema.
2 CVS: either haeomrrhagic or embolic
3 Retinal haemorrhage
4 Arrhytmias: most common AF
5 Renal failure.
6 Aortic aneurysm and / or aortic dissection
20. 20
Treatment of HTN
A- general measures: Avoid caffeine beverges, avoid drugs e.g: NSAIDs,
alcohol or decongestants (common cold ttt) and improve life style including:
salt restriction, stop smoking, low fats diet and regular exercise.
B- Pharmaholgical therapy: includes different drugs categories:
1 Angiotensine converting enzyme (ACE ) inhibitors: e.g: captopril or enlapril
2 Angiotensin Receptors Blockers (ARBs) eg: vlasartan or olmesartan.
3 Beta blockers (BBs): eg:bisoprolol, metoprolol, nebivolol or carvidolol.
4 Calcium channel blockers (CCBs): e.g:verapamil or amlodipine.
5 Thiazide diuretics eg: hydrochlorothiazide or chlorothalidone.
6 Direct vasodialtors: eg:Hydralazine or minoxidil.
C- treatment of complications : eg treatment of cerebral haeorrage.
