先心病 (73p).pptVIP

Evaluating a child with a heart murmur Does the child have heart disease? Is it congenital heart disease? If it is congenital heart disease, what is the lesion? What is the severity of the lesion? Assessment of a child for the presence of heart disease Major Systolic murmur garde III or more specially with a thrill Diastolic murmur Cyanosis Cingestive heart failure Manifestation of shunts Definition: ASD is an abnormal communication between the two atria. Classification: Ostium secundum type Ostium primum type Endocardial cushion type ASD Accounts about 5%~10% of all CHD cases. The incidence is estimated to be 1 per 1500 live births. Is the most common CHD in adult. Male : Female 1: 2 Pathophysiology of ASD LR shunt determined by ： Size of the ASD lesion Pressure difference between two atria RV diastolic accommodation Pre Obstructive PA Hypertension SVC IVC Pulmonary Vein Shunting Hypertrophy RA LA Hypertrophy RV LV （Volume of blood↑） ( Ejection of Blood ↓） Pul. Artery（Dilated） Aorta（Blood↓） Pul. Circulation ( Congestive） Sys. Circulation（Insufficiency） Frequent Chest Infection Failure To Thrive Congestive CHF Post Obstructive PA Hypertension SVC IVC Pul. Vein Shunting Hypertrophy RA LA Hypertrophy RV LV（Mixed Blood） Pul. Artery（Dilated） Hyperkinetic PA Hypertension Sys. Circulation (Mixed Blood）