Common congenital heart diseases include patent ductus arteriosus, atrial septal defect, ventricular septal defect, pulmonary artery stenosis and tetralogy of Fallot.
There are many symptoms of congenital heart disease, and its clinical manifestations mainly depend on the size and complexity of malformation. Complex and serious deformities can cause serious symptoms and even life-threatening soon after birth. It should be noted that some simple malformations, such as ventricular septal defect and patent ductus arteriosus, may have no obvious symptoms in the early stage, but the disease will still develop and worsen potentially, so it needs to be diagnosed and treated in time to avoid losing the opportunity of operation. The main symptoms are:
1. Frequent colds, recurrent respiratory infections, and susceptibility to pneumonia.
2. Poor growth and development, emaciation and sweating.
3. Sucking is weak, feeding is difficult, or the baby refuses to eat, coughs, and is usually short of breath.
Children complain about fatigue and poor physical strength.
5. After crying or activity, the lips and nails are blue or purple, and the toes are rod-shaped.
6. For example, squatting, syncope and hemoptysis.
7. Auscultation found a murmur in the heart.
There are many treatments, such as surgery, interventional therapy and drug therapy. According to the condition, the cardiologist should make suggestions according to the specific situation of the child. There is no diversion or diversion from left to right. After timely operation, the effect is good and the prognosis is good. For patients with right-to-left shunt or complex malformation, the operation is complicated and difficult. Some patients cannot be completely corrected because of some imperfections in the heart structure, so palliative surgery can only be performed to relieve symptoms and improve the quality of life.
Etiology of valvular heart disease The main causes of valvular heart disease include rheumatic fever, mucinous degeneration, degeneration, congenital malformation, ischemic necrosis, infection and trauma. Can cause a single valve disease, but also can cause multiple valve diseases. The types of valvular lesions are usually stenosis or insufficiency. Once stenosis or dysfunction occurs, it will hinder the normal blood flow and increase the burden on the heart, thus causing heart function damage and leading to heart failure.
Symptomatic valvular heart disease often presents a process of chronic development. There may be no clinical symptoms in the early stage of valvular heart disease, and corresponding clinical symptoms appear when arrhythmia, heart failure or thromboembolism occur. Patients often show palpitation, shortness of breath, fatigue and burnout after exercise, and their exercise endurance is obviously reduced. After a little exercise, there will be dyspnea (that is, labored dyspnea), and in severe cases, there will be paroxysmal dyspnea at night, and even it is impossible to rest on your back. Heart valve diseases can also occur acutely due to acute ischemic necrosis and acute infective endocarditis, which are manifested as symptoms of acute heart failure, such as acute pulmonary edema.
Treatment 1. medical treatment
Diuretics are used in patients with heart failure such as sodium and water retention, digoxin, β -blockers and non-dihydropyridine calcium antagonists are used to control ventricular rate in patients with rapid atrial fibrillation, and anticoagulation therapy such as warfarin is used in patients with thrombosis risk and complications. At the same time, it emphasizes avoiding fatigue and emotional excitement, appropriately limiting sodium intake and preventing infection and other factors that induce heart failure.
2. Surgery
Surgical treatment such as artificial heart valve replacement or valvuloplasty is a radical method to treat valvular heart disease. For patients with valvular heart disease with symptoms of heart failure, we should actively evaluate the indications and contraindications of surgery and strive for the opportunity of surgical treatment.
3. Interventional therapy
Mainly used for balloon dilatation of stenotic valves. For patients with severe simple mitral stenosis, aortic stenosis and congenital pulmonary stenosis, if the valve calcification is not obvious, we can choose to expand the valve orifice area, relieve the valve stenosis and improve hemodynamics and clinical symptoms.
Coronary heart disease Coronary atherosclerotic heart disease is a kind of heart disease, which is often referred to as "coronary heart disease", which is caused by coronary atherosclerosis and leads to myocardial ischemia, hypoxia or necrosis.
Etiology Risk factors of coronary heart disease include modifiable risk factors and unchangeable risk factors. Understanding and intervening risk factors is helpful to the prevention and treatment of coronary heart disease.
The risk factors that can be changed are hypertension, dyslipidemia (high total cholesterol or low density lipoprotein cholesterol, high triglyceride and low density lipoprotein cholesterol), overweight/obesity, hyperglycemia/diabetes, unhealthy lifestyle including smoking, and unreasonable diet (high fat, high cholesterol, high calorie, etc.). ), lack of physical activity, excessive drinking, and social and psychological factors. Irreversible risk factors are: gender, age and family history. In addition, it is related to infection, such as cytomegalovirus, chlamydia pneumoniae and helicobacter pylori.
The incidence of coronary heart disease is often related to seasonal changes, emotional excitement, increased physical activity, satiety and heavy smoking and drinking.
Symptoms 1. Typical chest pain is induced by physical activity and emotional excitement. , accompanied by sudden precordial pain, mostly paroxysmal colic or squeezing pain, or a sense of oppression. Pain starts from the posterior sternum or precordial region and radiates upward to the left shoulder, arm and even the little finger and ring finger, which can be relieved by rest or taking nitroglycerin. The site of chest pain can also involve the neck, jaw, teeth, abdomen, etc. Chest pain can also occur in quiet state or at night, caused by coronary artery spasm, also known as variant angina pectoris. If the nature of chest pain changes, such as recent progressive chest pain, the pain threshold gradually decreases, and even when resting or sleeping, there may be some physical activity or emotional excitement. The pain is aggravated, the frequency changes and the duration is prolonged, which cannot be relieved by removing the inducement or taking nitroglycerin. Unstable angina pectoris is often suspected at this time.
Classification of angina pectoris: The classification method of CCSC Canadian Cardiovascular Association is widely used internationally.
Grade I: Daily activities, such as walking and climbing stairs, without angina pectoris.
Grade II: Daily activities are slightly limited due to angina pectoris.
Grade III: Daily activities are obviously limited due to angina pectoris.
Grade ⅳ: Any physical activity can lead to angina pectoris.
During myocardial infarction, chest pain is severe and lasts for a long time (often more than half an hour). Nitroglycerin can not be relieved, and nausea, vomiting, sweating, fever, and even cyanosis, blood pressure drop, shock and heart failure may occur.
2. It should be noted that some patients' symptoms are not typical, only manifested as precordial discomfort, palpitation or fatigue, or mainly gastrointestinal symptoms. Some patients may have no pain, such as the elderly and diabetics.
3. About 65,438+0/3 patients with sudden death suffered from coronary heart disease for the first time.
4. Patients who may have other systemic symptoms and heart failure.
The treatment of coronary heart disease includes: ① lifestyle changes: smoking cessation and alcohol restriction, low-fat and low-salt diet, proper physical exercise and weight control. ② Drug therapy: antithrombotic (antiplatelet and anticoagulant), reducing myocardial oxygen consumption (beta blockers), relieving angina pectoris (nitrates), regulating blood lipid and stabilizing plaque (statins); ③ revascularization therapy: including interventional therapy (endovascular balloon angioplasty and stent implantation) and surgical coronary artery bypass grafting. Drug therapy is the basis of all treatments. Long-term standard drug therapy should also be adhered to after interventional and surgical treatment. For the same patient, at a certain stage of the disease, drugs can control the disease ideally, while at another stage, drugs alone are often ineffective, so drugs combined with interventional therapy or surgery are needed.
Thoracic aortic aneurysm Thoracic aortic aneurysm is a "tumor-like" change in which one or more of the aorta protrudes outward due to various reasons. Thoracic aortic aneurysm refers to an aneurysm that occurs in aortic sinus, ascending aorta, aortic arch or descending aorta. It is degenerative, and a part of the thoracic aorta is abnormally dilated and deformed, protruding like a tumor.
About 80% of thoracic aortic aneurysms are secondary to hypertension and atherosclerosis, and 14% is caused by syphilis. Other causes include congenital new factors, Marfan syndrome and chest contusion. Most of them occur after the age of 60, and the ratio of male to female is 10: 2. The prevalence of thoracic aortic aneurysm accounts for 20.3% ~ 37% of aortic aneurysm.
Symptoms The onset of this disease is slow, and there are no symptoms and signs in the early stage. In the later stage, the symptoms are caused by the compression of the surrounding tissues by the aneurysm. Its clinical manifestations vary with the size, shape, location and growth direction of aneurysms. If aortic aneurysm compresses trachea and bronchus, it can cause cough, shortness of breath, pneumonia and atelectasis; Oppression of esophagus causes dysphagia; Hoarseness caused by compression of recurrent laryngeal nerve; Compression of phrenic nerve causes phrenic paralysis; Compression of superior vena cava and brachiocephalic vein can cause edema of upper limbs, neck, face and upper chest; Compression of the sternum can cause chest pain.
Treatment 1. Surgical therapy
The timing of surgical treatment of thoracic aortic aneurysm is still affected by many factors. It is generally believed that when the diameter of aneurysm exceeds 6 ~ 7 cm, the operation risk is great. Surgical indications include patients with rapidly expanding aneurysms, severe aortic regurgitation or related symptoms. Patients with Marfan's syndrome usually have a high risk of exfoliation and rupture. When the diameter of aneurysm reaches 5.5cm, surgical treatment should be chosen. The operation of thoracic aortic aneurysm is usually to remove the aneurysm and replace it with an artificial blood vessel of appropriate size. The resection of ascending aortic aneurysm requires complete cardiopulmonary bypass, while the resection of descending aortic aneurysm requires partial cardiopulmonary bypass to support the blood circulation at the distal end of the aneurysm. Aortic arch aneurysms can also be successfully removed, but the operation process is complicated and dangerous. Not only must the aneurysm be removed, but some patients must replant all the brachiocephalic vessels. About half of patients with thoracic aortic aneurysm and 3/4 patients with descending aortic aneurysm can be wrapped by aneurysm. Cystic aneurysms can sometimes be removed directly without removing the aorta. For ascending aortic aneurysm involving aortic annulus and aortic regurgitation, polyester vascular replacement with artificial aortic valve can be used, and polyester vascular replantation can be used. In recent years, considerable progress has been made in surgical treatment. Most treatment centers report that the early survival rate of selective thoracic aortic aneurysm resection is 90% ~ 95%.
In the treatment of thoracic descending aortic aneurysm, percutaneous intravascular implantation of fixed stent graft is far less traumatic than surgery, which can reduce the possibility of paraplegia caused by the interruption of blood supply to spinal artery during surgery. Although this technique is still in the experimental stage, it is expected that in the near future, it may play an important role in patients who are unable to be treated surgically and are at risk of aortic aneurysm rupture. Under the intense physiological stress of operation, complications of atherosclerosis, such as myocardial infarction, cerebral infarction and renal failure, are often caused. The most common causes of early postoperative death are myocardial infarction, hemorrhage, respiratory failure and infection. Old age, emergency operation, prolonged aortic occlusion, aneurysm dilatation and intraoperative hypotension are the most important factors that determine perioperative mortality. Late postoperative mortality is usually related to cardiac complications and rupture of aneurysms formed at the edge of transplantation or other parts of aorta.
2. Medical treatment
For the survivors of aneurysm dilatation and obvious atherosclerosis, the long-term effect of drug therapy has not been confirmed, but it has been reported that β -blockers have a clear effect on adult Marfan syndrome, which can slow down the rate of aortic dilatation and reduce the incidence and mortality of aortic dissection and aortic regurgitation. In the follow-up of patients with small thoracic aortic aneurysm and surgically treated thoracic aortic aneurysm, the dp/dt of cardiac isovolumic contraction can also be reduced and blood pressure can be controlled.
The causes of pericardial diseases include acute pericarditis, chronic pericarditis, pericardial effusion, cardiac tamponade, pericardial injury and pericardial tumor. Etiology includes virus infection, bacterial infection, autoimmune diseases, trauma, surgery, radiation, chemicals and so on. Part of the etiology and pathogenesis are still unclear, and environmental changes and external stimuli can also be the causes of pericardial diseases.
Symptoms Acute pericarditis: Pain in the posterior sternum and precordial area is the characteristic of acute pericarditis, which is common in the fibrin exudation stage of inflammatory changes. Pain can radiate to the neck, left shoulder, left arm, and also reach the upper abdomen. Pain is acute and related to respiratory movement. Coughing, taking a deep breath, changing posture or swallowing often aggravate the condition. Some patients may have symptoms such as dyspnea and edema due to cardiac tamponade, and infectious pericarditis may be accompanied by fever.
Chronic pericarditis: dyspnea after fatigue is often the earliest symptom of constrictive pericarditis. In the later stage, mediastinal elevation and pulmonary congestion may be caused by a large amount of hydrothorax and ascites, resulting in difficulty in breathing at rest and even sitting breathing. A large number of ascites and hepatomegaly oppress abdominal viscera, leading to abdominal distension. In addition, fatigue, loss of appetite, dizziness, fatigue, palpitation, cough, epigastric pain, edema and so on may occur.
Pericardial effusion and cardiac tamponade: dyspnea is the most prominent symptom of pericardial effusion. When dyspnea is severe, the patient may sit up and breathe, and may also have cyanosis, dry cough, hoarseness and dysphagia, as well as epigastric pain, systemic edema, pleural effusion or ascites.
The treatment method is symptomatic treatment and surgical treatment according to the etiology and the situation.
Etiology of cardiac tumors Cardiac tumors can be divided into primary tumors and secondary tumors. Primary cardiac tumors can be divided into benign and malignant. Secondary cardiac tumors are all malignant, which are transferred from malignant tumors in other parts of the body to myocardial tissue. The incidence rate is much higher than that of primary heart tumor, which is 30 ~ 40 times that of primary heart tumor. Because of the complex types of cardiac tumors, its etiology is still unclear.
Symptoms 1. Symptoms of cardiac blood flow obstruction
Symptoms and signs caused by cardiac tumor itself may include chest pain, syncope, congestive left and/or right heart failure, valve stenosis or insufficiency, arrhythmia, conduction disorder, intracardiac shunt, constrictive pericarditis, bloody pericardial effusion or pericardial tamponade, etc.
2. Whole body performance
Cardiac tumors can produce a variety of non-cardiac systemic manifestations, such as fever, anemia, emaciation, accelerated erythrocyte sedimentation rate and cachexia.
3. Arterial embolism
The clinical manifestations of embolism caused by debris or thrombus shedding on the surface of cardiac tumor include systemic arterial and/or pulmonary embolism symptoms, such as hemiplegia and aphasia.
4. Abnormal electrocardiogram
Atrial fibrillation, tachycardia, right bundle branch block, atrial or ventricular enlargement, etc.
Surgical resection is the first choice for the treatment of cardiac tumors, and its prognosis depends on the pathological type and invasion range of the tumors. As long as the cardiac benign tumor can be resected, the prognosis is good and the recurrence rate of myxoma is low. Surgical treatment of cardiac malignant tumors can clarify the nature of tumors, relieve mechanical obstruction and relieve the symptoms of patients, but almost all cardiac malignant tumors have a poor prognosis. Surgical treatment is only palliative surgery, which is easy to recur, with an average survival time of 3 months to 1 year. There are many requirements for heart transplantation, and the results are uncertain. Chemotherapy is the only choice for cardiac lymphoma. Nursing care after cardiac surgery
1, pipeline nursing
Keep tracheal intubation, stomach tube, urinary tube, infusion tube, manometer tube and drainage tube unobstructed and properly fixed. Closely observe the amount, color, nature and urine of pericardium, mediastinum and thoracic cavity drainage fluid, closely observe the changes of vital signs and CVP, and handle any abnormality in time. Patients with tracheal intubation need to suck sputum according to the breathing sounds of both lungs.
2, bleeding
The drainage fluid is bright red, accompanied by low blood volume such as decreased blood pressure and increased pulse volume. Active thoracic bleeding should be considered, and the doctor should be informed in time to deal with it in time.
3. Arrhythmia
Closely monitor ECG, pay attention to the changes of heart rate, heart rhythm and blood electrolyte, and report arrhythmia to the doctor in time for timely treatment.
4. Heart failure
Patients stay in bed, continue to take oxygen for 4 ~ 6L/min according to the doctor's advice, and perform cardiotonic diuretic treatment according to the doctor's advice. Strictly control the intake and record the amount of liquid in and out.
5, posture care
The patient who was not awake after general anesthesia lay flat with his head tilted to one side, and his condition was stable 6-8 hours after operation. The bedside is raised 30 degrees, so that the patient is in a position with his head high and his feet low. The patient will take a semi-recumbent position after taking off the ventilator. Conducive to drainage and expectoration.