Scientific researchers have done a lot of statistics to show that: the small wrinkles at the earlobes and arterial anomalies are related. A wrinkle in the earlobe is a localized manifestation of a process that is unfolding in the arteries at a time when the disease is already present. The earlobe is the only fleshy part of the ear made up of fat and connective tissue with no cartilage. When the arteries harden, the ear, like all other tissues, receives less blood, and the earlobe is the part of the ear that is most sensitive to this lack of blood, hence the appearance of wrinkles in the earlobe. When you have earlobe wrinkles, get your heart checked.
Angry: In a study of 1,600 people last year, U.S. medics found that the risk of a heart attack doubled in the two hours after a person became angry.
Sadness: In a study of 1,774 heart attack patients at the American Heart Conference, medics said the risk of a heart attack increased 14-fold in the 24 hours after the death of a loved one.
Fear: Israeli studies have shown that when Scud missiles began to strike in the Gulf War, there was a marked increase in the number of deaths from heart attacks, although no one died as a result of injuries caused by the missiles. Researchers in the United States have also confirmed that fear undoubtedly played a major role in the deaths on the day of the 1994 Los Angeles earthquake.
Nervousness: researchers have found that nervousness greatly increases the risk of a sudden attack for heart patients.
1. Why should congenital heart disease be treated and eradicated early?
Congenital heart disease (hereinafter referred to as congenital heart disease) is a malformation formed when the heart develops abnormally in the fetus, accounting for six to eight out of 1,000 newborns, some of which require surgical treatment. Doctors should conduct a thorough examination of the newborn; parents should also have some medical knowledge, such as the color of the baby's lips and lips after birth, breathing difficulties and heart murmurs, etc., should go to a specialist clinic as soon as possible to check and ask for treatment.
The early treatment and eradication of CHD is an inevitable trend in the development of cardiac surgery for three reasons: (1) early mortality is high. The majority of complex congenital heart disease, such as transposition of the great arteries, heavy tetralogy of Fallot, single ventricle, tricuspid atresia, complete atrioventricular canal malformation, permanent arterial trunk, and pulmonary artery atresia, etc., most of them die in the first few months of life due to severe cyanosis, hypoxia and metabolic acidosis, or die of heart failure due to pulmonary hyperemia, or recurrent pulmonary infections. For example, 50% of transposition of the great arteries die in the first month of life, and 90% die within 1 year. (2) Secondary lesions of the pulmonary vasculature and heart with serious consequences. For example, giant ventricular septal defects are prone to obstructive lesions of the pulmonary vasculature that arise after the age of 2 years until they produce Eisenmenger syndrome with right-to-left shunting. In contrast, in those who undergo surgical treatment after 2 years of age, pulmonary vascular lesions continue to develop after surgery in approximately 2.5% of patients. In contrast, this is not the case if surgery is performed within 2 years of age. Therefore, these patients should be operated on before the age of 2 years. For example, in cyanosis-type preexisting heart disease such as False Tetralogy of Fallot and Tetralogy of Fallot, the right ventricular hypertrophy is not heavy and the collateral circulation is less before 2 years of age, which not only reduces the difficulty of the operation, but also recovers the cardiac function well after the operation. In the case of transposition of the great arteries, the atrial septum is first opened after birth, and the arterial switch operation is performed within two weeks. If the operation is delayed, the right ventricle connected with the lungs will atrophy due to the decrease of pulmonary vascular resistance, and it cannot take up the resistance of the body circulation after the arterial switch operation and will suffer from heart failure. (3) Cardiovascular medical diagnostic techniques, surgical techniques, and surgical equipment are becoming increasingly sophisticated. There is the ability to perform corrective surgery in infants and even newborns. For some corrective surgery mortality rate is high, can not take the corrective or other surgical methods of patients, the implementation of improved Fontan (Fontan) surgery or the newly developed whole vena cava and pulmonary artery connection surgery; "A" or "B" type of pre-excitation syndrome, can apply the Type "A" or "B" pre-excitation syndrome, can apply catheter ablation or cut the Kent bundle method, so that the patient's arrhythmia is cured, to avoid the risk of sudden death; dilated cardiomyopathy, endocardial elastin fibrosis, can be used for heart transplantation; Eisenmenger syndrome can be used for heart-lung transplantation or single-lung transplantation. These techniques have been reported at home and abroad in infants and even newborns.
2. Does heart disease affect children's growth and development?
Whether the heart disease is congenital or acquired, children's growth in infancy and early childhood will be slower than that of their peers. As a result, parents are often concerned about their child's growth and development at the same time as they are concerned about their child's illness.
The delayed growth in children with heart disease is often related to their low cardiac output. Oxygen carrying capacity in the tissues is reduced because heart disease may repeatedly cause depressed heart failure, pulmonary hypertension, frequent lung infections, and early abnormal nutritional status or localized tissue hypoxia. Other heart diseases, such as myocarditis or ventricular enlargement can also lead to mitral valve atresia insufficiency, where blood can reflux into the right atrium, reducing in cardiac output and delaying growth and development. A statistic in Taiwan found that among children with heart disease, growth retardation is most evident in single ventricle, followed by Ebstein's heart malformation, transposition of the great vessels, tetralogy of Fallot, tricuspid atresia, perpetual arterial trunks, and anomalous reflux in the pulmonary veins.
The types of heart disease that occur in infancy and childhood can be broadly categorized as congenital heart disease, rheumatic heart disease, and infectious endocarditis or myocarditis, depending on their incidence. The causes of the above types of heart disease may not be fully understood, but it has been reported in the literature that congenital heart disease is associated with colds and flu contracted in early pregnancy, viral wind diagnosis, the use of inappropriate medications by pregnant women, air pollution and brewing, and other factors. As for rheumatic heart disease, after the streptococcus bacteria attack the pharynx, it may cause systemic infection, and the mitral and aortic valves of the heart are most likely to be involved. When various kinds of heart diseases occur in infants and young children, besides the health will be threatened, it will also cause family and social burdens for students. Therefore, only by starting with prevention and early detection can we improve the results of surgery, especially to reduce the sequelae of growth retardation, and the earlier the diagnosis and treatment, the better the chances of healthy development as in normal children.
How do parents care for a child with heart disease? This is a problem that most parents of sick children **** have. Due to the physiological defects of sick children, their growth and development is slower than that of normal children, so parents often hope to give their sick children the next day's nourishment to provide a variety of high-protein foods, in fact, the diet of children with heart disease is the first to be balanced, because their heart load capacity is lower than that of the general public, and they should pay special attention to the ability to absorb, pay attention to the consumption of low-salt diets. In terms of dynamics, moderate activity can help normal circulation of blood, but the risk of cyanosis children exercise is higher, should not be forced, suitable for walking and other mild activities, non-cyanosis children can follow the doctor's advice, depending on the individual circumstances of the choice of the type of exercise and the amount of exercise.
In addition, in order to promote the growth and development of the child, parents should choose fresh air, high oxygen content of the living environment, in order to cope with the urgent need of the cyanosis child, the conditions of the family can be equipped with a small portable oxygen bags or oxygen cylinders, in the onset of timely application.
3, which congenital heart disease should be treated surgically?
Surgical treatment of congenital heart disease not only has certain indications, but also pay attention to the timing of the operation, such as the more aware of the atrial septal defect, the diagnosis is clear that the operation should be elective. Because the natural course of atrial septal defects turning point in the 30-40 years old, the patient with the age of growth, pulmonary hypertension, if cyanosis is a strong contraindication to surgery. Therefore, mastering the timing of surgery is the key to the success of surgery. Corrective treatment of adult congenital heart disease due to more complications, slow recovery, high mortality rate, not as favorable as corrective treatment in childhood, this point of view has been recognized.
At present, preexisting heart disease is generally divided into two clinical categories, one is divided into two categories with or without symptoms of cyanosis, i.e., cyanotic and non-cyanotic, which is now less frequently used; the other is divided into three categories with hemodynamics combined with pathologic anatomy and pathology:
(1) left-to-right shunt, i.e., arterial blood flow from the right cardiac system to the right cardiac system through an abnormal channel, which helps this kind of patients with high oxygen level can not appear. Cyanosis. The perceived left-to-right shunt is arterial duct failure, atrial septal defect, aortic sinus aneurysm rupture, etc., accounting for about 70% of congenital heart disease, generally should be early elective surgical treatment. According to statistics, about more than 50% of patients with pre-coronary heart disease, belongs to the ventricular septal defect, if the defect is not big, about 1/2 before the age of 8 years old can be healed by themselves, for this kind of patients, doctors usually do not encourage surgery, should be observed until the age of 5 or 6 years old, and then depending on the severity of the disease to decide whether to operate.
(2) Right-to-left shunt category. This type of patients in the pathologic anatomy in addition to the defect between the left and right heart system, but also with the right heart out of the way obstruction, so that the venous blood shunt into the arteries, venous and arterial blood mixing reduces the oxygen content of the blood, cyanosis symptoms can occur. Perceived right-to-left shunts in diseases such as tetralogy of Fallot, tricuspid tricuspid, and tricuspid valve subluxation deformity. It accounts for about 15.5% of cases. Cyanosis of the newborn at birth, most of the Ming complete transposition of the great arteries, Fale tetralogy of Fallot, Fale tetralogy of Fallot is generally in the postnatal period of 2 - 3 months, when vomiting or crying appeared lip purple, 6 months after the skin manifestation of cyanosis, with the age and the development of the disease can be pestle fingers (toes), these patients are best in the 2 years of age, surgical radical treatment. At present, the radical surgery of tetralogy of Fallot has achieved promising results, and the success rate of surgery has reached 97%.
(3) No shunt category. This type of pathology there is no defect between the right and left systems, mainly the blood flow out of the heart is obstructed. Common diseases without shunt are pulmonary stenosis, aortic constriction, etc., accounting for about 14.5% .
All of the above shunts can be corrected by surgery. In addition, some difficult and complex malformations, such as double outlet of the right heart, single ventricle, triple atrial heart, Ebstein's anomaly, etc., can also be corrected through the development of corrective surgery.
4, what should be done before heart surgery?
Cardiac surgery is usually preceded by a systematic examination, the purpose of which is to clarify the diagnosis, select the indications for surgery, and determine the effect of surgery and prognosis. In recent years, with the continuous development of imaging technology, non-invasive examination techniques have been widely used in clinical practice, especially color Doppler ultrasound diagnostic technology and cardiac electrophysiology technology, which have effectively improved the rate of compliance with the surgical diagnosis, and the examination techniques commonly used before cardiac surgery include the following:
(1) General X-ray examination, which can show the size, shape, and position of the heart, atria and blood vessels, and the amount of cardiac and pulmonary blood flow in the heart and lungs. changes and the amount of blood in the heart and lungs, providing clues to important signs for diagnosis. Because it is non-invasive and the method of examination has been standardized, it is often used as one of the objective techniques before and after surgical treatment and follow-up observation.
(2) Electrocardiography. Electrocardiogram is a kind of recording diagram that uses different leads to measure and record the potential difference that changes on the surface of the human body, and the electrocardiogram has different changes in different types of heart diseases. Therefore, electrocardiogram has an important auxiliary significance in the diagnosis of heart disease.
(3) Echocardiography, echocardiography is a non-invasive method of examination, this method can be detected through the chest wall of the thickness of the various chambers of the heart and its activities and the size of the large blood vessels and their interconnections, which can help clinical diagnosis of the efficacy of the analysis. (4) Doppler ultrasonography is a new, non-invasive technique that has been used since the 1970s to examine intracardiac hemodynamics. Doppler ultrasound is a new, non-invasive technique used to examine intracardiac hemodynamics since the 1970s. It can reflect the macroscopic state of blood flow on the cardiovascular cross-section, and is the latest Doppler ultrasound diagnostic technique. It is mainly used for the diagnosis of valvular insufficiency, intracardiac shunt, cardiac function, and the study of hemodynamics in physiological and pathological states. (5) Cardiovascular angiography. Cardiovascular angiography is an invasive diagnostic technique. The purpose of angiography is to provide precise morphological diagnosis, but it must be combined with hemodynamic examination to provide "qualitative" and "quantitative" diagnosis of anatomical and circulatory functions for surgical treatment, and for the non-invasive various examination methods that cannot be clearly diagnosed. For congenital cardiac macrovascular diseases that cannot be clearly diagnosed by various non-invasive examination methods, imaging can provide details of anatomical abnormalities and hemodynamic changes, which is conducive to surgery. (6) Cardiac catheterization Cardiac catheterization is an important method of diagnosis in which a plastic catheter, which is impervious to X-rays and has a certain degree of toughness, is sent to the designated part of the heart and great vessels from the peripheral blood vessels to analyze the waveform of the pressure curve according to the pathway of its travel, pressure, and the blood oxygen content, and to compute various parameters. Cardiac catheterization combined with cardiovascular angiography is a common method of diagnosing complex malformations. It is mainly used for diseases that do not match the clinical data and need differential diagnosis. For example, ventricular septal defect combined with severe pulmonary hypertension, pulmonary artery stenosis, can not be used to select the indications for surgery, determine the effect of surgery and cardiac function.
In recent years, with the improvement of medical devices and operation techniques, the application of cardiac catheterization has been gradually expanded to the therapeutic field. Clinical application of balloon catheter can treat stenotic valvular disease, such as pulmonary stenosis balloon catheter dilatation angioplasty; mitral valve, aortic valve balloon catheter dilatation angioplasty and so on. The examination techniques described above are not necessary for every cardiac patient, and the examination items are usually determined by the doctor according to the clinical needs. The patient should actively cooperate in order to make a clear diagnosis and timely surgical treatment.
5. What should be done before heart surgery?
The heart is a vital organ of the human body, and heart surgery is different from other surgical procedures because the human heart keeps beating minute by minute. Cardiac surgery is not only technically complex, but also very dangerous. Adequate preoperative preparation is essential to improve the success rate of surgery, reduce surgical complications, and promote the early recovery of patients. Heart surgery patients should cooperate with doctors and nurses to do all the preparatory work.
(1) psychological preparation: due to the happy is a major cardiac surgery, patients with different diseases will have different psychological reactions to surgery, we found through observation, preschool children due to insufficient knowledge of the disease psychological reaction is lighter, mainly fear of pain; school-age children or adults due to the preoperative course of prolonged, long suffering from the disease of the pestering and tormenting, the psychological activity is more complex, its **** the same! Psychological characteristics are eager to look forward to surgery, but also afraid of surgical accidents and fear, anxiety, manifested as emotional tension, restlessness, and even crying. It has been reported in the literature that preoperative adverse psychological reflection has a direct impact on surgical prognosis, therefore, it is very important to make adequate psychological preparation before surgery.
(2) In order to help patients correctly understand the surgery and actively cooperate with the treatment, medical staff should do a good job of preoperative bile mission and guidance, introduce patients to the knowledge related to cardiac surgery, understanding of the surgical process, and if necessary, visit the monitoring ward, so that the patient can cooperate with the treatment method. It is essential for family members to give proper guidance, support and encouragement to patients before surgery. Medical personnel and family members should **** the same to help patients overcome the fear of surgery. Set up confidence to overcome the disease, so that the patient can accept the operation in the best physical and mental state.
(3) general preoperative preparation: 1 day before the operation, the patient's attending physician generally want to talk with the patient or the patient's family, explaining the preoperative diagnosis, surgical program, treatment methods, easy to appear in the operation of the problem and the prognosis, and to answer the patient and the family questions, patients and family members of the operation, such as agreeing to the operation, the family should sign the operation list, and leave the parents' names and The patient's name, address, and telephone number should be left on the operating sheet.
(4) the afternoon of the first day before the operation, usually held a preoperative seminar, organized by the director of the Department of surgery, the operator, extracorporeal circulation machine diversion of medical personnel and anesthesiologists and other doctors to participate in the preoperative seminar. At the meeting, the surgical plan, operation steps, possible intraoperative problems and rescue measures, postoperative monitoring points, etc. will be studied in detail, and the surgical prognosis will be evaluated. Possible intraoperative and postoperative accidents include anesthesia accidents, bleeding, difficulty in cardiopulmonary resuscitation, cardiac arrhythmia, machine malfunction, embolism, conduction bundle injury, cardiac dysfunction, respiratory failure, and postoperative infections, etc. The medical staff will make every effort to strengthen the protection to avoid surgical accidents and to improve the success rate of surgery.
(5) Preparation of goods: 1 day before the operation, family members should help good living supplies such as cups of water, spoons, drinks, slippers, placketed shirt, soap, toothpaste, handkerchiefs, etc., handkerchiefs generally need to be cut into small cubes for sputum; another must be prepared to do the basic care of a large packet of handkerchiefs; infants and young children should be prepared to powdered milk, bottles; adult female patients to prepare their own sanitary napkins and a change of underwear, pants, and so on. After the operation items are ready, they will be left in the patient's bedside cabinet and sent to the guardianship ward by the nurse on the day of the operation. Valuables, such as jewelry, watches, cash, etc. can be kept by family members, not easy to remove the ring on the nurse.
(6) Routine preparation: A weight measurement 1 day before surgery to the nurse's station to measure the weight, for intraoperative and postoperative medication and ventilator tidal volume adjustment to provide a basis. B skin preparation The purpose is to prevent incision infection. On the first day before surgery, the nurse should shave and clean the patient's skin according to the routine. Patients who cannot take a bath for a long time should be wiped down before surgery, but they should pay attention to keeping warm to prevent catching a cold.C Allergy test and injection of antibiotics To prevent infections, antibiotics are routinely used in the postoperative period. Allergy tests should be done before injecting antibiotics and using anesthetics, and those with positive allergy tests should consider switching to other medications.D Blood sampling Cardiac surgery requires blood transfusion, and blood should be sampled before transfusion to do a cross-matching blood test.E Enema In order to reduce abdominal distension and keep the intestinal tract clean, patients should be given a cleansing enema at bedtime one day prior to surgery and in the morning of the surgery day, and they should be fasted for 12 hours prior to the surgery, and they should not be fed with any food after the enema.F Taking Sedative medication Before the operation, we should have enough sleep, the patient can't sleep because of nervousness and fear, we should give a certain dose of sedative sleeping medicine to ensure that the next day's operation will be carried out smoothly. (5) preoperative training: patients must be bedridden after surgery, patients on ventilators can not speak, in order to meet the needs of patients, reduce postoperative complications, promote recovery, preoperative training should be carried out on the patient. a deep breathing training after cardiac surgery is generally used abdominal respiration, the patient will be placed in the quarter of the ribs (the heart fossa), the upper abdomen, the shoulders, the arm and the abdomen relaxation, so that the thorax is sunken, with the mouth gradually deep exhalation, 3 times a day, 5-6 times each time. b deep breathing training: patients should be given a certain dose of sedative drugs to ensure that the next day's operation. B. Sputum expectoration training Effective sputum expectoration can prevent respiratory complications. In particular, it has preventive effect on pneumonia and pulmonary atelectasis. After deep breathing, the patient can use abdominal muscle action to cough hard and exhaust the sputum fully. Postoperative nurses should assist patients to cough at least several times per hour.C Practice urination and defecation in bed Patients who still cannot get out of bed after removing the catheter after surgery. Therefore, you should start practicing urination in bed 1 week before surgery. It is difficult for adult patients to urinate in bed, patients can use the palm of the hand to gently press the service to increase the abdominal pressure, in order to facilitate urination. D Smoking cessation Smoking has a great impact on the recovery of respiratory function after cardiac surgery, patients should practice smoking cessation in the first month before the operation, and quit smoking immediately by means of distraction, elimination of smoking, etc., and continue to quit smoking during the recovery period after the operation. E Sign language training Patients who are not able to speak on a ventilator can learn to sign language to express their needs before surgery. Patients who are unable to speak on the ventilator after surgery can learn sign language to express their needs before surgery. Commonly used sign language are called aunt (nurse) - pat the bed; want to poop - extend the thumb; want to urinate - extend the little finger; thirst - bend the index finger to the thumb in the shape of a cup; pain in the incision - clench the fist; phlegm - extend the index finger.
(7) into the operating room before the preparation: the patient into the operating room, the nurse should be inserted into the stomach tube, urinary catheter, preoperative injections, temperature, heart rate, blood pressure, etc., such as found that the patient has a cold, fever, or female patients menstruation can not do the operation, must be changed to another date of surgery, into the operating room, the patient also has to change the recuperative clothing, take down the dentures, watches and so on. After the patient is admitted to the operating room, his/her family members need to wait in the reception room of the hospital, and the doctor will notify the family in time if there is any change in his/her condition. Family members should not wait in the ward, corridor, stairway, or in front of the operating room door, so as not to hinder the normal order of the hospital. From the date of the decision to operate, the patient shall not leave the ward without authorization. During the preoperative preparation period, the patient shall consciously cooperate with and listen carefully to the preaching and guidance of the medical staff, and assist the medical staff to make all the preparations in a safe and timely manner, so as to ensure that the operation will be carried out smoothly.