Name of the Professor
29th October 2015
The following case studies reflect the various forms of congenital heart diseases. Congenital heart diseases are referred to a set of abnormalities present either in the heart or the cardiovascular system at the time of birth (Bjornard et al. 87-94). The majority of the case studies indicated that the patients were suffering mainly from Coarctation of the aorta and Anderson-Tawil Syndrome. Apart from such defects, other congenital defects include “Tetralogy of Fallot” and Di-George’s syndrome. However, the point of discussion would be to evaluate the pathophysiology, diagnosis and management of coarctation of the aorta and based on the given patient criteria. Coarctation of the aorta refers to a congenital disease where the aorta is extensively narrowed, and such abnormality is noted immediately at birth. The narrowing of the aorta leads to increase in the peripheral resistance. The increased peripheral resistance is responsible is causing the hypertensive episodes noted in the case studies. Increased peripheral resistance causes the after- load on the left ventricle to increase significantly. The narrowing of the aorta occurs typically at the position of patent ductus arteriosus. The congenital disease occurs to a failure of regression of the patent ductus arteriosus. Normally the ductus arteriosus regresses immediately after birth, as a consequence of physiological adjustments in fetal circulation after birth.
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(Bjornard et al. 87-94).
Case Study Appraisal
The child presented with high blood pressure and a decrease in heart rate and was hence given only furosemide, which is a diuretic to reduce the increased blood pressure. Since, in the case of coarctation of the aorta the aorta is extensively narrowed, and such abnormality is noted immediately at birth, in this case too. The narrowing of the aorta led to an increase in the peripheral resistance. The increased peripheral resistance was responsible is causing hypertension. Even after, the diuretic was added the blood pressure remained uncontrolled and started to increase further. The patient was added atenolol. Atenolol is a beta2 adrenergic receptor blocker and was meant to reduce the force of contraction of the heart. This was projected to reduce the cardiac output due to the inadequate filling of the heart and decrease the blood pressure (Bjornard et al. 87-94).
Reduction in blood pressure was very important because a failure in the adequate pumping of blood from the ventricles may lead to heart failure. The work of the ventricles is greatly increased, and hence circulation of blood to the peripheries is highly compromised. Such condition causes weakness in muscles and fainting due to inadequate perfusion of blood to the brain (Bjornard et al. 87-94).
Such a philosophy was the driving force for putting the patient into ventilator assisted treatment as because the sPO2 levels were decreased. Although, the mean sPO2 was 98%, but it sometimes dropped to 93%. Such a situation may lead to oxygen deficiency in major tissues and organs. It was also noted that the child was suffering from an increase in breathing rate to due hypoxic induction. Such a situation was needed for a compensatory balance due to the reduction in the sPO2 levels, during different phases of treatment. Hence, ventilation assistance was quite rightly provided.
The echocardiogram reflected a long QT interval. Such an effect was due to the presence of subsequent Anderson-Tawil Syndrome in the child. Since, the disease is associated with potassium conduction; the child was administered potassium (Bjornard et al. 87-94).
Progression of the Diseases
The progression of the disease is linked to the symptoms exhibited by the child during the different phases of their life, starting from birth. Initially, coarctation of the aorta is asymptomatic, so the patient was managed with a single anti-hypertensive. However, with an increase in blood pressure the need of more anti-hypertensive increased. The adjustment in ventilation was due hypoxic stimulation that increased the rate of breathing in the child (Bjornard et al. 87-94).
Care and Outcome
Even with the combination of anti-hypertensive, it was difficult to control the blood pressure of the child. The care plan for the child was surgical intervention due to the sustained increase in blood pressure. Surgical intervention is the most preferred treatment options in conditions of coarctation of the aorta. The principle involves either to create a bypass, so the blood does not have to travel through the narrowed portions of the aorta (Bjornard et al. 87-94). Therefore, the physician correctly discussed the advantages and cons of the bypass to the parents of the child, discussed in the case study.
The projected outcome would be a decrease in the peripheral resistance since the aorta will be held open. The blood flow through the aorta would improve which will lead to normal levels of perfusion in different tissues. An adequate supply of oxygen will decrease the necessity of ventilation assisted breathing, due to a return of sPO2 to near 100%. The patient may need to be on K+, due to the underlying Anderson-Tawil Syndrome.
Bjornard, K., Riehle-Colarusso, T., Gilboa, S. M. and Correa, A. Patterns in the prevalence of
Congenital heart defects, metropolitan Atlanta, 1978 to 2005. Birth Defects Res Part A:
Clin Mol Teratol. 2013, 97:87–94.Print
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