Cardiopulmo and Spinal conditions (Pedia)

• Primary cardiac tube


  One of the four main components the heart begins to form with
• Secondary, anterior heart field


  One of the four main components the heart begins to form with
• Tertiary field cells


  One of the four main components the heart begins to form with
• Cardiac neural crest cells


  One of the four main components the heart begins to form with
• Fetal circulation


  • Placenta acts as the oxygenator so the lungs do little work
  • RV and LV contribute equally to the systemic circulation and pump against similar resistance
  • Shunts are necessary for survival (Ductus venosus, Foramen ovale, Ductus arteriosus)
• Transitional circulation


  1. With first few breaths lungs expand and serve as the oxygenator (and the placenta is removed from the circuit)

  2. Foramen ovale functionally closes

  3. Ductus arteriosus usually closes within first 1-2 days
• Neonatal circulation


  • RV pumps to pulmonary circulation and LV pumps to systemic circulation
  • Pulmonary resistance is high
  • By 6 weeks pulmonary resistance drops and LV becomes dominant
• Congenital Heart Disease (CHD)


  • Cardiac anomalies arising as a result of a defect in the structure or function of the heart and great vessels which is present at birth
  • Lesions either obstruct blood flow in the heart of vessels near it, or alter the pathway of blood circulating through the heart

  
• Classification of CHD


  • Acyanotic
  • Cyanotic
• Acyanotic CHD


  Volume or pressure overload (Patent Ductus Arteriorsus (PDA), Ventricular Septal Defect (VSD), Atrial Septal Defect (ASD), Coarctation of Aorta)

  
• Cyanotic CHD


  Increase or decrease pulmonary blood flow (Tetralogy of Fallot, Transposition of great vessels, Tricuspid Atresia)
• Atrial Septal Defect (ASD)


  • Often asymptomatic
  • Symptoms when manifested: Fatigue during feeding and playing, Shortness of breath, Sweating, Palpitations, Stunted growth

  
• Ventricular Septal Defect (VSD)


  • Abnormal opening in the ventricular septum allowing mixing of oxygenated and deoxygenated blood from left ventricle to right ventricle
  • Most commonly occurring type of CHD
  • Types: Supracristal VSD, Membranous VSD, Muscular VSD

  
• Ventricular Septal Defect (VSD)


  • Signs and symptoms are relative to the size of the defect
  • Symptoms are not usually seen at birth
  • General manifestation: Shortness of breath during feeding, Poor growth, Failure to gain weight, Pounding heart, Frequent respiratory tract infections, If reversal of shun occurs - cyanosis, clubbing, respiratory distress

  
• Patent Ductus Arteriosis (PDA)


  • Failure of closure of ductus arteriosus
  • Oxygenated blood passes from the aorta to the pulmonary artery and mixes with deoxygenated blood which goes to the lungs
  • Characterized by increased blood vlume to the lungs and pulmonary hypertension and congestion

  
• Patent Ductus Arteriosus


  • Shortness of breath, Congested breathing, Disinterest in feeding, Poor weight gain, Sweating, Tachypnea, Pounding puls
• Atrioventricular Septal Defects


  • Signs and symptoms include lung congestion, pulmonary hypertension, increased work of breathing, and feeding intolerance

  
• Coarctation of Aorta


  • Symptoms in older children may include headache, leg cramps, and a pale appearance. Blood pressure differs from upper extremities (high) to lower extremities (low).

  
• Aortic Stenosis


  • Signs and symptoms may include fatigue, murmur, chest pain, fainting, or arrhythmia
• Pulmonary Stenosis


  • Signs and symptoms may include respiratory distress, fatigue, murmur, or chest pain
• Tetralogy of Fallot (TOF)


  • A complex condition of several congenital defects that occur due to abnormal development of the fetal heart during the first 8 weeks of pregnancy
  • Conditions involved: VSD, Pulmonary valve stenosis, Overriding aorta, Right ventricular hypertrophy

  
• Tetralogy of Fallot (TOF)


  • Cyanosis, Irritability, Lethargic, Reduced physical activity, Clubbing of nails, Difficulty in breathing

  
• Transposition of Great Vessels (TOG)


  • The aorta is connected to the right ventricle and the pulmonary artery is connected to the left ventricle
  • Oxygen-poor blood goes to the misconnected aorta back to the body and oxygen-rich blood goes back to the lungs
  • Clinical presentation: Cyanosis, Rapid and laboured breathing, Cold and clammy skin, Failure to thrive

  
• Assessment and treatment


  • Assessment and treatment is relative to the symptoms and presentation of the child
  • Physical therapy point assessments are on auscultation (heart sounds) and gross physical activities
  • Usual interventions are incorporated in play therapy
• 18% of the population of chronic lung diseases patients are children
• Around 4% of these children are inflicted with asthma
• 15,000-20,000 have cystic fibrosis
• Asthma


  • Affects 10% of the pediatric population
  • Most prevalent chronic disorder but mortality is rare in this disease
  • Associated with allergic (atopic) individuals with family history
  • Males > Females
• Types of asthma


  • Atopic (Extrinsic asthma - most common, inflammation mediated by systemic IgE production)
  • Non-atopic (Intrinsic asthma - not common, inflammation mediated by local IgE production – not caused by environmental allergen)
• Symptoms of asthma


  • Air flow obstruction
  • Hyper-responsive bronchioles – due to histamine release
  • Inflammation
• Medical treatment for asthma


  • Pharmacologic agents (Symapthomimetics, Methylxanthines, Corticosteroids, Sodium comoglycate)
  • Environmental control (Control of allergens)
  • Immunulogic hyposensitization (Minute doses of exposure leading to development of antibodies)
• Physical therapy considerations


  • Exercise-induced component of asthma - six minutes of exercise maintaining a heart rate of 170 bpm, a sudden drop in airway function occurs about 5-6 minutes after execise cessation - this is similar to an asthma attack
• Cystic fibrosis is the most common lethal genetic disorder of the white race
• Occurrence of cystic fibrosis is 1/2000 white children, carrier rate of 5%
• Pathophysiology of cystic fibrosis

  • Mendelian recessive pattern
  • Mutation in the CF transmembrane conductance regulator (CFTR) gene - results to ion transport defect - build up of thick mucus - respiratoy insufficiency, systemic obstructions and abnormalities
  • Pathogens: pseudomonas, staphylococcus aureus
• Assessment and treatment for cystic fibrosis

  • Auscultation
  • Respiratory therapy – draining of fluids

  
• Spina bifida is the 2nd most common cause of childhood disability after CP
• Spina bifida


  Incomplete closure of the posterior components of the vertebrae because of a developmental disorder
• Mechanism of injury in spina bifida

  • Failed neural tube closure in the embryonic spinal region - prolonged exposure to amniotic fluid environment - spinal cord becomes haemorrhagic and die of amniotic fluid toxicity
  • Neurodegeneration in utero - reason for the neurological manifestations of SB
  • Role of Genetics: Amino acid alteration mutations, Folate one-carbon metabolism encoding - low on folate status results to dysfunctional conversions, Siblinghood and twins

  
• Risk factors for neural tube defects

  • Maternal factors: Maternal nutrition, Smoking, Hyperthermia, Low socio-economic status, Infections and illnesses, Diabetes, Obesity, Psychological stress, Use of Valproic Acid
  • Environmental factors: Air Pollution, Disinfectant by-products in drinking water, Nitrate-related compounds, Organic solvents, Pesticides, Polycyclic aromatic hydrocarbons