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ACQUIRED HEARTACQUIRED HEART

DISEASEDISEASE

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Primary myocardialPrimary myocardial

disease(Cardiomyopathydisease(Cardiomyopathy

)) Hypertrophic cardiomyopathyHypertrophic cardiomyopathy

Dilated(congestive)Dilated(congestive)

cardiomyopathycardiomyopathy

Endocardial !roelastosisEndocardial !roelastosis

Do"or#!icin cardiomyopathyDo"or#!icin cardiomyopathy

Restrictive cardiomyopathyRestrictive cardiomyopathy

Right ventric#lar dysplasiaRight ventric#lar dysplasia

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CardiovascularCardiovascular

infectioninfection In$ective endocarditis (s#!ac#teIn$ective endocarditis (s#!ac#te

!acterial endocarditis)!acterial endocarditis)

%yocarditis%yocarditis

&ericarditis&ericarditis

Constrictive pericarditisConstrictive pericarditis

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'aasai disease'aasai disease

(m#coc#taneo#s lymph node(m#coc#taneo#s lymph node

syndrome)syndrome) Ac#te Rhe#matic *everAc#te Rhe#matic *ever

+alv#lar heart disease+alv#lar heart disease

Cardiac t#morCardiac t#mor

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DoxorubicinDoxorubicin

cardiomyopathycardiomyopathy %ost common chronic CH*%ost common chronic CH*

Ris $actor,Ris $actor,

Age-. yearsAge-. years

C#m#lative dose /.001C#m#lative dose /.001

200mg3m4200mg3m4

A regimen larger5in$re6#ent dosesA regimen larger5in$re6#ent doses

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PathophysiologicPathophysiologic

featuresfeatures Dilated 7+ ith decreasedDilated 7+ ith decreased

contractilitycontractility

Elevated lling press#reElevated lling press#re

Red#ced C8Red#ced C8

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Clinical manifestationsClinical manifestations

Asymptomatic541. mo signs o$ CH*Asymptomatic541. mo signs o$ CH*

Hepatomegaly5distended nec veinHepatomegaly5distended nec vein

9allop rhytm5so$t systolic m#rm#r9allop rhytm5so$t systolic m#rm#r

o$ %R5TRo$ %R5TR

C:R, cardiomegalyC:R, cardiomegaly

EC9 sin#s tachycardiaEC9 sin#s tachycardia

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Echo, dilated 7+5decreasedEcho, dilated 7+5decreased

contractilitycontractility

Symptomatic cm, high mortalitySymptomatic cm, high mortality

raterate

Die !y ; y a$ter onset o$ theDie !y ; y a$ter onset o$ the

illnessillness

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managementmanagement

Anticongestive meas#res ithAnticongestive meas#res ith

digo"in5di#retics5a$ter load red#cing agentsdigo"in5di#retics5a$ter load red#cing agents

Do"oDo"o

contin#o#s in$#sioncontin#o#s in$#sion Close monitoring $or cardiac to"icity !yClose monitoring $or cardiac to"icity !y

echo5angio5!iopsyecho5angio5!iopsy

dose 05;mg3g3day Cardiac transplantationCardiac transplantationselected ptsselected pts

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1. Presence of structural abnormalities of the heart or great arteries

with significant pressure gradient or turbulence

2. Bacterimia, even transient

* Almost all patients have a history of C! or A!

* Any locali"ed infection #eg. Abscess, osteomyelitis, pyelonephritis $can seed organism into the circulation

* Bacterimia fre%uently results after dental procedures

Infective endocarditisInfective endocarditis

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Pathology

&egetation of infective endocarditis is usually found on the

low pressure side of the defect

'(p ) in P!A, vegetations are found in the PA # Pulmonary Artery $

icrobiology + treptococcus viridans, 'nterococci and taphylococcus aureus

are responsible for - /0 of the cases

+ After dental procedures ) . viridans

+ After genitourinary surgery ) 'nterococci

+ Post operative endocarditis ) taphylococci

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Clinical manifestation eart murmur is universal #1//0$

+ ever #3,/4 ,5/C$+ plenomegaly is common #670$

+ 8in manifestation ) petechiae, 9sler:s node

+ 'mbolic phenomena

+ ign of heart failure may be present as the complication

;AB) + Positive blood cultures are found in - /0 of patients

in the absence of previous antimicrobial therapy + Anemia, ;eu8ocytosis

+ edimentation rate is increased

+ icroscopic hematuria is found in /0 of patients

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+ Presumptive) underlying heart disease with

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@he overall recovery rate is 3/+370

+ Prevention) + @he most important

+ aintenance of good oral hygiene is more important than

antibiotic prophyla(is + 'ndocarditis prophyla(is is indicated for certain cardiac

conditions = procedures

+ @he antibiotic prophyla(is is given orally 1 hour before a

procedure, parenteral antibiotics are given within / minutes

of starting a procedure

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1. '(tremely rare in pediatric age group

2. @he most common is AB!99A

+ >nfants 1 yr old- 670 are rhabdomyomas = teratomas

+ Children 1+17 yr old3/0 rhabdomyomas, fibromas and my(omas

. ore than /0 of primary tumors are benign

5. Primary malignant tumors are e(tremely rare in infants and

children

7. econdary malignant tumors also rare in children

Cardiac tumorCardiac tumor

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+ Don specific = vary primarily with the location of the tumor

+ yncope or chest pain may be a presenting complaint

+ udden une(pected death

+ Altered contour of the heart on E+ay

+ Don specific @+@ changes on 'CF+ Accurate determination of the presence, e(tent = location

of the tumor with echo and doppler

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Thank youThank you