PAE503 — Cardiovascular and Respiratory Disorders: Lecture Note

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This is the complete lecture note for PAE503 Cardiovascular and Respiratory Disorders. You can read it online below, open it in the full viewer, or download the PDF for offline study. It pairs with the course's video lectures, so you can read and watch together.

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la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Course code: PAE 503 Course title: Cardiovascular and Respiratory Disorders Course credit load: 2 Units Series 1: Foundations of Cardiovascular Evaluation • Part 1.1: Overview of the Cardiovascular System and Classification of Disorders o Sub Part 1.1.1: Anatomy and function of the cardiovascular system o Sub Part 1.1.2: Epidemiology and aetiology of cardiovascular disorders in children o Sub Part 1.1.3: Classification of cardiovascular disorders • Part 1.2: General Examination of the Child with Cardiovascular Disease o Sub Part 1.2.1: General inspection and growth parameters o Sub Part 1.2.2: Examination of the peripheral pulses o Sub Part 1.2.3: Blood pressure measurement technique • Part 1.3: Jugular Venous Pressure and Precordial Examination o Sub Part 1.3.1: Anatomy and physiology of the jugular venous pulse o Sub Part 1.3.2: Technique of jugular venous pressure measurement o Sub Part 1.3.3: Systematic examination of the precordium • Part 1.4: Diagnostic Investigations in Cardiovascular Evaluation o Sub Part 1.4.1: The chest radiograph in cardiovascular diagnosis o Sub Part 1.4.2: Electrocardiography in cardiovascular diagnosis o Sub Part 1.4.3: Echocardiography in cardiovascular diagnosis Introduction Picture a busy paediatric outpatient clinic. A mother brings in her six month old son because he tires easily during feeding and seems to breathe faster than her other children did at the same age. Findings such as these are common triggers for a cardiovascular evaluation in children, and how confidently you respond to them depends entirely on how well you understand the systematic approach to assessing the cardiovascular system. This Series opens the PAE 503 course by building that foundation, moving from the basic anatomy and classification of

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS cardiovascular disorders through to the physical examination skills and diagnostic tools that will support everything you study in the Series that follow. The aim of this Series is to equip you with the knowledge and clinical skills required to conduct a thorough and systematic cardiovascular evaluation of a child, from history and classification through to physical examination and an appreciation of the key diagnostic investigations used to confirm a diagnosis. This Series introduces the anatomy, epidemiology, and classification of cardiovascular disorders in children, the general examination of a child with suspected cardiovascular disease, including the peripheral pulses and blood pressure measurement, the jugular venous pressure and precordial examination, and the diagnostic investigations, namely the chest radiograph, electrocardiography, and echocardiography, that support the clinical diagnosis of cardiovascular disorders in children. Series Learning Outcomes At the end of this Series, you should be able to: • SLO 1.1: describe the cardiovascular system and its clinical relevance in the evaluation of a child, • SLO 1.2: enumerate the classification of cardiovascular system disorders encountered in paediatric practice, • SLO 1.3: list the general examination findings suggestive of cardiovascular disease in a child, • SLO 1.4: describe the technique of peripheral pulse examination and blood pressure measurement, • SLO 1.5: explain the technique and clinical significance of jugular venous pressure measurement, • SLO 1.6: describe the systematic examination of the precordium, • SLO 1.7: discuss the role of the chest radiograph in the diagnosis of common cardiovascular disorders, and • SLO 1.8: discuss the role of electrocardiography and echocardiography in cardiovascular diagnosis.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1.1 Overview of the Cardiovascular System and Classification of Disorders 1.1.1 anatomy and function of the cardiovascular system How blood moves through the four chambers The cardiovascular system comprises the heart, blood vessels, and the blood that circulates within them, working together to deliver oxygen and nutrients to every tissue of the body while removing waste products of metabolism. The heart itself is a four chambered muscular organ made up of the right atrium, right ventricle, left atrium, and left ventricle, separated by the interatrial septum and interventricular septum. Deoxygenated blood returns from the body through the superior vena cava and inferior vena cava into the right atrium, passes through the tricuspid valve into the right ventricle, and is pumped through the pulmonary valve into the pulmonary artery towards the lungs. Oxygenated blood returns from the lungs through the pulmonary veins into the left atrium, crosses the mitral valve into the left ventricle, and is ejected through the aortic valve into the aorta to supply the rest of the body. In children, the heart is proportionally larger relative to body size than in adults, and the heart rate is correspondingly faster, particularly in infancy, a normal difference worth remembering before you begin interpreting vital signs in a young child. Fill in the blank: Deoxygenated blood passes from the right atrium into the right ventricle through the ________ valve. 1.1.2 epidemiology and aetiology of cardiovascular disorders in children Cardiovascular disorders in children arise from a variety of causes, broadly grouped into congenital causes, present from birth due to abnormal cardiac development in utero, and acquired causes, which develop after birth as a result of infection, inflammation, or other insults to an initially normal heart. Congenital heart disease affects approximately 8 in every 1,000 live births worldwide, and its aetiology is often multifactorial, involving genetic factors such as chromosomal abnormalities, maternal factors such as poorly controlled diabetes mellitus or rubella infection during pregnancy, and environmental exposures. Acquired cardiovascular disorders are frequently linked to infection and inflammation. In Nigeria and much of sub-Saharan Africa, acute rheumatic fever following untreated streptococcal throat infection remains an important cause of acquired heart disease in children, alongside conditions such as infective endocarditis and Kawasaki disease. Recognising these epidemiological patterns helps you anticipate which cardiovascular disorders are most likely in a given clinical setting. Fill in the blank: A child presenting with fever, joint pain, and a new heart murmur several weeks after an untreated sore throat should raise suspicion for ________.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1.1.3 classification of cardiovascular disorders Cardiovascular disorders in children are commonly classified into two broad categories, congenital heart disease and acquired heart disease. Congenital heart disease is further subdivided into acyanotic lesions, in which oxygenated and deoxygenated blood do not mix significantly, such as ventricular septal defect, atrial septal defect, and persistent ductus arteriosus, and cyanotic lesions, in which mixing of blood produces visible bluish discolouration of the skin, such as tetralogy of Fallot. Acquired heart disease includes conditions such as rheumatic valvular heart disease, cardiomyopathy, myocarditis, pericarditis, and infective endocarditis, each with distinct clinical presentations but a shared potential to impair cardiac function if not identified early. A clear grasp of this classification will help you organise your clinical reasoning as you move into Series 2 and 3, which explore congenital and acquired heart diseases in much greater depth. Fill in the blank: Congenital heart disease is subdivided into acyanotic lesions and ________ lesions. Category Mechanism Examples Congenital Heart Disease Structural malformations present at birth Ventricular septal defect, atrial septal defect, tetralogy of Fallot Acquired Heart Disease Secondary to infection, inflammation, or systemic illness Rheumatic heart disease, infective endocarditis, myocarditis Arrhythmias Abnormal impulse generation or conduction Supraventricular tachycardia, congenital long QT syndrome, Wolff-Parkinson-White syndrome Cardiomyopathies Primary myocardial dysfunction Dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy Pericardial Disorders Inflammation or fluid accumulation around the heart Pericarditis, pericardial effusion, cardiac tamponade Vascular Disorders Abnormalities of blood vessels Kawasaki disease, coarctation of the aorta, vasculitis syndromes Table 1.1: Classification of cardiovascular disorders in children. Pilot questions 1.1 1. Which four chambers make up the normal human heart? (Linked to SLO 1.1) 2. State the approximate incidence of congenital heart disease among live births. (Linked to SLO 1.1)

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 3. Distinguish between acyanotic and cyanotic congenital heart disease. (Linked to SLO 1.2) 4. List three examples of acquired heart disease in children. (Linked to SLO 1.2) 5. Explain why acute rheumatic fever remains an important cause of acquired heart disease in Nigeria. (Linked to SLO 1.2) 1.2 General Examination of the Child with Cardiovascular Disease 1.2.1 general inspection and growth parameters What to look for before you touch the child A cardiovascular examination begins the moment you see the child, well before you touch a stethoscope to the chest. General inspection should note the child's respiratory rate, the presence or absence of cyanosis, clubbing of the fingers and toes, and any visible chest deformity such as a precordial bulge, which may suggest chronic cardiac enlargement. You should also assess the child's overall nutritional state, since children with significant cardiovascular disease frequently present with failure to thrive because increased metabolic demand from cardiac work outpaces caloric intake. Plotting the child's weight, length or height, and head circumference on an appropriate growth chart is therefore essential, as a faltering growth trajectory is often one of the earliest indicators of an underlying cardiac problem, sometimes preceding the detection of a murmur. Signs of respiratory distress such as nasal flaring,

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