Pda Part 4 Nat History

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Heart bypass is one of two techniques used in the treatment of coronary heart disease. The other is angioplasty and stenting. We explain the difference. CABGD, or heart bypass, is one of two techniques used in the treatment of CHD. The other is percutaneous coronary intervention (PCI), often called angioplasty and stenting. Both aim to improve the flow of oxygen-rich blood to the heart. The first heart bypasses were done in the 1960s, and the UK’s first coronary angioplasty was done in 1980, followed by the first coronary stent insertion in 1988. Angioplasty is a minimally invasive method of widening a coronary artery. It uses a balloon catheter to widen the artery from within, and a stent is usually placed in the artery to keep it open. No anaesthetic is needed (although the patient may be offered sedation), and patients can often go home the same day or the next day.The number of people having heart bypass has decreased by about a third in the past 10 years, which is linked to the development of drug-eluting stents that are used during PCI. Drug-eluting stents have a polymer coating that slowly releases a drug over time to help prevent the blockage from recurring. The recovery time for angioplasty is much quicker than heart bypass, but angioplasty is not advisable for everyone with CHD. For example, people who have triple-vessel disease are recommended to have heart bypass, and if you have diabetes, heart bypass offers better survival outcomes. Angioplasty is often used for people with less-severe coronary artery disease. When making a decision on whether heart bypass or angioplasty is indicated, doctors have guidelines and a scoring system to help them. It’s also important to involve the patient and their family in order to determine what the best option for the patient is.

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ETIOLOGY AND EPIDEMIOLOGY Congenital heart disease occurs in 8 per 1,000 births. The spectrum of lesions ranges from asymptomatic to fatal. Although most cases of congenital heart disease are multifactorial, some lesions are associated with chromosomal disorders, single gene defects, teratogens, or maternal metabolic disease (see Table139-2). Congenital heart defects can be divided into three pathophysiological groups (Table 143.1). 1. Left-to-right shunts 2. Right-to-left shunts 3. Obstructive, stenotic lesions Acyanotic congenital heart disease includes left-to-right shunts resulting in an increase in pulmonary blood flow (patent ductus arteriosus [PDA], ventricular septal defect [VSD], atrial septal defect [ASD]) and obstructive lesions (aortic stenosis, pulmonary stenosis, coarctation of the aorta), which usually have normal pulmonary blood flow. VENTRICULAR SEPTAL DEFECTEtiology and Epidemiology The ventricular septum is a complex structure that can be divided into four components. The largest component is the muscular septum. The inlet or posterior septum comprises endocardial cushion tissue. The subarterial or supracristal septum com prises conotruncal tissue. The membranous septum is below the aortic valve and is relatively small. VSDs occur when any of these components fail to develop normally (Fig. 143.1). VSD, the most common congenital heart defect, accounts for 25% of all congenital heart disease. Perimembranous VSD

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A heart defect due to an abnormal connection between the lower chambers of the heart (ventricles). A ventricular septal defect is a common heart defect most often present at birth, but it can occur in adults after surgery or a heart attack. It involves a hole in the wall between the heart's lower chambers. A birth defect that causes a hole in the wall between the heart's upper chambers (atria). Atrial septal defects (ASDs) that aren't diagnosed until adulthood can damage the heart and lungs, shortening life. A heart defect caused by problems in the heart's development. Patent ductus arteriosus (PDA) is an opening between two blood vessels leading from the heart. A narrowing of the large blood vessel (aorta) that leads from the heart. Coarctation of the aorta is usually present at birth (congenital) and may occur with other heart defects. A rare condition caused by a combination of four heart defects that are present at birth. Tetralogy of Fallot defects cause oxygen-poor blood to flow out of the heart and into the rest of the body. Risk factors include a viral illness such as rubella (German measles) during pregnancy, maternal alcoholism or a family history of the condition. Congestive heart failure Also called: CHF, heart failure A chronic condition in which the heart doesn't pump blood as well as it should. Heart failure can occur if the heart cannot pump (systolic) or fill (diastolic) adequately. In right-sided heart failure, the heart's right ventricle is too weak to pump enough blood to the lungs. As blood builds up in the veins, fluid gets pushed out into the tissues in the body. Right-sided heart failure symptoms include swelling and shortness of breath. High blood pressure Also called: HBP, hypertension A condition in which the force of the blood against the artery walls is too high. Usually hypertension is defined as blood pressure above 140/90, and is considered severe if the pressure is above 180/120.

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