Clinical Profile Essay

You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.

Critical Congenital Heart Defect (CCHD) is a subgroup of congenital heart defects that normally necessitates surgical intervention or catheterization procedure during the neonatal period (Good, Canale, Goodman, & Yeager, 2015). According to Mahle et al. (2009), although there are measures taken to detect CCHD like prenatal ultrasound and comprehensive newborn physical examination during newborn’s birth hospitalization, there is still a significant percentage of newborns with CCHD that is left undetected and discharged home without being diagnosed. Delay in diagnosis of CCHD increases morbidity and mortality (Mahle et al., 2009). In response to this, Riede et al. (2010) mentioned that the diagnostic gap in CCHD could be bridged by screening newborns using pulse oximetry

An African American baby boy was born at one hospital but transferred to another hospital due to his critical condition. Now two months old, this baby boy’s Chief of Complaint is he was born with Dextrocardia or is also known as Detroversion, Dextroposition or Dextrorotation. He is 51 cm long and weighs 5.11 kg and for long-term care he was trached on 10/16/14. This baby boy was also born with HLHS (Hypoplastic Left Heart Syndrome). This patient is suspected of having CF but further tests need to be performed before conformation.

Congenital heart disease in newborns is a very common birth defect and effects roughly 1 in 100 or 1% of the babies born in the United States. Some of the heart defects that are a part of congenital heart defects include, hypoplastic left heart syndrome (HLHS), pulmonary atresia (PA), Tetralogy of Fallot (TOF), Total anomalous pulmonary venous return (TAPV/TAPVR), tricuspid atresia and many more.

The purpose of this journal is to reflect on my experience and skills gained during my clinical placement at Ben Taub Hospital. On my first clinical day, I was excited and nervous at the same time. My first placement was in the PREOP/PACU area. I was assigned to help a patient who had been in the PACU area going on 2 days. Normally, once the patient comes from surgery they are only in the PACU area for a short period of time before they are discharged home or given a bed in another area of the hospital. This particular patient still had not received an assignment for a bed. The physicians would make their rounds to come check on him daily. The patient was a 28-year-old Hispanic male, non-English speaking, he had a hemicolectomy. He had a NG tube, urinary Foley catheter, and a wound vac. My preceptor had just clocked in and she needed to check on the patient’s vitals and notes from the previous nurse. Once she introduced me to the patient and explained while I was there, she then asked me to check his vitals. (Vital signs indicate the body’s ability to regulate body temperature, maintain blood flow, and oxygenate body tissues. Vital signs are important indicators of a client’s overall health status (Hogan, 2014). I froze for a quick second. I have practiced taking vitals numerous of times and I knew I could do it correctly. I started with the temperature first, when I was quickly corrected on a major mistake I had made by my preceptor. I HAD FORGOT TO WASH MY HANDS and PUT

Congenital Heart Defect’s (CHD) affect about 1% of all births in the United States or about 40,000 babies per year (www.CDC.gov). Tetralogy of Fallot (TOF) is a CHD that accounts for an estimated 10% of these births. There are many factors that are involved in the diagnosis, treatment and quality of life for these children. The effects of the CHD vary in severity, therefore the effects it has on a child’s life vary. The etiology of TOF, how specific organs, cells, and tissues are affected, and what organ systems are affected will all be discussed and explained. . The effects vary greatly between patients this paper will focus on the average effects of this condition in order to provide a better understanding of TOF.

Congenital left ventricular outpouching (LVO) is an uncommon perinatal diagnosis. Various terms used in the medical literature to describe the LVO are a source of perplexity. The novel classification developed in a recent review by Rad et al attempting to provide a clear differentiation of the mixed definitions based on anatomical and cardiac imaging data. Our report presents a case series of prenatal diagnosis of LVO. The application of Rad et al original classification and its impact on the patients’ outcome are discussed.

Tetrology of Fallot(TOF) is the most common prenatal congenital cyanotic heart disease accounts for about 1/3600 live births and about 7% to 10% of of all congenital heart disease and is the most common cause of cyanosis in the neonatal period1 , 2. Typical Tetralogy of Fallot (TOF) may be missed in Four chamber view. An abnormal Four chamber view is rarely seen in typical TOF cases . In the typical form of TOF the fetal echocardiography is often characterized by a normal four-chamber view, a subaortic Ventricular septal defect (VSD), Dilated over riding of aorta seen in a LVOT view, Pulmonary stenosis and an increased Aorta/Pulmonary artery ratio, minimal antegrade flow in the main pulmonary artery and the aortic flow originated from right and left ventricle. All pregnant women with low risk factors , suspected fetal cardiac anomalies and with increased risk factors should be analyzed by extended fetal echo during the level 2 scan (18 – 22 weeks scan ). It is also important to identify the side of the aortic arch, which is quite easier in the prenatal period in three vessel view . This will be useful if surgery is planned postnatally. Extracardiac abnormalities, such as midline defects, central nervous system and renal abnormalities may be found in fetuses with TOF. These extracardiac defects are associated with chromosomal abnormalities. When TOF is diagnosed, serial follow up scans at 5 – 6 weeks intervals are adviced to know about the growth of the

Gary M Satou, and published by medscape website. Congestive heart failure is a chronic condition in which the heart doesn't pump blood as it supposed to be. Thorough history taking and physical examination, including an assessment of the upper-extremity and lower-extremity blood pressures, are crucial in the evaluation of an infant or child with congestive heart failure. The first sign of the congestive heart failure is usually an abnormally rapid heart rate. As the heart failure increases, the signs of venous congestion begins to show. Left-side of the heart is associated with the signs of pulmonary venous congestion, and the right side of the heart is associated with systemic venous congestion. Later stages of the congestion heart failure symptoms is low cardiac output. The signs of this type of disease vary with the age of the child. The symptoms starting with an infant include tachypnea, respiratory distress, and difficult with feeding, Older children with congestive heart disease could have fatigue or lower energy levels, abdominal pain, and vomiting. In the presence of this disease, the cardiac sihouette is enlarged on the chest radiograph. The goals of medical therapy for congestive heart failure consist of reducing the preload, reducing the afterload, improving oxygen delivery, and enhancing

Congenital disorders with intellectual disability (ID) constitute a particularly significant medical problem because of the high prevalence and life-long care that patients will need. The extreme genetic heterogeneity of ID is a major problem for pre- and postnatal diagnosis. In some cases, however, early detection of a mutation may be important to prevent the manifestation of the handicap (Avbelj et al. 2007). Congenital hypothyroidism (CH) is one of the most frequent causes of preventable ID, which can be averted by administering thyroid hormone in early postnatal life. This is achieved by newborn screening detection.

Congenital heart disease’s incidence depends on how the population is studied. With better diagnosis through the introduction of echocardiography the incidence figures of congenital heart diseases has raised from the range of 5-8 per 1000 live births to 8-12 per 1000 live births (Hoffman JIE, 2013).

Premature closure of the ductus arteriosus is a rare finding. In the majority of cases, it occurs secondary to maternal indomethacin exposure, other nonsteroidal anti-inflammatory drugs, or structural anomalies such as tetralogy of Fallot and truncus arteriosus.1 “Idiopathic stenosis of the ductus arteriosus has been reported and can lead to cardiovascular dysfunction such as tricuspid and pulmonary regurgitation, right heart dilatation, functional pulmonary atresia, persistent neonatal pulmonary hypertension, hydrops fetalis, and even fetal death.”1 Until the use of fetal echocardiography and pulsed wave Doppler interrogation, diagnosis was not made until autopsy in fetuses with severe hydrops.1 The use of these diagnostic methods allow

Congenital cyanotic heart disease (CCHD) is a cardiac defect which facilitates complete mixing of the deoxygenated systemic venous blood returning from the tissue and the fully oxygenated pulmonary venous blood from the lung in a common receiving chamber. (4)

There can be many life threatening complications if not treated early. In one case study congenital hypopituitarism presented with renal failure. Patient developed renal failure due to initial cardiovascular compromise related to hypotension4. Sometimes microphalus is only the presentation5. It can also be associated with midline alterations6 .

The research for CP in obstetrics has been led by Eastman and DeLeon since the mid-1950s. Their study had 5 major findings that have been the basis for more current research. Their findings were that although prematurity is a risk-factor, the majority of CP develops in infants were born at term. Secondly, placental abruption and cord prolapse, while dangerous to the fetus and uncommon, do not contribute a major share to CP. Thirdly, while in the delivery room, half of the term infants that were deemed in good health then later developed CP. Fourth, congenital anomalies can be attributed as a cause of CP. Lastly, mothers who were febrile during labor increased the chances of their children developing CP. The author goes onto to talk about how we (as doctors and researchers) know what we know about CP. Nelson cites the development of neuroimaging technologies, helping with the discovery of brain malformations as a contributing cause of CP. The author then delves into the causative