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Interview with
Prof. Martin P. O´Laughlin |
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Martin P. O´Laughlin, M.D.,
Associate Professor,
Pediatric Cardiology,
Director Pediatric Cardiology
Catheterization Laboratory,
Duke University Med. Center,
Durham, North Carolina, USA |
| Prof.
Martin P. O´Laughlin |
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"What major changes occur
in the function of the heart at birth ?" |
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The major changes that occur
in the function of the heart at birth promote a change from a circulation
using the placenta for oxygen and carbon dioxide exchange to one in
which the lungs are used for that purpose. Before birth, the fetus
has two pathways for blood to pass by the lung artery to go to the
body, then back to the placenta. These are called the patent foramen
ovale and the patent ductus arteriosus.
The patent foramen ovale allows blood to flow between the upper two
chambers of the heart and the patent ductus arteriosus allows flow
between the great arteries after they leave the heart. After birth,
the baby breathes, the resistance to flow to the lungs drops, and
the two bypass pathways close naturally. |
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"What basic examinations
of the heart are done immediatley
after birth and why ?" |
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A complete physical examination
including a cardiac examination is performed immediately after birth.
The examination will focus on the heart but include observing the
respiratory rate and pattern, feeling of pulses in the arms and legs,
noting color of the skin and nailbeds, and feeling the chest and abdomen
for abnormal impulses or enlarged organs. These clues will help the
provider assess the cardiopulmonary status of the patient. |
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"The primary caregiver of
a 1 month old baby notes a bluish coloration of the toes and fingernails
at rest. What could be common causes of this ?" |
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A bluish coloration of the
toes and fingernails might indicate a congenital heart disease caused
by blue or non-oxygenated blood's flowing to the left side of the
heart and out to the body. The most common heart diseases which can
cause this are the following: tetralogy of Fallot, truncus arteriosus,
totally anomalous pulmonary venous return, tricuspid atresia, pulmonary
valve stenosis, and transposition of the great arteries. There may
be other non-cardiac causes as well. This type of coloration should
prompt a call to the physician, and should lead to a full evaluation
by the Pediatrician or Family Physician and any specialist to whom
the patient might be referred. |
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"A six year old boy is observed
by his teacher getting very short of breath walking up the stairs
at school.
He complains that his heart's "beats funny". What could cause this
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For the most part, the patient's
feeling of his heart's beating "funny" in this type of a case would
be a result of the exertion and not a cause of the tiredness. Deconditioning
(the patient's being out of shape) could be considered, for example.
However, there are rare conditions in which a fast or irregular heart
beat can be the primary cause of shortness of breath. One of the best
tests for that would be for a school nurse or other trained professional
to take a pulse rate with attention to the rhythm or regularity of
the heart beat. That information would be of value to the primary
physician to see if a cardiology referral were needed. |
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