I. Congenital heart disease
Diagnostic points: ①The child’s growth and development may lag behind that of children of the same age and is prone to respiratory tract infections.
②With or without cyanosis.
③Most of them can hear heart murmur in the corresponding area, and severe cases can be accompanied by tremor in the anterior chest area.
④In which children with tetralogy of Fallot like to squat and pestle-like fingers (toes) are seen.
Drug therapy: 1. Cardiac: ①Digoxin: 0.25mg/d orally in adults; 0.06~0.08mg/kg in children under 2 years old, 0.04~0.06mg/kg in children over 2 years old, either orally or by sedation; ②Sideland: 0.2~0.4mg/d by sedation, 1~2 times/d. Sun Zongquan, Department of Cardiac Surgery, Wuhan Union Hospital
Diuretic: ①Tachyphylaxis: adults oral 20mg/d or 40mg/every other day (can be increased to 120mg/d if needed), or intramuscular or intravenous 20~40mg/d; children oral 1-2mg/kg, can be increased if necessary; ②Hydrochlorothiazide: adults oral 25~100mg/d, divided into 1~3 times (can be increased to 100~200mg/d, divided into 2~3 times if necessary); children oral 2~2mg/d, divided into 2~3 times. (If necessary, it can be increased to 100~200mg/d, divided into 2~3 doses); children take 2mg/(kg.d) orally, divided into 2 doses; (3) Spironolactone: adults take 20~40mg/d orally, 3 times/d.
3. Dilation: Captopril: adults take 12.5mg/time orally, 2~3 times/d (if necessary, increase to 50mg/time, 2~3 times/d); children take 0.3mg/kg orally at the beginning, 3 times/d if necessary, increase 0.3mg/kg every 8~24 hours, not more than 6mg/kg daily.
4. Reduce pulmonary hypertension: sodium nitroprusside: IV, 1~3 μg/(kg.min); nitroglycerin: IV, start at 5 μg/min, preferably with micro pump; prostaglandin E1: IV 10 μg + NS250ml or 5% GS, 1 time/d.
Note: Diuresis is not required for cyanotic heart disease; sodium nitroprusside can be started slightly faster and can be slowed down after blood pressure decreases, but when used for heart failure and cardiogenic shock, it should be started straight and slow at 10 drops/min, and then increased as appropriate, and should not be used for more than 72 hours; individual differences in patients to nitroglycerin, there is no fixed suitable dose for IV, and the dosage should be adjusted according to individual blood pressure, heart rate and other hemodynamic parameters. The dosage should be adjusted according to individual blood pressure, heart rate, and other hemodynamic parameters.
II. Heart valve disease
Diagnostic points: 1. Previous history of rheumatic fever or elderly nonrheumatic heart valve lesions, traumatic heart valve lesions, infective endocarditis, heart valve lesions caused by coronary artery disease, and heart valve lesions caused by valvular mucus degeneration.
2. Heart murmur can be heard in the corresponding valve area in the precordial region.
3. It can cause heart failure, various arrhythmias (atrial fibrillation is more common), subacute infective endocarditis and embolism (embolism is most common) and their related symptoms.
4. Examination: anti-streptolysin “O” (anti-O), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), etc. can be abnormal; electrocardiogram, chest plain film, cardiac echocardiography and color Doppler examination can clarify the diagnosis.
Drug therapy: 1. Cardiac: ①Digoxin: 0.25mg/d orally for adults; 0.06~0.08mg/kg for children under 2 years old, 0.04~0.06mg/kg for children over 2 years old, either orally or by sedation; ②Sidiram: 0.2~0.4mg/d by sedation, 1~2 times/d.
2. Diuretic ①Tachyphylaxis: adults oral 20mg/d or 40mg/every other day (can be increased to 120mg/d if needed), or intramuscular or intravenous 20~40mg/d; children oral 1-2mg/kg, can be increased if necessary; ②Hydrochlorothiazide: adults oral 25~100mg/d, divided into 1~3 times (can be increased to 100~200mg/d, divided into 2~3 times if necessary (If necessary, it can be increased to 100~200mg/d, divided into 2~3 times); children take 2mg/(kg.d) orally, divided into 2 doses; ③Spironolactone: adults take 20~40mg/d orally, 3 times/d.
3. Slowing down heart rate: ①Propafenone: oral: adults 100~200mg/time, 3~4 times/d, extreme 900mg/d, children 5~7mg/kg, 3 times/d, halved after the onset of effect, maintain the efficacy; sedation: adults 1~1.5mg/kg, 5 minutes sedation (if necessary after 20 minutes can be repeated once or 0.5~1mg/minute sedation maintenance), children each time 1mg/kg, 5 minutes of sedation (can be repeated after 20 minutes if necessary); ② Amiodarone: oral: 200mg/time, 3 times/d (after meal), after 1~2 weeks, change to 200~400mg/d maintenance as needed; sedation: 5~10mg/kg, slowly injected; sedation: 300mg/time, add 250ml of saline, finish drip within 30 minutes.
4. Dilation: Captopril: adults take 12.5mg/d orally, 2~3 times/d (if necessary, increase to 50mg/d, 2~3 times/d); children take 0.3mg/kg orally at the beginning, 3 times/d if necessary, increase 0.3mg/kg every 8~24 hours, not more than 6mg/kg daily.
Note: If there is rheumatic manifestations need anti-rheumatic treatment; for those with heart failure aura, early and thorough treatment is needed, giving cardiac agents, diuretics and other drugs, in order to prevent heart failure it is necessary to use digitalis in small amounts for a long time; simple obstructive heart valve disease is prohibited digitalis drugs; patients with wind heart disease under 30 years of age, it is advisable to inject long-acting Kenomycin 1.2 million units/month every winter and spring for prevention, in Patients with wind heart disease under 30 years of age should be given long-acting Kenomycin injections of 1.2 million units/month in winter and spring for prophylaxis, and even more prophylactic injections during the epidemic period of upper respiratory tract infection; patients with combined atrial fibrillation and other possible thrombosis are routinely treated with antiplatelet and anticoagulation.
Coronary atherosclerotic heart disease
Diagnostic points: 1. angina pectoris: (1) pressure and suffocation in the chest, stuffy feeling, severe burning pain, usually lasting 1-5 minutes, occasionally up to 15 minutes, can be relieved by itself; (2) pain often radiates to the left shoulder, the left arm front inner side up to the little finger and ring finger; (3) pain appears when the burden on the heart increases (such as increased physical activity, excessive mental stimulation and cold), and can disappear after rest or sublingual administration of (4) The pain may be accompanied (or not) by symptoms of weakness, sweating, shortness of breath, apprehension, palpitations, nausea or dizziness.
2. Myocardial infarction: ① Sudden onset of severe pain in the retrosternal or precordial region, radiating to the left shoulder, left arm or elsewhere, and the pain lasts for more than half an hour and cannot be relieved by rest and nitroglycerin; ② Shortness of breath, dizziness, nausea, chills, excessive sweating, and a weak pulse; ③ Wet, cold, grayish skin and a seriously ill appearance; ④ The only manifestation of syncope or shock in about one tenth of patients.
Drug treatment: 1. Pain relief: nitroglycerin, 0.3-0.6mg contained; cardiac pain relief 5-10mg contained; Xinkang extended-release tablets 20-40mg orally, 1 time/d; Imodium 30-60mg orally, 1 time/d; Lunan Xinkang tablets 20mg orally, 3 times/d; morphine 5-10mg or dulcolax 50-100mg subcutaneously or intramuscularly.
2. Anticoagulation and thrombolysis: Bay aspirin 100mg orally, 1 time/d; Bolivar (cloprorel) tablets 75mg orally, 1 time/d; Warfarin 2.5~5.0mg orally, 1 time/d; Urokinase 1.5 million U + NS 100ml, 30 minutes of sedation.
3. Regulation of blood lipids: Lipitor tablets 10mg orally, 1 time/d; Shujiazhi 20mg orally, 1 time/d; Blood lipidcon 0.3g orally, 2 times/d.
4. Anti-arrhythmia: Lidocaine 0.5~1mg/kg by static push (