Withnon-cyanotic heart dieseae, you have some type of a congenital defect. Congenital just means that theindividual is born with it, but what happens as aresult is that blood moves from the left side of the heartto the right side of the heart. In this example, you see thatwe have a little hole here in the wall between the leftventricle and the right ventricle. Since the pressure ishigher on this left side that’s sending the bloodthroughout the entire body, that is going to causeblood to go from the left to the right ventricle. Now, my question is, howdoes the doctor diagnose that an individual has somenon-cyanotic heart defect? Well, one of the first thingsis that you can hear it. So, let’s draw a little ear here. You’ll be able to hear it, and also, you should be able see it. We’ll talk about how youcan do those things … let’s put a little pupil here. All right, so, you’ll be able to hear it, and you’ll be able to see it. Now for the hearing, well,just think about it this way. Let’s say you have a garden hose. This is my garden hose, and we have water that’s flowingthrough that garden hose, and all of a sudden, we decide “Hey we’re going to put alittle tiny hole in the hose.” So, right here we have a little hole. What’s going to happen? Well, of course, you’re goingto have water flying out in places that you don’t want it to go, and it’s going to kind ofsquirt in this direction. If you come closely here,you’ll be able to hear that. Right? Yeah! Of course, that makes sense. Well, how does a doctor do that? Well, the doctor can’t go in and put his ear right by that hole. What he can do is takethis little handy device that we’re all so familiar with, that’s called a stethoscope, and this end, it’s going in his ears. Then, you have this tube, and then, you have this chest piece, and where you can listento the sounds of the heart. Depending on the type ofnon-cyanotic heart disease that individual might have, he’ll be able to hear the squirting or some type of a characteristic sound that’s the result of that defect. This process, I’ll giveyou a fancy name for it, it called auscultation. All right, so, that iswhen the doctor comes with the stethoscope and sincethis is a congenital defect, when the baby is just born, he listens to the sound of the heart, and say, “Hey. I’mhearing something that’s it’s not exactly whatI would like to hear.” So, that is one way, bylistening to the heart. Then, you can see the heart. How do you see the heart? Well, by taking a picture. Unfortunately, you can’tjust take a regular camera. You need a more expensive machine, and that expensive machineis going to allow you to be able to visualize the chest area, and with that, it’s justlike we’re taking a picture. It’s just a little different. It’s not going to haveall the nice fancy colors, and you’ll be able to see the heart. All right, so, this is my heart. This is called a chest x-ray. All right. You going x-ray machine. You put the baby in the x-ray machine. You take a picture, and you look to see, all right, is there sometype of a structural defect that’s not suppose to be there? That’s one way to visualize the heart. There’s a second way to visualizethe heart that’s even better. Yeah, you can take a picture, or you can take a video. Right? With a fetal or postnatal … so, fetal is while the fetus isstill inside the mother’s womb, and postnatal, once that baby is born, you take an echocardiogram. So, echo … ooh, that doesn’t look right. Echocardiogram. What that does is you’reusing sound waves, and you’re projecting it onto a screen, so, that you can see the heart. You see the heart as it’s beating. You see it contracting.You see the valves closing. You can also see in real time if there are defects that should not be there. So, that’s number two. We can visualize the heart by either using a chest x-ray or a fetal orpostnatal echocardiogram. There are some otherissues that we might notice with non-cyanotic heart disease. We said that blood isgoing from the left side to the right side, andif you have more and more blood going to the right side where it’s ultimately going to your lungs, so, you have more gong to your lungs some coming back but notgoing as much to the body, eventually, you’re going to get buildup in pressure in your lungs. If you get a buildup inpressure in your lungs, that can feed back to the right side causing buildup in pressure over here too. If we have that buildupin pressure over here, the ventricle has to do much more work. Now, if you go to the gym,and you’re exercising, and you’re doing a lot of work, what’s going to happen to your muscles? Well, their going to get larger. Their going to get significantly stronger. That’s going to start to happen on the right side where youhave a larger heart muscle. If you have larger heart muscle, you will notice this when a doctor comes and does an electrocardiogram. So, we take an electrocardiogram. Cardiogram where we are looking at the electrical signals throughout the heart. With that, I’m goingto just sketch one out. Right now we have our P wave, and then, our QRS complex, and then, we have our T wave. If I look at that, so, this P wave, our QRS complex, andthen, we have our T wave. The P wave gives me theelectrical activity of the atria. The QRS complex isgiven you the electrical activity of the ventricles. All right. I’m not going to go into all the details. I’m just going to kind of make it just that simple for now. If you have enlargement of the ventricles, or the right ventricle, what’s that going to do to the signal? Do you expect to see the same signal, a larger signal, a smaller signal? Well, if you have a bigger muscle, I would expect to see a significantly larger signal here with the ventricles. If that feeds back to your atria, and you have a larger right atrium, well, you might see this being a larger, a little broader, a little wider. There are characteristicsfeatures that you can see in the electrocardiogram, the ECG or EKG, depending on where you are in the world. That can give you an indication as to whether there is some type of a dysfunction in theheart, as a result of the load that’s placed on the right ventricle, and the right atrium, andenlargement of those structures. So, you can hear it. You can see it. There are some functionalthings that you can notice in the electrocardiogram to help diagnose a non-cyanotic heart defect.
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