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Because I can't see. Sure I'll introduce you. So. Ok, we live now. So, hi everyone. Thank you for joining on a Tuesday afternoon. So today we have Sean uh final year teaching us about talking to us about pediatric cardiology. So, um yeah, I hope you guys enjoy the lecture and make sure you fill out the form at the end. So I'll pass it over to Sean and we can begin. Yeah. Hello. Hi, everyone. Um uh as, as very nicely introduced, my name is Sean. Um, and I'm gonna give you the lecture on pediatric cardiology. Um I hope everyone is. Well, uh there is a ment code. Uh, it's in the top flight and I'm sure one of the lovely er, um uh volunteers will um, put it in a chart as well. Um, so if you wouldn't mind joining that ment code, the first thing is just like a, like a, how are you find your fifth year? Um, let me know please if the men doesn't work. Um I'm hoping it will work also. I think one of the, the amount of people tried. Um, but if it, if it doesn't work, please let me know. Um And then yeah, we, we'll begin um so pediatric cardiology. So I'm just looking place to place because I've got notes in different places. Um pediatric cardiology is kind of a niche niche subject. So I'm hoping that I can help you the best. Uh I can. Um So who am II have just finished final year? Um So we finally having a bit of a break. Um at least, um and you might know from some societies like both meds, I've cheated a lot for um Med Ed and, and then before, um also shout out to my Pacers group uh as well if they're, if they're about. Um and the way I like to do my lectures. So I really like you guys to like watch and engage in lectures as much as possible. I made it II remember when I was watching all these ma lectures, er, in third year and fifth year um that I really disliked when people kind of talked about things and then didn't put them on the slides or didn't put them on the notes. So I have basically got the slides as a nice summary and everything else is in the notes section. Of course, you're gonna get these slides if um if people fill out the feedback. So the good thing is that whatever happens, anything I say and anything that's on the slide you're gonna get and you're gonna, so just don't worry about taking notes just please try and concentrate as much as possible. I've also scattered about 10 SBA S throughout the lecture um that you can do after certain uh certain things. Um And there are 10 extra SB at the end which will uh get released with the slides. Um Obviously just for some of the resources used um past me cas um really good for, for general, I mean, for finals, I think probably better than for the 5th, 5th year specialties. They like to go quite niche but, you know, still really good. Uh zero to finals. Amazing. If you, if you hadn't heard of it, Doctor Tom Watchman, um previous me guys and I'm sure the ma guy this year as well was amazing. Um So, yeah, so, um session instruction, these are just some of the symbols that I'm used. I'm using, especially pay, pay attention to the higher yield and lower yield things. Um because I've used those quite a lot um to show which ones you need to know because I said it's a niche topic, but there's still questions that like always come up. Um And yeah, let's, uh let's get on with it. So this is what we're gonna cover. We'll talk about the principles. Uh We'll talk about the condition of the presentation. I'll split them into three categories and then we'll talk a bit about B LS. But if we don't have time, I may um just leave the slides up because it's, it's something that you, it's not too hard to, to learn yourself without me explaining it to you. Um And we'll start with the principles. So let's go. So I think the principles of cardiology are quite, quite misrepresented in the sense that I think people skip over them and try to learn about the pathology. So I'm gonna try and walk you through the best I can and you might have heard of this before. You might not have and it might be on you. So I try to try to walk through it quite slowly. Um So we'll first talk about how the circulatory system is set up in the baby, which I think is really important to understand in order to understand the pathology. Um So what we know is that gas exchange happens in the lungs, in adults and, and er Children. Um and after in the fetus, the lungs aren't functional. It's the placenta, which is where fetal blood gets oxygenated and waste carbon dioxide gets removed. So we can put that on the diagram there. And the fetus has basically three shunts to help it um avoid unnecessary like sorry uh blood flow to unnecessary parts such as the liver, such as the lungs um and to help blood flow to more necessary parts for, for growth and development like the brain and, and other organs. Um So we'll start with the placenta um which basically as you know, blood flows through the placenta to the umbilical vein. Really important to remember is one umbilical vein, cos we'll talk about the umbilical artery as well in a second. Um And then basically of the umbilical vein, you have two options. Option one, you go via the portal vein to the liver, which as I said, doesn't need as much oxygenation cos all the sort of waste exchanges happening in the placenta. It's not that important. Um But you can go through the liver by the hepatic vein to the inferior vena cava. The other option is the first of the shunts we'll talk about and that's the doctor's stenosis. Now, the doctor's fos connects the umbilical vein to the inferior inferior vena cava and basically bypass the liver because we don't, again, we don't need the liver getting all of that blood. Um So after you've done that, we have the right atrium and then we have the second shunt, the second shunt is called the Framan Ovale. I think there's one people might have heard of because you have the condition um patent Framan ovale and the Framan ovale basically connects the, the right atrium as you can see to the left atrium um and allows blood to bypass the right ventricle and the lungs go straight into the aorta as you can see. Uh over here. Um Now, the second shot we have, sorry, the third shot we have is the doctor's stenosis. And this is basically the other path that the uh the blood can take. So if your blood does go um to the right ventricle, um and starts going to the pulmonary artery, it can flow from pulmonary artery into the aorta straight away, um bypassing the lungs again. So everything eventually ends up in the aorta. But a lot of it bypasses the lungs from either the frame of a or the doctor's arteriosis. Um then from the aorta, you go down to the internal iliac arteries. Um This is like such a classic fact to remember that the umbilical arteries you can see here stem from the internal iliac arteries. Um It's just a little fat but it, it sometimes just like comes up in questions like a classic question like where do the umbilical arteries come from internal iliac arteries? Um And then remember there's two umbilical arteries, only one umbilical vein. That's another classic f so these are three shunts that are present in fetal circulation, but we know that they're not present in the in adults. So, um what happens? Well, first of all, let's talk about why these shunts work. You have high pulmonary vascular resistance due to undeveloped lungs. Therefore, you have high pressures in the right atrium and the right ventricle, lower pressure in the left atrium and right and left ventricle. And we know that blood flows from higher pressures to lower pressures. So it's in the right to left shunt. Uh Sorry, II forgot to say uh as well, just at the end, the PDA er, is kept open by prostaglandins. Um, these are really high in fetal circulation which helps it to stay open. Um, so what happens at birth? Essentially, one, immediately after birth, you obviously have the umbilical cord in clamped. That means there's no blood flow in the umbilical veins. The doctor's vinosus closes, it becomes the ligamentum vinosum and it's just this ligament and actually, I think it develops into the falciform ligament in your liver. Um that, that got brought up in a path Viber. So if anyone's uh gone in for that, there you go. That was a good fact for you. Um What else happens? The alveoli open up uh As you tell the baby takes their first breaths, it's massive, massive, massively decreased as pulmonary vascular resistance, thats when pulmonary vascular resistance gets decreased. There's a fall in pressure in the right ventricle and the right atrium, the left atrial pressure is now exceeding the right atrial pressure. And as we know, blood flows from higher pressures to lower pressures. So, if the left atrial pressure is higher than the right atrial pressure, um and as well, you get the left atrium squashing the atrial septum which helps to close the frame of the vale. Um So basically, you get closure of the shunt. Uh and after a few weeks, it becomes sealed and it becomes er this fossa of virus, which is the structure within the seps of the heart. Um The other thing that gets closed is the third shot that doctors arteriosis. So the baby breaths and the blood oxygen level rises, this decreases. Prostaglandins, cos prostaglandins that this is, is triggered by low oxygen um like in the fetus. Um But when you have oxygen flowing through your blood, it's gonna decrease the prostaglandin release. It's gonna close that ductal arteriosis and it's gonna become the ligamentum of ters. Um Which of which adults have. I hope that's all makes sense. So far. There are a few summary diagrams um just for just we don't need to have a at um So we'll move on to our first question just about uh physiology. And I'm hoping are we, I can look at, look at some of the responses and how you're finding fifth years so far, everyone's just had long, intense, difficult fighting. Yeah, it is really long. It is really long and I um ii completely understand, but once it's over and especially once you have like only half, half a year for six year and yet to this point, it feels amazing. So all worth it all worth it guys. Um Hopefully that question should be open for you guys. Um So have a read of the question here if it's not open, if one of the murder people can, can tell me. Um But hopefully it should be open and when a few people have responded, um then I will uh I will show you guys the answer I get. We've got a few responses. Nice. I'll let a few more people respond just in case they want to. Um And then I'm hoping if I press this, it should show you the right answer. It should. Ok. Yes. Um Hopefully everyone can see the right answer now on their screens as well, but I can obviously flick to it here. Um So roller across the landing is to keep the dox to open and also make and deter blood, which is critical for survival in certain cardiac conditions, which we'll talk about next question. Um And if I scroll across, yeah, perfect. So again, give you guys about 30 seconds or so to answer that one.