1、Approach to child with heart disease,Pushpa Raj Sharma Professor of Child Health Institute of Medicine,Diseases of heart,Pericardium,Myocardium,Endocardium,Blood vessels,Prevalence,Congenital Cyanotic: 22% Acyanotic: 68% VSD 25% ASD 6% PDA 6% TOF 5% PS 5% AS 5%,Acquired Kawasaki disease Rheumatic Tu
2、bercular Collagen,Ceylon Med J 2001 Sep; 46 (3): 96-8; Indian J Pediatr. 2001 Aug;68 (8):757-7 Nelsons Textbook of pediatrics; 17 ed.,Common acyanotic lesions,Ventricular septal defects Atrial septal defects Atrio-ventricular septal defects Patent ductus arteriosus Truncus arteriosus Pulmonary steno
3、sis Aortic stenosis Mitral stenosis/incompetence Coarctation of aorta Tricuspid regurgitation,Common Cyanotic Lesions,Decreased flow 1. Tetralogy of Fallot 2. Tricuspid Atresia 3. Severe Pulmonic Stenosis 4. Ebsteins anamoly Increased Flow 5. Transposition of great vessles 6. VSD with pulmonary atre
4、sia,Common Lesions producing cyanosis,7. Truncus Arteriosus 8. Hypoplastic left heart 9. Single ventricle10. TAPVR with infradiaphragmatic obstruction,Presenting complaints/signs,Failure to thrive Exercise intolerence Easy fatigability Chest indrawing Sweating during feeding Bluish spells Fever with
5、 rigor Palpitation Convulsion,Fast breathing Oedema Hepatomegaly, spleenomegaly Clubbing Cyanosis Focal neurological lesion Other organ defects Chromosomal anomalies,Cyanosis: is it a cardiac cause or lung cause,Hyperoxia testNeonates with cyanotic congenital heart disease usually do not have signif
6、icantly raised arterial Pao2 during administration of 100% oxygen.,Ventricular Defect,Small VSD Asymptomatic A loud, harsh, or blowing holosystolic murmur. Large VSD dyspnea, feeding difficulties, poor growth, profuse perspiration, recurrent pulmonary infections, and cardiac failure in early infancy
7、.,80%,Syndromes associated with this condition,VSD: ECG is normal but may show right ventricular hypertrophy, if present indicates defect is large and presence of pulmonary hypertension or pulmonry stenosis,Ventricular Septal Defect (VSD),Large VSD: The presence of right ventricular hypertrophy, ole
8、geimic lung fields (pulmonary hypertension or an associated pulmonic stenosis), gross cardiomegaly with prominence of both ventricles, the left atrium.,Small VSDs, the chest radiograph is usually normal,Ventricular Septal defects,3050% of small defects close spontaneously, most frequently during the
9、 1st 2 yr of life. Small muscular VSDs are more likely to close (up to 80%) than membranous VSDs are (up to 35%). infants with large defects have repeated episodes of respiratory infection and heart failure despite optimal medical management. Surgical repair prior to development of an irreversible i
10、ncrease in pulmonary vasculalr resistance (usually prior to the patients second birthday).,Atrial Septal Defects: secundum,Most common form of ASD (fossa ovalis)In large defects, a considerable shunt of oxygenated blood flows from the left to the right atrium. Mostly asymptomatic The 2nd heart sound
11、 is characteristically widely split and fixed.,Secundum,Atrial Septal Defects:primum,Situated in the lower portion of the atrial septum and overlies the mitral and tricuspid valves. In most instances, a cleft in the anterior leaflet of the mitral valve is also noted. Combination of a left-to-right s
12、hunt across the atrial defect and mitral insufficiency C/F similar to that of an ostium secundum ASD,Atrial Septal Defect,Enlargement of the right ventricle Enlargement of atrium Large pulmonary artery increased pulmonary vascularity is.,The electrocardiogram in patients with a complete AV septal de
13、fect is distinctive. The principal abnormalities are (1) superior orientation of the mean frontal QRS axis with left axis deviation to the left upper or right upper quadrant, (2) counterclockwise inscription of the superiorly oriented QRS vector loop, (3) signs of biventricular hypertrophy or isolat
14、ed right ventricular hypertrophy, (4) right ventricular conduction delay (RSR pattern in leads V3 R and V1 ), (5) normal or tall P waves, and (6) occasional prolongation of the P-R interval,Atrial Septal Defects,Secundum ASDs are well tolerated during childhood. Antibiotic prophylaxis for isolated s
15、ecundum ASDs is not recommended. Surgery or transcatheter device closure is advised for all symptomatic patients and also for asymptomatic patients with a Qp:Qs ratio of at least 2:1. Ostium primum defects are approached surgically,Patent Ductus Arteriosus,Small defect no symptoms. Large defect: Wid
16、e pulse pressure Enlarged heart Thrill in L second IS Continuous murmur X-ray: prominent pulmonary artery with increased vascular markings.,Primary Pulmonary Hypertension,Prominent pulmonary artery. Prominent right ventricle Prominent vascularity in the hilar areas Decreased vascualr marking in the
17、periphery. No treatment,Mitral insufficiency: Rheumatic,High volume load Inflammatory process,Enlarged left ventricles,Dilatation of the left atrium,Pulmonary congestion,Symptoms of left sided failure,Repeated insult,Spontaneous improvement,Chronic mitral insufficiency,Raised Pulmonary AP,Enlarged r
18、ight ventricle and atrium,Symptoms of right heart failure,Mitral insufficiency: Rheumatic,Signs of heart failure Heaving apical impulse Apical systolic thrill Accentuated 2nd sound Holosystolic murmur radiating to axilla,ECG: bifid P waves and left ventricular hyertrophy X-ray: prominent left atrium
19、 and ventricle (straight left border),Prophylaxis against recurrence of rheumatic fever,Rheumatic valvular disease: Mitral stenosis,Takes 10 years to develop Symptoms proportionate to severity Left ventricular failure right ventricular failure Loud first heart sound with opening snap. Diastolic murm
20、ur Absent murmur if heart failure. Surgical intervention if symptomatic,Mitral Stenosis,Loud 1st sound Diastolic murmur left atrial enlargement prominence of the pulmonary artery enlarged right-sided heart chambers; ECG: prominent notched P wave.,Pericardial Effusion,Presenting complaint Precordial
21、pain Cough Dyspnoea Abdominal pain Vomiting Fever Other organs involvement,Signs: Position: leaning forward. Puffy face Friction rub Absent apical impulse Muffled heart sounds Pulsus paradoxus Distended neck veins Low QRS complex, T inversion,Pericardial Effusion,A relatively large pericardial effus
22、ion must be present to cause an enlarged cardiac shadow with the usual “water bottle” configuration on a chest roentgenogram,The test that differentiates,The cardiac seize and the vascularity in the chest X-ray,Cardiac disease with normal/decreased vasculature,Viral myocarditis Tetralogy of Fallot P
23、ulmonary atresia Tricuspid atresia Endocardial fibroelastosis Aberrant left coronary artery Cystic medial necrosis Diabetic mother,Cyanotic,Tetralogy of Fallot,Ventricular septal defect Pulmonic stenosis Overriding aorta Right ventricular hypertrophy,Cardiac disease with increased vasculature,Atriov
24、entricular septal defects Congestive cardiac failure Transposition of great arteries with VSD Total anomalous pulmonary venous drainage Truncus arteriosus Single ventricle without pulmonary stenosis Hypoplastic left heart syndrome,Congestive Cardiac Failure,Enlarged heart Plethoric lung fields specially at bases,
