Approach to child with heart disease. Pushpa Raj Sharma Professor of Child Health Institute of Medicine. Diseases of heart. Blood vessels. Endocardium. Myocardium. Pericardium. Congenital Cyanotic: 22% Acyanotic: 68% VSD25% ASD6% PDA6% TOF5% PS5% AS5%. Acquired
Approach to child with heart disease
Pushpa Raj Sharma
Professor of Child Health
Institute of Medicine
Ceylon Med J 2001 Sep; 46 (3): 96-8; Indian J Pediatr. 2001 Aug;68 (8):757-7
Nelson’s Textbook of pediatrics; 17 ed.
1. Tetralogy of Fallot
2. Tricuspid Atresia
3. Severe Pulmonic Stenosis
4. Ebstein’s anamoly
5. Transposition of great vessles
6. VSD with pulmonary atresia
7. Truncus Arteriosus
8. Hypoplastic left heart
9. Single ventricle
10. TAPVR with infradiaphragmatic obstruction
Failure to thrive
Sweating during feeding
Fever with rigor
Focal neurological lesion
Other organ defects
A loud, harsh, or blowing holosystolic murmur.
dyspnea, feeding difficulties, poor growth, profuse perspiration, recurrent pulmonary infections, and cardiac failure in early infancy.
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
Small VSDs, the chest radiograph is usually normal
Large VSD: The presence of right ventricular hypertrophy, olegeimic lung fields (pulmonary hypertension or an associated pulmonic stenosis), gross cardiomegaly with prominence of both ventricles, the left atrium.
Most common form of ASD (fossa ovalis)
In large defects, a considerable shunt of oxygenated blood flows from the left to the right atrium.
The 2nd heart sound is characteristically widely split and fixed.
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 shunt across the atrial defect and mitral insufficiency
C/F similar to that of an ostium secundum ASD
Enlargement of the right ventricle
Enlargement of atrium
Large pulmonary artery
increased pulmonary vascularity is.
The electrocardiogram in patients with a complete AV septal defect 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 isolated 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
Prominent pulmonary artery.
Prominent right ventricle
Prominent vascularity in the hilar areas
Decreased vascualr marking in the periphery.
High volume load
Enlarged left ventricles
Dilatation of the left atrium
Symptoms of left sided failure
Chronic mitral insufficiency
Raised Pulmonary AP
Symptoms of right heart failure
Enlarged right ventricle and atrium
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 and ventricle (straight left border)
Prophylaxis against recurrence of rheumatic fever
Loud 1st sound
left atrial enlargement
prominence of the pulmonary artery
enlarged right-sided heart chambers;
ECG: prominent notched P wave.
Other organs involvement
Position: leaning forward.
Absent apical impulse
Muffled heart sounds
Distended neck veins
Low QRS complex, T inversion
A relatively large pericardial effusion must be present to cause an enlarged cardiac shadow with the usual “water bottle” configuration on a chest roentgenogram
The cardiac seize and the vascularity in the chest X-ray
Ventricular septal defect
Right ventricular hypertrophy
Plethoric lung fields specially at bases