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Cardiology Conference. Gatchalian , Gaw , Geraldoy , Geronimo, Geronimo, Geronimo December 22, 2010. C.F. 2 months old / male CC: Fever. C.F. 2 months old / male CC: Fever. C.F. 2 months old / male CC: Fever. Review of Systems. General: (-) noticeable weight loss

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cardiology conference

Cardiology Conference

Gatchalian, Gaw, Geraldoy, Geronimo, Geronimo, Geronimo

December 22, 2010

review of systems
Review of Systems
  • General: (-) noticeable weight loss
  • Cutaneous: (-) rashes, (-) discoloration
  • HEENT: (-) ear discharge, (-) epistaxis, (-) gum bleeding
  • Respiratory: refer to HPI
  • Cardiovascular: refer to HPI
  • GI: (-) diarrhea, (-) constipation
  • GUT: yellow urine, (-) edema of the hands and feet
  • Extremities: (-) swelling, (-) joint swelling
  • Nervous/Behaviour: (-) tremors, (-) convulsions
  • Hematopoietic: (-) pallor, (-) easy bruisability
immunization history
Immunization History
  • Received the following at a local health center:
  • BCG 1
  • Hepatitis B 1
  • DTP 1
  • OPV1
    • Next dose due on December 27, 2010
family history
Family History
  • (+) Rheumatic Heart Disease – maternal grandmother
  • (-) HPN
  • (-) Diabetes Mellitus
  • (-) Pulmonary Tuberculosis
  • (-) Allergies
socioeconomic and environmental history
Socioeconomic and Environmental History
  • Four bedroom house made of wood and concrete
  • Well lit and well ventilated
  • Garbage is collected daily, no segregation
  • Purified water from a water refilling station.
  • Baby bottles also sterilized
  • Stray cats
  • Second hand smoke
physical examination
Physical Examination
  • General Survey: awake, alert, in respiratory distress with alar flaring, ill looking, well-nourished, well-hydrated
  • Vital Signs: HR 140 bpm, RR 70 cpm Temp 36.0 °C Wt 4.7 kg (z=below 0 normal) Ht: 49 cm (z= below -3 severely stunted) BMI: 19.58 (z= above 2 overweight)
  • Head circumference 37 cm, chest circumference 36 cm, abdominal circumference 40 cm
  • Skin: Warm, moist skin, pink in color, good skin turgor, no rashes, no jaundice
physical examination1
Physical Examination
  • HEENT: normocephalic, anterior fontanel open, symmetric head, (-) scalp lesions, symmetric face; Eyeballs not sunken, pink palpebral conjunctiva, anictericsclerae, pupils 2-3 mm ERTL; Midline nasal septum, (+) whitish nasal discharge; Moist buccalmucosae, nonhyperemic posterior pharyngeal wall; Supple neck, (-) palpable lymph nodes
physical examination2
Physical Examination
  • Lungs/Chest: Symmetric chest expansion, (+) subcostal retractions, (+) crackles on both upper lung fields
  • Cardiovascular: adynamicprecordium, no precordial bulge, (-) Harrison’s groove, (+) holosystolic murmur at the lower left parasternalarea grade 3/6
  • Abdomen: globular abdomen, normoactive bowel sounds, soft, non tender, no masses
  • Spine: midline, (-) sacral dimpling, (-) tufts of hair
  • Genitalia: Penis 2cm, testes descended bilaterally, no phimosis, no discharge
  • Extremities:full peripheral pulses, no cyanosis, no clubbing
neurologic examination
Neurologic Examination
  • Cerebrum: alert
  • Cranial nerves: Pupils isocoric, 2-3mm ERTL, (+) direct and consensual light reflex, (-) gross facial asymmetry, (+) gag reflex
  • Cerebellum: (-) no involuntary movements
  • Motor: (-) rigidity, (-) spasticity, (-) Flaccidity
  • Meningeal Signs: (-) nuchal rigidity, (-) Brudzinski’s, (-) Kernig’s, (-) tonic neck reflex
clinical impression

Clinical Impression

Congenital Heart Disease



Difficulty breathing (dyspnea)

Frequent respiratory infections in children

Sensation of feeling the heart beat (palpitations) in adults

Shortness of breath with activity

Abdominal distention

Cyanosis in some patients

Chest pain



Poor weight gain or failure to thrive in infants with severe blockage

Shortness of breath

Sudden death

Bounding pulse

Fast breathing

Poor feeding habits

Shortness of breath

Sweating while feeding

Tiring very easily

Poor growth

Dizziness or fainting

Shortness of breath

Pounding headache

Chest pain

Cold feet or legs

Failure to thrive

Poor growth

Breathlessness with activity

Chest pain

Fainting, weakness, or dizziness with activity


Shortness of breath

Fast breathing

Hard breathing


Failure to gain weight

Fast heart rate

Sweating while feeding

Frequent respiratory infections

ventricular septal defect1
Ventricular Septal Defect
  • most common ACHD (25%)

* Roger’s disease

* Interventricularseptal defect

* Congenital cardiac anomaly

ventricular septal defect2
Ventricular Septal Defect
  • Physical size of the VSD is a major determinant of the size of the left-to-right shunt
  • Restrictive VSD (usually <0.5 cm2) - right ventricular pressure is normal
  • Large nonrestrictive VSDs (usually >1.0 cm2)- right and left ventricular pressure is equalized
anatomical classification
  • Membranous/ perimembranousVSD
    • Most common CHD (males>females)
  • • Muscular VSD
    • “Swiss cheese” VSD
  • SupracristalVSD
    • Least common
the contribution of pulse oximetry to the early detection of congenital heart disease in newborns

The contribution of pulse oximetry to the early detectionof congenital heart disease in newborns

Romaine Arlettaz, Andrea SerainaBauschatz, Marion Mönkhoff , Bettina Essers, Urs Bauersfeld

Eur J Pediatr (2006) 165: 94–98

  • To determine the effectiveness of a pulse-oximetric screening performed on the first day of life for the detection of congenital heart disease in otherwise healthy newborns
  • To determine if a pulse-oximetric screening combined with clinical examination is superior in the diagnosis of congenital heart disease to clinical examination alone
  • Study design: prospective multi-centre study
  • Zurich, Switzerland; May 2003 to May 2004
  • Population: infants above 35 weeks of gestation (n=3,262)
  • Postductalpulse-oximetric screening in the first few days of life is an effective means for detecting cyanotic congenital heart disease in otherwise healthy newborns