approach to child with heart disease
TRANSCRIPT
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Approach to child with heart disease
Dr Kiran VS
Consultant, Pediatric Cardiology
Narayana Hrudayalaya
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Presenting complaints/signs
• Failure to thrive
• Exercise intolerence
• Easy fatigability
• Chest indrawing
• Sweating during feeding
• Bluish spells
• Fever with rigor
• Palpitation
• Convulsion
• Fast breathing
• Oedema
• Hepatomegaly,
• spleenomegaly
• Clubbing
• Cyanosis
• Focal neurological lesion
• Other organ defects
• Chromosomal anomalies
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NADAS’ CRITERIA
• MAJOR• Systolic murmur III or
more• Diastolic murmur• Cyanosis• CHF
• MINOR• Systolic murmur II or
less• Abnormal S2• Abnormal CXR• Abnormal ECG• Abnormal BP
Presence of 1 Major OR 2 Minor criteria = Heart disease
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Bedside Evaluation
History & Clinical examination
Arterial Saturation (Pulse Oximetry)
X ray chest
ECG
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3 months old- severe failure to thrive
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Look for cyanosis and clubbing
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Look at the respiratory pattern and for evidence of recession
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Hepatomegaley
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Apex
RV LV
Diffuse Localized
Down&out Up & in
Med retrac Lat retrac
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Feel the precordium for hyperactivityand for thrills
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Do what is necessary to calm the baby down!
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Listen carefully
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Listen at the back for radiation of murmurs
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CCHD
• Age of presentation
At birth – TGA
1- 2 wks – Duct dependant lesions
2 wks - 2 months – Inc PBF
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Hyperoxia test
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Echo
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ASD
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VSD
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PDA
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CoA
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TOF
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Cyanotic spell• Occurs in < 2 years
• Onset is spontaneous,usually early morning
• Infant cries incessantly
• Cyanosis deepens, Tachycardia
• Gasping, anoxic seizures & apnoea ensues
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Mx of Spell• Keep calm• Knee chest • IV fluid bolus• Bicarbonate • Morphine IM or SC• Metoprolol (0.1 mg/kg)• Phenylephrine• If all else fails: • General anesthesia• or
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Older Blue baby• SBE prophylaxis, good dental hygiene
• Iron prophylaxis
• Phlebotomy for symptomatic polycythemic
• Keep hydrated
• Rx fever/gastroenteritis early
• Beta blockers in PS
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Hearty Thanks!!