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Approach to child with heart disease
Dr Kiran VS
Consultant, Pediatric Cardiology
Narayana Hrudayalaya
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
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
Bedside Evaluation
History & Clinical examination
Arterial Saturation (Pulse Oximetry)
X ray chest
ECG
3 months old- severe failure to thrive
Look for cyanosis and clubbing
Look at the respiratory pattern and for evidence of recession
Hepatomegaley
Apex
RV LV
Diffuse Localized
Down&out Up & in
Med retrac Lat retrac
Feel the precordium for hyperactivityand for thrills
Do what is necessary to calm the baby down!
Listen carefully
Listen at the back for radiation of murmurs
CCHD
• Age of presentation
At birth – TGA
1- 2 wks – Duct dependant lesions
2 wks - 2 months – Inc PBF
Hyperoxia test
Echo
ASD
VSD
PDA
CoA
TOF
Cyanotic spell• Occurs in < 2 years
• Onset is spontaneous,usually early morning
• Infant cries incessantly
• Cyanosis deepens, Tachycardia
• Gasping, anoxic seizures & apnoea ensues
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
Older Blue baby• SBE prophylaxis, good dental hygiene
• Iron prophylaxis
• Phlebotomy for symptomatic polycythemic
• Keep hydrated
• Rx fever/gastroenteritis early
• Beta blockers in PS
Hearty Thanks!!