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!!