CVS short cases

1. Recognize anomaly: structural/ functional

If Cyanotic/1. Cyanosis2. Polycythemia3. Clubbing

AcyanoticDecide on murmur

2. Site/ extent of structural anomaly

If cyanotic: Fallots? Or not?If Fallots

1. No cardiomegaly2. Soft P23. No heart failure

3. Complications 1. Pulm.HTN Loud P2Palpable P2Parasternal heave/RVHECG: prominent R wave in R chest leadPeak P waveCXR: perip prunning

2. Cardiomegaly Shifted apex

3. Ventricular hypertrophy Heaving apex

4. Heart failure TachycardiaTachypneaGallop rhythmSweating while feedingCardiomegaly/ hepatomegalyRapid/unexplained wt gainLung creptsFTTEdema

5. Failure to thrive Crossing centile in 1-2 yr old childNo wt gain

6. Growth failure Stunting in bigger childWastingCong ht dx can cause hepatomegaly,, unexplained wt gain

7. Shunt reversal Cyanosis + loud P2

8. Bact. endocarditis Janeway/ Osler’s/ splinter h’rrhage, hematuria

9. Embolic phenomenon hemiparesis→ earliest sign to elicit would be pronator drift

4. Association VACTERLCHARGECATCH

5. Cause Syndrome Downs, Turner’s, Noonas, Digeorge, Velocardio facial

Cong. infection RubellaToxoplasmosis: hepatomegaly, skin rash, cataract, microcephaly, deafness

6. Evidence of intervention

Yapa Wijeratne M/07/189

Effect on growthComment on current wt centileGrowth pattern: flattening, crossing centilesFTT → ↑ BMR is due to symp overactivityDifficulty in feeding/ frequent vomiting/ recurrent chest infection/ associated other anomalies

Reasons for tachypneaCong ht dx are associated with tachypnea

1. HF: rapid shallow breathing/ not much effort of breathing/ fine crepts/ cardiomegaly/ hepatomegaly/ m/

2. RTI: recession/ ↑ effort/ noises 3. Or both

Size & extent of the lesion1. ANY complication→ means lesion is large→ needs Sx2. Intensity of heart M does NOT correlate with size of the lesion. (loud M does not mean that lesion is

small or large)3. Apical mid diastolic M [(functional M) in large VSD/ PDA] indicates pulm circulation is twice the

systemic circulation: blood is shunted to R/S(pulm vasculature)→ comes back to LA→ LV. Sx is needed. So with VSD comment that no mid diastolic M in mitral area.

Comprehensive diagnosis

1. Complex cyanotic ht dx with growth failure probably has had a embolism in brain.2. Large VSD or AV canal defect with pulm HTN & FTT in a child with trisomy 21, probably has LRTI also.

[If young mother is nearby, “young mothers have higher chance of having translocation than older mothers, therefore I offer this mother karyotyping bcz of the usefulness of that information in the process of counseling.” ]

Yapa Wijeratne M/07/189