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Pediatric Cardiovascular Emergency

Approach and initial management of PCE for pediatricianDr Hamid MohammadiPediatric Cardiologist

Shiraz University of Medical sciences Pediatric WardNov 2016Thanks for Dr Shahraban Abdulla ;Consultant Pediatric Cardiologist; Latifa Hospital, DHA for sharing his presentation in this field

What we earn with this presentation Lecture structureCardiovascular emergency among pediatric emergency department Introduction

What we should doneManagement

Guide to correct diagnosisClue for DDX

Sign and SymptomCommon Cause

What is the presenting scenarioPresentation

IntroductionCardiac emergencies are among the most stressful ED presentations.Cardiac Problem in infancy & childhood are not rare, often are complex.Cardiac disease in infancy & childhood can be congenital or acquired.2nd or 3rd cause of emergency mortality department

PCE - Common Causes

Ductal Dependent CHD with PDA dependency

Scenario oneA 5 days old neonate with cyanosis and irritability since last night

She is product of NVD with no significant prenatal and delivery time historyNow she is tachypnic and has respiratory distress

Ductal dependent lesion- Causes

Ductal dependent lesion- Presentation

Ductal dependent lesion- Management

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Hyper cyanotic AttackTOF physiology is the major cause of this attackMay be result of non cardiac sourcePresentation:Period of uncontrollable crying / panicRapid and deep breathing (hyperpnoea)- Clear lungDeepening of cyanosisheart murmurLimpness, convulsions Rarely, death. Common in Early morning

Spell Physiology and TxTreatment strategy: SVRKnee chest positionPhenylephrineDecrease anxiety:Hugging BabyMorphineO2 therapyHydrationTreatment of AcidosisInderal (0.01mg/kg Iv slowly)Sedation and IntubationKetamine ( SVR)

Decompensated HeartThe end stage of Cardiac disease

Scenario TwoA 6 month old infant with nausea, vomiting and malaise since 2 weeks ago. Since 2 days ago patient had sporadic cough and also poor feeding

Negative family history of any cardiac disease in childhoodPatient has grunting and R/D Abdominal exam reveled Hepatomegaly

Decompensated Heart - Causes

Decompensated Heart Common PresentationDifferent causes lead to similar sign and symptom in the end stage Typical CHF presentationDiagnostic Clue for HF:Gallop Rhythm Hepatomegaly (Rt side failure)Poor filling pressure (More with Lt side failure)Cold extremity (More with Lt side failure)Rales (Lt side Failure)

Decompensated Heart Specific Presentation

Decompensated Heart failure- Management

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ArryhtmiaWhen your art and knowledge are everythings

Scenario Three

Emergency DysrhythmiaCauses and Presentation

Emergency Dysrhythmia - Management

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TamponadDiagnosis is critical for early intervention

Scenario Four

Tamponade- Causes

Tamponade - PresentationBeckes triad is not usual in pediatric and is late finding ( Muffled Heart sound, Engorge Neck vein , Hypotension)Pulsus paradoxusKussmaul's signNon specific symptomNeed high index of suspicion to detectNeed Echocardiographic assessment for early intervention

Tamponade - Presentation

Decompensated Heart failure- Management

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PointsHistory and Physical exam is the most informative data to select the best management in pediatric Cardiovascular emergency (PCE)Most of Cardiovascular emergency could be managed without echocardiography in initial visitIv fluid handling, Diuretic and inotrope support are the 3 basis of treatment in the PCE

Research proposal

Dr Hamid MohammadiThank you