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Childress-PediatricCardiology

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Childress-PediatricCardiology Powered By Docstoc
					   Who EVER invitied a                      PEDIATRIC CARDIOLOGY

   Cardiologist to speak at a                  Children also have heart disease!

   Childrens Conference?                       8 per 1000 live births

                                               Very different than adult type
                                               heart disease!




OVERVIEW OF PEDIATRIC                                    MURMURS
   CARDIAC DISEASE                          Only a SOUND
   • A few   types of CHD
                                             Frequent and usually INNOCENT, but if
      •   Murmurs                            murmur does not meet criteria, further
                                             investigation in warrented

              •   Chest Pain
                                            Abnormal murmurs are often due to CARDIAC
                                            DEFECTS
                   •   Frequent Questions




                                                                                        1
         Types of Murmurs                         Typical Location of Murmurs




        Innocent Murmurs                         Chest Pain In Children
        Vibratory
        Short                                   Very COMMON
        Mid-systolic
        Lower Left Sternal Boarder              Many Causes
        Changes with position
                                                If SUDDEN, SHARP and SHORT
        NEVER                                   LIVED - Always Chest Wall Pain
           Diastolic
           Associated with a Thrill (<gr 4/6)
           Heard in Back




Acyanotic Congenital Heart Disease                Ventricular Septal Defects
      Ventricular Septal Defects
      Atrial Septal Defects

      Patent Ductus Arteriosis
      Pulmonary Stenosis
      Aortic Stenosis




                                                                                 2
Ventricular Septal Defects                   Atrial Septal Defects
                                       Three major anatomic types:

                                               Secundum - Fossa Ovalis

                                               Ostium Primum - Endocardial cushion

                                                Sinus Venosis - SVC or IVC
                                                      assoc. with PAPVC




   Atrial Septal Defects                       Cyanotic Defects
       Secundum ASD
                                          • Tetrology of Fallot (and variants)


                                                     p
                                            • D-Transposition of Great Arteries


                                             • Hypoplastic Left Heart Syndrome


                                                • Hypoplastic Right Heart Syndromes




     Cyanotic Defects                          Cyanotic Defects
• Tetrology of Fallot (and variants)      • Tetrology of Fallot (and variants)


4 Components
   Malalignment VSD
   Overriding Aorta
   Infundibular Pulmonary Stenosis
   Right Ventricular Hypertrophy




                                                                                      3
                                                  Surgery for HLH Syndrome
     Hypoplastic Left Heart
                                                        Cardiac Transplantation

                                                         Norwood Sequence


                                                                    Three Surgeries by 2 y/o


                                                                65% to 85% survival < 20 yrs




                                               SIGNS AND SYMPTOMS
 SIGNS
                                                   Rapid Breathing and Heart Rate
           AND
                                                   Enlarged Liver
                   SYMPTOMS
                                                   Blue Lips and Tongue
                                                   Poor Feeding
                                                   Sweating
                                                   Poor Exercise Tolerance
                                                   Murmur ??




Frequent Concerns and Questions              Frequent Concerns and Questions

   Teenage boy has CHEST PAIN,                  Child has a MURMUR - Cause for concern??
   Is this dangerous?

                                                ANS: Usually Murmur is INNOCENT
    ANS: Almost never important unless ill      and of no concern - Ask your provider.
    with fever, cough, short of breath




                                                                                               4
Frequent Concerns and Questions                      Frequent Concerns and Questions

  Child has KNOWN HEART DISEASE,                       Teenage Girl has palpitations, fluttering or
    what restrictions apply?                           rapid heart rate. Is this of concern?


  Usually NO RESTRICTION, although some                ANS: Almost never a problem. Less than 5%
  should be allowed to rest when tired. A few          have a cardiac cause.
  can not do weight lifting or football/wrestling.




Frequent Concerns and Questions                      Frequent Concerns and Questions
                                                       Child has known heart disease, what about
    Teenager has fainting or near fainting spell.
                                                        play ground
    Could this be a cardiac problem?
                                                        PT/OT
                                                             p y
                                                        hard play
    ANS: Usually not. Most are not a “disease”          excitement - carnival rides etc

    OF CONCERN:                                         ANS: Generally allow child to SELF LIMIT
                                                            with a few exceptions. (Fainting danger,
    CRASH - not a “Swoon”                                    Cardiomyopathy, recent heart surgery,
                                                             etc.)
    Repeated complete LOC or Seizure




               And Finally -
       A brief word on Cardiac Arrest




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