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Chapter-06 Cardiology

BOOK TITLE: IAP Management Algorithms for Common Pediatric Illnesses

Author
1. M Zulfikar Ahamed
ISBN
9789352501977
DOI
10.5005/jp/books/12810_7
Edition
1/e
Publishing Year
2016
Pages
14
Author Affiliations
1. Sree Avittom Thirunal Hospital, Government Medical College, Thiruvananthapuram, Kerala
Chapter keywords
Congenital heart disease, gross structural anomaly, electrocardiogram, obstructive pulmonary disease, asymptomatic murmur, recurring chest infections, chest pain syndrome, tender hepatomegaly, cardiomegaly, Heart failure, echocardiography

Abstract

This chapter provides an overview of diagnosis of congenital heart disease in newborn, infant and child, management of congestive heart failure and management of congenital heart disease in infants and children. Congenital heart disease (CHD) is a gross structural anomaly of heart and/or great vessels from birth. It could be present in 5–8/1, 000 live births. One-third of this is trivial, one-third significant and one-third critical. If the CHD has arterial desaturation, it is called cyanotic and the CHD with saturation beyond 95% is called acyanotic, generally. Congenital heart disease can be recognized by means of history, physical examination, chest X-ray, electrocardiogram (ECG) and echocardiography. The common presentations of CHD are heart failure, cyanosis, shock, asymptomatic murmur, hypertension, recurring chest infections, chest pain syndrome etc. Acyanotic CHD is common in a child. Most will be asymptomatic. Heart failure in infancy and childhood is \'a clinical syndrome which reflects the inability of the heart to pump blood to meet the metabolic requirements of the body, including those needs incurred by growth; or able to do so at a higher filling pressure\'. Pathophysiologically CHF can be divided into three types: Type I, Type II, and Type III. Causes of CHF in infancy and childhood have a chronological order. This phenomenon is quite useful, looking for and identifying a cause for CHF in childhood. Clinical recognition of CHF in infancy is different from that of an older child. The classical quarter of findings is tachycardia, tachypnea, tender hepatomegaly and cardiomegaly. Chest X-ray still is useful in preliminary evaluation of CHF at any age. It looks at heart size, lung blood flow, presence of pulmonary hypertension (PAH). A 14 lead electrocardiogram (ECG) with or without a rhythm strip (lead II) is quite useful. It is a must in all forms of CHF. It can be treated in the wards or as obstructive pulmonary disease (OPD). Initial general measures include rest, fowler position, oxygen when indicated, correction of electrolytes and hemoglobin (Hb) abnormalities and volume depletion.

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