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Pediatric Cardiology
ML Kulkarni
CHAPTER 1:
Cardiovascular System Examination
INTRODUCTION
HISTORY TAKING
Present History
Family History
Antenatal History
Birth History
GENERAL PHYSICAL EXAMINATION
Pulse
1. Rate
Tachycardia
Bradycardia
2. Rhythm
Causes of Irregular Rhythm
Causes of Regularly Irregular Rhythms
Causes of Irregularly Irregular Rhythms
Pulse Deficit
3. Volume
4. Equality of Pulses
Character
1. Anacrotic Pulse (Fig. 1.4)
2. Double Beating Pulses
Bisferiens Pulse
Bifid Pulse
Dicrotic Pulse (Fig. 1.5C)
Pulsus Alternans
Pulsus Paradoxus (Fig. 1.7)
Mechanism of Pulsus Paradoxus
Determination of a Paradoxic Pulse (using Sphygmomanometer)
Causes of Pulsus Paradoxus
Collapsing Pulse (Waterhammer Pulse) (Fig. 1.8)
Method of Palpating Collapsing Pulse
Causes
Respiratory Rate
Type of Respiration
Tachypnoea
Decreased RR
Temperature
Blood Pressure
Different Methods of Examining BP in Children
GUIDELINES FOR MEASURING BP
Falacies in Recording Blood Pressure
Abnormalities of Blood Pressure
Hypertension
Conditions Associated with High BP in Upper Limbs
Hypotension
Pulse Pressure
Capillary Filling Time
CYANOSIS
Differential Cyanosis
CLUBBING
Clinical Grading of Clubbing
Signs of Clubbing
Congestive Cardiac Failure
Infants
Children
Physical Signs of Infective Endocarditis
I. Systemic Infection
II. Intravascular Lesions
III. Immunologic Features
Peripheral Signs of Aortic Regurgitation
Final step is to evaluate features of various syndromes associated with cardiac lesions
Presence of scars of previous surgeries or other procedures should be carefully looked for Scars
Cardiovascular Examination
INSPECTION
a. Precordium
Conditions Associated with Precordial Bulging
Conditions Associated with Flattened Precordium
b. Pulsation
Apex Beat
Conditions Associated with Displaced Apical Impulses
Conditions Associated with Invisible Apex Beat
Extent of Apex Beat
Conditions Associated with Diffuse Apex Beat
Conditions Associated with Forcible Apex Beat
c. Precordial Pulsations
Second Left ICS Pulsations
Third Left ICS Pulsations
Third and Fourth ICS Pulsations
d. Extraprecordial Pulsations
Epigastric
Suprasternal
Right Side of the Chest
Back
Jugular Venous Pressure (JVP)
Examining Jugular Venous Pulse
Abnormalities of Waves
‘a’ Waves
‘x’ waves
‘v’ waves
‘y'waves
Elevated JVP
Kussmaul's Sign
PALPATION
a. Apex Beat
Technique of Palpating Apex Beat
b. Heart Sounds
c. Thrill
d. Parasternal Heave
PERCUSSION
a. Right Border of Heart
b. Left Border of Heart
c. Second Left Intercostal Space
Technique of Percussion
AUSCULTATION
Procedure for Auscultating the Heart
Heart Sounds
First Heart Sound (S1)
Second Heart Sound (S2)
Normal Splitting of Second Heart Sound
Pathophysiology
Wide Inspiratory Splitting
Pathophysiology
Pathophysiology
Wide and Fixed Split
Causes of Wide Fixed Splitting
Pathophysiology
Reversed Splitting of Second Heart Sound
Associated Cardiac Conditions with Reversed Splitting
Pathophysiology
Single S2 (Fig. 1.19E)
Due to Reduced Intensity of Components of Second Heart Sounds
P2 Synchronous with A2
Extra-Sounds
Extra-Sound in Diastole
Extra-Sounds in Systole
Third Heart Sound (Fig. 1.20)
Fourth Heart Sound (Fig. 1.21)
Tips for Auscultating S3 and S4
Triple Rhythm
Gallop Rhythm
Summation Gallop
Quadruple Rhythm
OTHER SOUNDS
1. Opening Snap
Pathophysiology
2. Systolic Ejection Click
Pulmonary Area
Aortic Area
Mid-systolic Ejection Click
Pericardial Rub
MURMURS
Grading of Murmurs
Classification of Murmurs
Innocent Murmurs
Vibratory Murmur
Characteristics
Pulmonary Systolic Murmur
Venous Hum
Characteristics
Tips in Auscultating Venous Hum
Organic Murmur
Systolic Murmurs
Ejection Systolic Murmur
Causes of Ejection Systolic Murmur
Pansystolic Murmur
Causes of Pansystolic Murmur
Diastolic Murmur
1. Mid-Diastolic Murmur
Early Diastolic Murmur
Causes of Early Diastolic Murmur
Atriosystolic or Presystolic Murmur
Causes of Presystolic Murmur
Continuous Murmur
Causes of Continuous Murmur
CHAPTER 2:
An Overview of Congenital Heart Disease
DEFINITION
Incidence
Etiology
Monogenic—Autosomal Dominant
Chromosomal
Multifactorial
Environmental Drugs
Infections
Maternal Conditions
Gestational Age and Occurrence of CHD
Syndromes with CHD
Diagnosis and Approach to CHD
Congenital Heart Lesions Presenting with Collapse
Congenital Heart Lesions Presenting with an Asymptomatic Murmur
I. Characteristics of Left to Right Shunt
II. Characteristics of Right to Left Shunt
III. Characteristics of Obstructive Lesions
Diagnosis of CHD with Chest X-ray and ECG
X-ray in CHD
Diagnosis of Heart Disease
Extracardiac Complications of CHD and Eisenmenger's Syndrome
Malposition of Heart
Clinical Diagnosis of Cardiac Malposition
Recurrence Risk
Radiology in Malposition of Heart
Viscero-atrial Concordance
ECG in Cardiac Malposition
Summary and Features of Common Congenital Heart Diseases
Ventricular Septal Defect
Patent Ductus Arteriosus
Atrial Septal Defect
Aortic Stenosis
Pulmonary Stenosis
Tetralogy of Fallot
Factors Causing Cyanosis
Treatment of Cyanotic Spells
Transposition of Great Arteries
CoA
CHD—Summary
CHAPTER 3:
Basic Embryology of Congenital Heart Disease
INTRODUCTION
Development of Cardiac Tubes
Development of Sinus Venosus
Development of Pulmonary Venous System (Fig. 3.3)
Formation of Cardiac Septa
Septum Formation in the Common Atrium
Septum Formation in the Truncus Arteriosus and Conus Cordis
Right Oblique View
Septum Formation in the Ventricle
Development of Aortic Arches
Fetal Circulation
Features of Fetal and Neonatal Circulation
Circulatory Changes in Newborn
CHAPTER 4:
Anatomy of Congenital Heart Defects
INTRODUCTION
Ventricular Septal Defect (VSD)
VSD Classification
Patent Ductus Arteriosus
Rare Location of PDA
Atrial Septal Defect (ASD)
Simple ASD
a. Ostium Secundum (Fig. 4.3A)
b. Sinus Venosus Defect (Fig. 4.3B)
c. Ostium Primum Defect (Fig. 4.3C)
Complete Atrioventricular Defect
Tetralogy of Fallot
Transposition of the Great Arteries (Fig. 4.5A)
Congenital Corrected Transposition of Great Vessels
Pulmonary Stenosis (Fig. 4.7)
Coarctation of the Aorta
Total Anomalous Pulmonary Venous Return (TAPVR) (Fig. 4.9)
Ebstein Anomaly of Tricuspid Valve (Fig. 4.10)
Truncus Arteriosus
Single Ventricle
Double Outlet Right Ventricle (Fig. 4.13A)
CHAPTER 5:
Approach to a Child with Acyanotic Heart Disease
I. DOES THE CHILD HAVE A HEART DISEASE ?
II. IS IT CONGENITAL HEART DISEASE ?
III. IF IT IS CONGENITAL HEART DISEASE, WHAT IS THE TYPE OF LESION ?
Left to Right Lesions
Obstructive Lesions
Right to Left Shunts
IV. WHAT IS THE SEVERITY OF THE LESION ?
I. GENERAL EXAMINATION
Look for Cyanosis and Clubbing
Assess Growth of the Child
Examine Pulse and Blood Pressure
Jugular Venous Pressure
Determine the Visceral Situs
II. CARDIOVASCULAR EXAMINATION.
Pulsations in Precordium
Cardiovascular Auscultation
III. INVESTIGATIONS
Chest X-ray
Electrocardiogram
Echocardiographic
MANAGEMENT
CHAPTER 6:
Common Acyanotic Congenital Heart Diseases: How to Diagnose and Manage
ACYANOTIC
Femorals felt
Cyanotic
ATRIAL SEPTAL DEFECTS (ASDs)
CLOSURE
VENTRICULAR SEPTAL DEFECTS (VSDS)
Large VSDs, Low PVR
Large VSDs, High PVR
THERAPY
Inoperable
Moderate VSD
Small VSD
Large VSD
PATENT DUCTUS ARTERIOSUS
Pulmonary Stenosis
PDA Therapy
COARCTATION OF THE AORTA
AORTIC STENOSIS
HEART DISEASE AND ENDOCARDITIS PROPHYLAXIS
CHAPTER 7:
Approach to a Child with Cyanotic Congenital Heart Disease
CHAPTER 8:
Common Cyanotic Congenital Heart Diseases: How to Diagnose and Manage
TETRALOGY OF FALLOT (Figs 8.1 to 8.3)
TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION (TAPVC) (Figs 8.4 to 8.6)
TRUNCUS ARTERIOSUS (Fig. 8.7)
TRICUSPID ATRESIA (Fig. 8.8)
TRANSPOSITION OF THE GREAT ARTERIES (Fig. 8.9)
CONCLUSION
CHAPTER 9:
Review of Common Surgical Procedures
ATRIAL SWITCH OPERATIONS
Mustard Procedure
Operation Technique
Senning Operation
Principle
Operation Technique
ARTERIAL SWITCH OPERATION (JATENE'S PROCEDURE)
Operation Technique
Rastelli's Repair
Damus-Kaye-Stansel Repair
CHAPTER 10:
Cardiac Malpositions
TERMINOLOGY
1. Situs Solitus (Situs=position; solitus=usual)
Features
2. Situs Inversus (Situs= position; inversus=reversal)
Features
Cardiac Displacement
Situs Ambiguous (Ambiguous = indefinite)
Heterotaxy (Hetero = other; taxy = arrangement)
Isomerism (Isos = equal; meros = part)
Right Isomerism
Left Isomerism
Asplenia
Polysplenia
Ventricular Loop
Atrioventricular Concordance
Ventriculo-arterial Concordance
Discordance
I. Visceroatrial Situs
II. Cardiac Chambers
a. Right Atrium (RA)
b. Left Atrium (LA)
c. Left Ventricle (LV)
d. Right Ventricle (RV)
III. Ventricular Inversion
IV. Transposition of the Great Vessels
1. Complete Transposition (D-Transposition)
2. Corrective Transposition (L-Transposition)
CLINICAL DIAGNOSIS OF CARDIAC MALPOSITION
X-ray
ECG in Cardiac Malposition
Summary
CHAPTER 11:
Radiological Anatomy of Congenital Heart Disease
INTRODUCTION
How to Estimate Cardiothoracic Ratio?
VIEW OF HEART CHAMBER ENLARGEMENT
Left Ventricular Enlargement
PA View (Fig. 11.3A)
Lateral View (Fig. 11.3B)
Right Ventricular Enlargement
PA View (Fig. 11.4A)
Lateral View (Fig. 11.4B)
Left Atrial Enlargement
PA View (Fig. 11.5)
Right Atrial Enlargement (Fig. 11.6)
Anatomy of Pulmonary Arteries
Evaluation of Pulmonary Arteries
Importance of Pulmonary Vascularity in CHD
Congested Pulmonary Vasculature
Pulmonary Artery Segment (PAS)
Decreased Pulmonary Perfusion
Pulmonary Venous Congestion and Oedema
Enhanced Bronchial Circulation
Conditions Associated with Right Aortic Arch
Visceral Situs
The Cardiac Positions
Situs Inversus with Mirror Image Dextrocardia (Fig. 11.8)
Visceral Heterotaxy
Bilateral Right Isomerism and Asplenia (Fig. 11.9)
Bilateral Left Isomerism and Polysplenia (Fig. 11.10)
Practical Tips in Radiographs of CHD
Classic Radiological Finding in Individual CHD
CHD WITH NORMAL PULMONARY BLOOD FLOW
Coarctation of Aorta
Over One Year
Pulmonary Valve Stenosis with Intact Septum
Aortic Stenosis
CYANOTIC CHD WITH DECREASED PULMONARY FLOW
Tetralogy of Fallot (Fig. 11.12)
Tricuspid Atresia
Tricuspid Atresia with Increased Pulmonary Flow (Fig. 11.13B)
Hypoplastic Left Heart Syndrome
Ebstein's Anomaly
CYANOTIC CHD WITH INCREASED PULMONARY BLOOD FLOW
Complete TGA
Corrected TGA
Total Anomalous Pulmonary Venous Return (TAPVR)
TAPVR with Obstruction
TAPVR without Obstruction
In Older Patients with Non-obstructive Supracardiac TAPVR (Fig. 11.17)
Truncus Arteriosus
Double Outlet RV
RADIOLOGY OF HEART—OVER ALL ASSESSMENT
Enlarged Heart Size
Mild
Gross
Cardiac Configuration
Lungs
CHAPTER 12:
Basic Principles of Pediatric ECGs and Classic ECG Findings in Congenital Heart Disease
HOW TO READ PEDIATRIC ECGs?
Determination of Heart Rate (Fig. 12.2)
Rule of Thumb for Determining Heart Rate (Fig. 12.2)
Rhythm
Electrical Axis
Electrical Axis Deviation based on Hexaxial Reference System
Method to Estimate Electrical Axis
Plotting Electrical Axis
Exercise I (Fig. 12.5)
Exercise II (Fig. 12.6)
Steps in Calculating QRS Axis
Exercise III
Ventricular Hypertrophy
Criteria for Right Ventricular Hypertrophy (RVH)
Suggestive Criteria for RVH
Criteria for Left Ventricular Hypertrophy (LVH)
Suggestive Criteria for LVH
Criteria for Combined Ventricular Hypertrophy (CVH)
Suggestive Criteria for CVH
PR Interval
ABNORMAL PR INTERVAL
Prolonged PR Interval and Associated Conditions
Short PR Intervals
Variable PR Interval
QT Interval
Abnormal QT Interval
Short QT Interval
QRS Complex (Fig. 12.8)
QRS Duration
QRS Axis
Abnormal QRS Axis
QRS Amplitude
P Waves (Fig.12.9)
Abnormalities of P Wave
Q Waves
Abnormalities of Q Wave
ST Segment
T Waves
Neonatal ECG
Premature Infant
Differential Diagnosis of Common ECG Findings
Classic ECG Findings in Individual CHD
Ventricular Septal Defect (VSD)
Atrial Septal Defect (ASD)
Patent Ductus Arteriosus (PDA)
Endocardial Cushion Defect
Pulmonary Stenosis (PS)
Aortic Stenosis (AS)
Coarctation of Aorta
Dextrocardial
Tetralogy of Fallot (Fig. 12.12)
Transposition of Great Arteries (TGA)
Corrected TGA
Tricuspid Atresia
Ebstein's Anomaly
Single Ventricle
CHAPTER 13:
Echocardiographic Examination of Congenital Heart Disease
INTRODUCTION
Two-Dimensional Echocardiography
STRUCTURES OF HEART SEEN AT VARIOUS STANDARD VIEWS
Parasternal Approach
a. Long Axis Plane
b. Short Axis Plane
Apical Approach
Subcostal Approach
Suprasternal Approach
M-mode Echocardiography
Doppler Analysis
Doppler Colour Flow Mapping
Foetal Echocardiography
Indications for Foetal Echocardiography
Transesophageal Echocardiography
Pediatric Echocardiographic Measurements
ILLUSTRATIVE ECHO FINDINGS OF CONGENITAL HEART DISEASE
Ventricular Septal Defect (VSD)
Atrial Septal Defect (ASD)
Complete Atrioventricular Defect
Patent Ductus Arteriosus (PDA)
Coarctation of Aorta
Tetralogy of Fallot (TOF)
Transposition of Great Arteries (TGA)
Single Ventricle (SV)
Hypoplastic Left Heart Syndrome
Ebstein's Anomaly
Truncus Arteriosus
Total Anomalous Pulmonary Venous Return (TAPVR)
CHAPTER 14:
Interventional Procedures in Congenital Heart Disease
INTRODUCTION
SEPTOSTOMY
INTERVENTIONS FOR RIGHT SIDED OBSTRUCTION
Pulmonary Valve Stenosis (PVS)
Pulmonary Artery Branch Stenosis
Tetralogy of Fallot (TOF)
INTERVENTIONS FOR LEFT SIDED OBSTRUCTION
Aortic Valve Stenosis (AVS)
Discrete Subaortic Stenosis (DSS)
Supravalvar Aortic Stenosis
Congenital Mitral Valve Stenosis
Coarctation of Aorta (COA)
CLOSURE OF CARDIAC DEFECTS
Patent Ductus Arteriosus (PDA)
Secundum Atrial Septal Defect (ASD)
Ventricular Septal Defect (VSD)
EMBOLOTHERAPY
CHAPTER 15:
Rheumatic Fever in Children
DEFINITION
INCIDENCE
EPIDEMIOLOGY
Age
Season
Sex
RHEUMATIC FEVER IN TROPICAL COUNTRIES
RHEUMATIC FEVER IN DEVELOPING COUNTRIES
CLASSIFICATION OF STREPTOCOCCUS (BASED ON HEMOLYSIS)
α-Hemolysis
β-Hemolysis
Structure of Group A β Hemolytic Streptococcus (Fig. 15.1)
Pathogenesis of Rheumatic Fever
Host Factors
Mechanism of Pathological Damage
Pathology
1. Exudative Stage
2. Proliferative Stage
Clinical Manifestation and Diagnosis
RF Clinical Features
Arthritis
Carditis
Clinical Features of Carditis
Outcome of Acute Rheumatic Fever (5-year, Sangal et al)
Subcutaneous Nodules
Chorea
Erythema Marginatum
Lab Diagnosis of RF
Throat Culture
Sero-Diagnosis
Antistreptozyme Test
Treatment
Management of Acute Stage
Eradication of Streptococcal Infection
Prevention of Recurrence
Problems Encountered during Prevention
CHAPTER 16:
Cardiomyopathy in Children
DILATED CARDIOMYOPATHY
Clinical Presentation
Etiology
Investigations
ECG
Echocardiography
Blood Tests
Viral Studies
Endomyocardial Biopsy
Investigations in DCM: Summary
Treatment
Inotropes
Diuretics
Afterload Reduction
Beta Blocker
Anticoagulation and Aspirin
L Carnitine
Surgical Options
Medical Therapy for DCM: Summary
HYPERTROPHIC CARDIOMYOPATHY
Clinical Presentation
Natural History
Sudden Death: Risk Factors
Syncope
Family History
Hypertrophy
Holter Monitoring
Blood Pressure Response to Excercise Testing
Genetic Testing
Treatment
Symptomatic Patients
Obstructive HCM: Medical Treatment
Obstructive HCM: Non-medical Treatment
Non-obstructive HCM: Medical Treatment
Asymptomatic Patients
Sudden Death: Prophylaxis
Management of HCM: Summary
CONCLUSION
REFERENCES
FOR FURTHER READING
CHAPTER 17:
Congestive Heart Failure
DEFINITION
Etiology of CHF
Pathophysiology
Clinical Manifestations of CHF
Management
Preload Manipulation
After Load Manipulation
Persistent Fetal Circulation
Contractility Manipulation
CHAPTER 18:
Refractory Heart Failure in Children
APPROACH TO RHF
INVESTIGATION
Echocardiography
Cardiac Catheterization
Laboratory Studies
TREATMENT
SUMMARY
CHAPTER 19:
Infective Endocarditis
INTRODUCTION
EPIDEMIOLOGY
PREDISPOSING FACTORS
PATHOGENESIS
ORGANISMS
Clinical Features
Fever
Cardiac Manifestation
Splenomegaly
Cutaneous Manifestations
Petechiae (20-40%)
Osler's Nodes (10-25%)
Splinter-Haemorrhage (15%)
Janeway Lesions (Less Than 10%)
Ophthalmologic Manifestations
Musculoskeletal Symptoms (44%)
Embolic Phenomena
Diagnosis
Lab Diagnosis
Blood Culture
Echocardiogram
Other Investigations
Haematological
Urine
Immunological Investigations
Complications
Management
Prevention
Standard Prophylaxis
In Patients Unable to Take Oral Medication
High-Risk Patients
CHAPTER 20:
Pericardial Diseases in Children
PERICARDIUM ANATOMY AND PHYSIOLOGY
DISEASES OF PERICARDIUM
PERICARDITIS
Acute Pericarditis
Clinical Features
ECG Changes
Laboratory Studies
Chest X-ray
ECHO
Pericardial Effusion
Clinical Features
ECG Findings
Chest X-ray
ECHO
Analysis of Pericardial Fluid
Treatment
Cardiac Tamponade
Clinical Features (Tamponade)
Pulsus Parodoxus
Method
Mechanism
Treatment
Constrictive Pericarditis
Pathophysiology
Clinical Features
Physical Signs
Mechanism
ECG
X-ray
Echocardiographic Findings
CT/MRI
Cardiac Catheterization
Treatment
SPECIFIC FORMS OF PERICARDIAL DISEASES
Purulent or Bacterial Pericarditis
Treatment
Viral Pericarditis
Tuberculous Pericarditis
ECHO
NON-INFECTIOUS CAUSES OF PERICARDIAL DISEASES
CONGENITAL PERICARDIAL DEFECTS
Congenital Absence of Pericardium
Pericardial Cyst
Diverticula
CHAPTER 21:
Cardiopulmonary Arrest (CPA) and Cadiopulmonary Resuscitation (CPR) in Neonates, Infants and Children
CONCEPT OF THE CHAIN OF SURVIVAL
CPR IN NEONATES, INFANTS, AND CHILDREN
DIAGNOSIS
Treatment
Rationale of BLS
PEDIATRIC BASIC LIFE SUPPORT (PBLS) (Child under 8 years)
Sequence of PBLS: the ABC's
Establish Unresponsiveness
Airway (4–5 seconds)
Breathing (4–5 seconds)
Circulation
Airway Obstruction
Heimlich Maneuver
PEDIATRIC ADVANCED LIFE SUPPORT (PALS)
AIRWAY MAINTENANCE
Equipment
Breathing (Ventilation)
INTUBATION
OXYGEN
CIRCULATION
Asystole
DEFIBRILLATION, CARDIOVERSION AND EXTERNAL PACING
VASCULAR ACCESS
Peripheral Veins, Central Venous Catheters, Interosseous Needle, Arterial Line
DRUGS AND FLUIDS IN RESUSCITATION
Antiarrhythmic Drugs
Supraventricular Tachycardia
Ventricular Tachycardia
Drugs Used to Maintain Cardiac Output and Blood Pressure
TERMINATION OF CPR
NO CPR CODE
NEONATAL ADVANCED LIFE SUPPORT (NALS)
DIAGNOSIS
NALS
Post-resuscitative Care
CHAPTER 22:
Pediatric Cardiac Dysrhythmias
AETIOLOGY
MECHANISMS OF DYSRHYTHMIAS
Abnormal Automaticity (Ectopic Rhythms)
Triggered Automaticity
Impaired Conduction
Re-entry
Clinical Approach
Clinical Assessment of Dysrhythmias
Advanced Investigations
DYSRHYTHMIAS
GROUP I: Normal Rate, Rhythm, Abnormal ECG
First Degree AV Dissociation (Block)
Wandering Pacemaker (Fig. 22.4)
Junctional Rhythm (Fig. 22.5)
Incomplete Right Bundle Branch Block (IRBBB) (Fig. 22.6)
Right Axis Deviation
Complete Right Bundle Branch Block(CRBBB) (Fig. 22.7)
Incomplete Left Bundle Branch Block (ILRBB) (Fig. 22.8)
Complete Left Bundle Branch Block (CLBBB) (Fig. 22.9)
Wolff-Parkinson-White Syndrome (WPWS)
Long QT Syndrome
Hypocalcemia
GROUP II: NORMAL RATE, IRREGULAR RHYTHM
Sinus Arrhythmia (Fig. 22.12)
Sinus Arrests (Fig. 22.13)
Premature Beats
Premature Atrial Beats (PAB) (Fig. 22.14)
Junctional Premature Beats (JPB) (Fig. 22.15)
Ventricular Premature Beats (VPB)
GROUP III: ABNORMAL RATES: TACHYCARDIAS
NORMAL QRS TACHYCARDIAS
AUTOMATIC TACHYCARDIAS
Sinus Tachycardia
ECTOPIC ATRIAL TACHYCARDIA (EAT) (Fig. 22.20)
Treatment
MULTIFOCAL ATRIAL TACHYCARDIA (MAT) (Fig. 22.21)
Treatment
JUNCTIONAL ECTOPIC TACHYCARDIA (JET)(Fig. 22.22)
Treatment
ATYPICAL VENTRICULAR TACHYCARDIA (AVT)
REENTRY TACHYCARDIAS
Sinus Node Reentry Tachycardia (SNRT)
Atrial Flutter (AF)
Treatment
Atrial Fibrillation (AF)
Supraventricular Tachycardias (SVT)
AV Nodal Reentry Tachycardia (Fig. 22.25)
SVT due to Accessory Bypass Pathways
Clinical Features of SVT
Treatment
WIDE QRS TACHYCARDIAS
MANAGEMENT OF WIDE QRS TACHYCARDIAS
Ventricular Tachycardia (Fig. 22.28)
ECG Features
MANAGEMENT OF VT
VT in CHD
VT in Myopathies
Chronic Therapy for Recurrent VT
Ventricular Fibrillation (VF) (Fig. 22.31)
GROUP IV: ABNORMAL RATES: BRADYCARDIAS
DISORDERS DUE TO IMPAIRED CONDUCTION
Sinus Node Dysfunction
Management
Atrioventricular Blocks
First Degree AV Block
Second Degree AV Block (Partial Heart Block)
Third Degree AV Block (Complete Heart Block)
Aetiology of Heart Blocks
Partial (First and Second Degree)
Complete (III Degree) Heart Block
Symptoms and Signs
Management
Bundle Branch Blocks (BBB)
Aetiology
Management
GROUP V: CARDIAC ARREST/VENTRICULAR FIBRILLATION
CHAPTER 23:
Cardiovascular Evaluation of a Neonate
INTRODUCTION
Transitional Circulation after Birth
CARDIAC EVALUATION OF THE NEWBORN
History
Family History
Maternal History
General Evaluation
Normal Physical Findings
Premature Infants (Common Findings)
Pulse
Blood Pressure
Other Methods
Indirect Blood Pressure Methods
Direct Method
Inspection
Palpate
Auscultate
Precordial Contour
Breathing Pattern
Association with Non-cardiac Anomalies
Palpation
Chest
Liver
Auscultation
First Heart Sound (S1)
Second Heart Sound (S2)
MANIFESTATIONS OF CARDIAC PROBLEMS IN THE NEWBORN
CYANOSIS IN THE NEONATE
Etiology
EVALUATION AND MANAGEMENT OF THE NEONATE WITH SUSPECTED CARDIAC DISEASE
Investigative Approach to a Neonate with Cyanosis
Chest X-ray Obtained
Arterial Blood Gas Analysis
Hyperoxia Test
ECG
ECHO
HEART FAILURE IN THE NEONATE
Investigative approach
Treatment of Congestive Heart Failure
HEART MURMURS
Pathologic Heart Murmurs
CHEST X-RAY IN EVALUATING CARDIAC DISORDERS IN A NEWBORN
How to Read a Chest Radiograph?
Dextrocardia or Mesocardia
Pulmonary Blood Flow
Decreased Pulmonary Blood Flow could be due to
Causes of Increased Pulmonary Blood Flow
Asymmetry of Pulmonary Blood Flow
ELECTROCARDIOGRAPHY
Normal Electrocardiography
Abnormal Electrocardiography
P-Axis
QRS Axis
Left Ventricular Hypertrophy (LVH)
Right Ventricular Hypertrophy (RVH)
Atrial Hypertrophy
Ventricular Conduction Disturbances
Persistent Pulmonary Hypertension of the Newborn (PPHN)
Prevalence
Etiology
Clinical Manifestations
Symptoms
Signs
Investigations
Treatment
Prognosis
PATENT DUCTUS ARTERIOSUS
Clinical Manifestations
Examination:
Investigations
Treatment
Surgery
INDEX
TOC
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