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Essentials of Pediatric Cardiology
Anita Khalil
CHAPTER 1:
Congestive Cardiac Failure
HEART FAILURE SYNDROMES
ETIOPATHOGENESIS
Congenital Heart Disease (CHD)
Acquired Heart Diseases
Arrhythmias
Anemia
Rheumatic Fever and Rheumatic Heart Disease
Hypertension
PATHOPHYSIOLOGY
CLASSIFICATION
CLINICAL FEATURES
Neonates
Infants
Children and Adolescents
MANAGEMENT
TREATMENT
Augmenting Myocardial Contractility
Inotropic Drugs
Digitalis
Sympathomimetic Agents
Phosphodiesterase Inhibitors
Reducing the Heart Size
Diuretics
Reducing Cardiac Work and Improving Working Environment
Angiotensin Converting Enzyme Inhibitors (ACE-inhibitors)
Angiotensin II Receptor Blockers (ARB)
Calcium Channel Blockers
Beta Adrenergic Antagonists
Correcting the Underlying Cause
Device Therapy
Surgical Therapy
GUIDELINES FOR MANAGEMENT OF CCF
CHAPTER 2:
Hypertension in Children
SUMMARY
CHAPTER 3:
Arrhythmias
DISORDERS OF CARDIAC RHYTHM AND CONDUCTION
Cardiac Arrhythmias
Anatomy and Physiology of Conduction System (Fig. 3.1)
Features of Presentation
History
Physical Examination
Electrocardiographic Monitoring
Sinus Rhythm (Fig. 3.3)
Tachyarrhythmias
Recognition of Tachyarrhythmias
Sinus Tachycardia
Sinus Arrhythmia
Supraventricular Tachycardia (SVT)-Atrioventricular Re-entrant Tachycardia
Pre-excitation Syndromes (Fig. 3.6)
Management of SVT (Fig. 3.11)
Atrial Flutter
Management
Atrial Fibrillation (AF) (Fig. 3.13)
Ventricular Arrhythmia (Fig. 3.14)
Premature Ventricular Contraction (PVC)
Ventricular Tachycardia (VT)
Long QT Interval Syndrome (LQTS)
Ventricular Fibrillation
Management of Ventricular Fibrillation (Flow chart 3.1)
Chronic Treatment9,10
Class lA: Quinidine, Procainamide
Class lB: Phenytoin/Mexiletine
Class III: Amiodarone/Sotalol
Bradyarrhythmias
Sinus Bradycardia
Sinus Node Dysfunction (SND) (Fig. 3.18)
Atrioventricular Block (A-V conduction) Disturbance (Fig. 3.19)
First Degree Atrioventricular Blockm (Fig. 3.20)
Second Degree Atrioventricular Block
Mobitz Type II Atrioventricular Block (Fig. 3.22)
Third Degree AV Block (Fig. 3.23)
Management
Medical
Guidelines for Radiofrequency Energy Catheter Ablation of SVT
Abnormal Heart with SVT
Normal Heart with SVT
Asymptomatic WPW
Bundle Branch Blocks
Right Bundle Branch Block (RBBB)
Left Bundle Branch Block (LBBB)
Pacemaker Therapy13
CHAPTER 4:
Pacemakers in Children
PACEMAKER THERAPY3
Indications for Permanent Pacing in Children and Adolescents (American College of Cardiology/American Heart Association)
Class II A Pacemaker Implantation–may be Benefcial
Class II B Pacemaker Implantation-Usefulness Less Well Established
Class III Pacemaker Implantation - not useful
Pacemaker - Types
Postoperative Precautions
Precautions
CONCLUSIONS
CHAPTER 5:
Cardiac Imaging
ECHOCARDIOGRAPHY
Echocardiographic Windows
Parasternal Windows
Echocardiographic Studies
B-mode, M-mode, Doppler and Color Flow imaging
Sedation Protocol
Ejection Fraction
Other Echocardiographic Techniques
Fetal Echocardiography
Transoesophageal Echocardiography (TEE)
Intravascular Echocardiography
MAGNETIC RESONANCE IMAGING
Indication of Magnetic Resonance Imaging-Evaluation of Congenital Heart Disease
Anatomical Evaluation
Evaluation in Specific Cardiovascular Disorders
Cardiac Functional Assessment by MRI
Factors Determining MRI Images
MRI Angiography
Clinical Cardiac MR Spectroscope
Pediatric Cardiac MRI Spectroscopy
Hazards and Contraindications of MRI
CONCLUSIONS
CHAPTER 6:
Congenital Heart Disease: General Aspects
INCIDENCE
ETIOLOGY
DIAGNOSTIC EVALUATION OF A CHILD WITH CONGENITAL HEART DISEASE
Does the Child have Heart Disease? (Flow chart 6.1)
Abnormal Chest Roentgenogram
Abnormal Blood Pressure
Fetal and Perinatal Circulation
Fetal Circulation
Course
Dimensions of Cardiac Chambers
Fetal Cardiac Output
Changes in Circulation After Birth
Clinical Features
Management
Medical Management
Treatment
Surgery
Primary Prevention (Table 6.5)
CHAPTER 7:
Congenital Heart Disease: Specific Lesions
ACYNOTIC-VOLUME OVERLOAD L-R SHUNT
Atrial Septal Defect (ASD)
Pathology
Clinical Manifestations (Fig. 7.2)
Electrocardiography (Fig. 7.3)
X-ray Studies (Fig. 7.4)
Echocardiography (Figs 7.5A and 7.5B)
Natural History
Management
Catheter Device Closure
Postoperative Follow Up
Ventricular Septal Defect (VSD)
Pathology (Figs. 7.6A and B)
VSD Classifcation
Clinical Manifestations (Figs 7.7 and 7.8)
History
Physical Examination
Electrocardiography (Fig. 7.9)
X-ray Studies (Fig. 7.10)
Echocardiography (Figs. 7.11A and B)
Magnetic Resonance Imaging (MRI)
Cardiac Catheterization and Angiocardiography
Differential Diagnosis in Infants
In Older Children
Complications
Natural History
MANAGEMENT
Medical
SURGICAL
Indications
Complications
Patent Ductus Arteriosus
Pathology
Mechanisms of Postnatal Closure
Clinical Manifestations (Fig. 7.14)
Physical Examination
Electrocardiography (Fig. 7.15)
X-ray Studies (Fig. 7.16)
Echocardiography (Fig. 7.17)
DIAGNOSIS
Small PDA
Large PDA
Complications
Natural History
Management
TREATMENT
Premature Infant
ACYANOTIC-PRESSURE OVERLOAD
Obstructive Variety Pulmonic Stenosis (PS)
Pathology
Clinical Manifestations (Fig. 7.19)
X-ray Study (Fig. 7.20)
Electrocardiography (Fig. 7.21)
Echocardiography
MANAGEMENT
Medical
Surgical
Aortic Stenosis (AS)
Pathology
Physiology
Clinical Manifestations (Fig. 7.27)
Electrocardiography
X-ray Studies (Fig. 7.29)
ECHOCARDIOGRAPHY
Valvular AS
MANAGEMENT
Medical
Surgical
Indications
Coarctation of Aorta (CoA)
Pathology
Hemodynamics
Clinical Manifestations (Fig. 7.33)
X-ray Chest (Fig. 7.34)
Electrocardiography (Fig. 7.36)
Physical Examination
Hallmark Finding
Echocardiography
Magnetic Resonance Imaging (Fig. 7.40)
Natural History
MANAGEMENT
Medical
Surgical
Procedure
Complications
MANAGEMENT
Medical
Persistent Truncus Arteriosus
Pathology (Fig. 7.52)
Collete and Edwards Classifcation10
Clinical Manifestations
Electrocardiography
X-ray Studies (Fig. 7.53)
Echocardiography (Figs. 7.54A and B)
Natural History
MANAGEMENT
Medical
Surgical
Palliative Procedure
Definitive Procedure
CYANOTIC: PRESSURE OVERLOAD RL-SHUNT
Tetralogy of Fallot (TOF)
Etiology
Developmental Considerations
Pathology (Fig. 7.56)
Associated Cardiac Anomalies
Pathophysiology and Hemodynamics
Blood Flow
Clinical Manifestation (Fig. 7.57)
Electrocardiography (Fig. 7.58)
X-ray Studies
Cyanotic TOF (Fig. 7.59)
Echocardiography
Natural History
Management
Medical
Surgical
Palliative Shunt Procedures
The Shunt Procedures
Currective Surgery-Brock's Procedure
Indications and Timing
Procedure
Complications
Tricuspid Atresia (TA)
Classifcation of Tricuspid Atresia27 (Fig. 7.62)
Clinical Manifestations (Fig. 7.63)
Electrocardiography (Fig. 7.64)
X-ray Chest (Fig. 7.65)
Echocardiography (Fig. 7.66)
Complications
Natural History
Management
Medical
Surgical
Palliative
Definitive Surgery
Ebstein's Anomaly
Physiology
Pathology (Fig. 7.67)
Clinical Manifestations (Fig. 7.68)
Electrocardiographic Features (Fig. 7.69)
X-ray Chest (Figs. 7.70A and B)
Echocardiography (Figs. 7.71A and B)
Complications
Natural History
Management
Medical
Surgical
Indications
Procedures
Complications
CHAPTER 8:
Perinatal Cardiology
PHYSIOLOGICAL PARAMETERS OF CLINICAL IMPORTANCE
Physical Examination
Normal Physical Findings
Evidence of Cardiac Abnormalitiy in a Newborn
Physical Examination
II. Blood Pressure Measurements
Direct Blood Pressure Measurements (Table 8.2)
Electrocardiography
Normal ECG4
Abnormal ECG
Left Ventricular Hypertrophy (Fig. 8.12)
Right Ventricular Hypertrophy (Fig. 8.13)
Ventricular Conduction Disturbances
Chest Roentgenography6
Abnormal Chest X-ray6
Perinatal Echocardiography (Table 8.3)
Indications for Two-dimensional Echo Examinations
Benefits of Fetal Echocardiography
Fetal Echocardiography5
Optimal Timing of Screening
ACKNOWLEDGEMENTS
Recognition of Cardiac Disorders in the Fetus and Newborn Period
Fetal
Recognition of a Cardiac Abnormality 7
Echocardiographic Assessment of Fetal Cardiovascular Abnormality
Intrauterine Interventions9
Neonatal Alert in Fetus with Duct Dependent Lesion
What is it that Parents want to know?
II. Preterm Neonate
Cardiovascular Sequelae of Prematurity
Patent Ductus Arteriosus
Pathophysiology of Ductus Arteriosus Patency
Clinical Manifestations
Management
Medical
Contraindications to use of Indomethacin
Surgical
III. Transient Myocardial Ischemia
Pathogenesis
Clinical Manifestations Depend on Severity of LV Dysfunction
Management
Prognosis
IV. Heart Murmurs
Innocent Murmurs
Pathologic Heart Murmurs
V. Cyanosis in the Newborn
Peripheral Cyanosis
Central Cyanosis-Clinical Approach
Hyperoxia (Nitrogen Washout) Test
Cyanotic Congenital Heart Disease
Persistent Pulmonary Hypertension of Newborn (PPHN)
Pathophysiology
Clinical Manifestations
Treatment
Prognosis
IV. Heart Failure in the Newborn
Cardiac Causes
Non-cardiac Causes
Clinical Features
Ross Classifcation
Management
Investigations
Acute Management Principles
Chronic Management
Arrhythmias
Full term Newborns
Preterm and Low Birth Weight Newborns
Classifcation
Treatment
Disturbances of Atrioventricular Conduction (Figs. 8.23A and B)
First Degree A-V Block
Second Degree A-V Block
Third Degree A-V Block (Complete Heart Block)
CHAPTER 9:
Rheumatic Fever: Recent Advances
CHAPTER 10:
Rheumatic Heart Disease: Valvular Defects
AORTIC VALVE DISEASE 1,4
Aortic Regurgitation
Pathology
Hemodynamics
Clinical Picture (Fig. 10.11)
Natural History
Management
Investigations
X-ray Chest (Fig. 11.12)
Echocardiography (Figs. 10.13A and B)
Treatment
Medical
Surgical
Indications
Procedure and Mortality
Complications
Tricuspid Regurgitation
Hemodynamics
Clinical Picture
Investigations
Management
CHAPTER 11:
Myocardial Disorders
MYOCARDITIS
Epidemiology
Etiology
Pathophysiology
Pathology
Immunology
Role of Cytokines in Myocarditis and Dilated Cardiomyopathy
Clinical Presentation
Diagnosis and Noninvasive Testing
Differential Diagnosis
Treatment
Prognosis
Vaccination
Specific Causes of Myocarditis
Chagas Disease
Diagnosis
Treatment
Toxoplasmosis
Treatment
Cytomegalovirus
Treatment
Lyme Disease
Treatment
Giant Cell Myocarditis (Fig. 11.6)
HIV Infection and Myocarditis
Non-infectious Infammatory Myocarditis
Collagen Diseases
Mucocutaneous Lymph Node Syndrome
Etiology and Pathogenesis
Pathology44
Clinical Picture
Acute Phase (First 10 days)-Diagnostic Criteria
Sub Acute Phase (11-25 days after Onset)
Convalescent Phase
Echocardiography
Laboratory Studies
Natural History
Treatment
CARDIOMYOPATHY
Dilated Congestive Cardiomyopathy (DCM)
Etiopathogenesis (Fig. 11.10)
Pathology
Clinical Picture
Physical Examination
Laboratory Investigations
Natural History
Treatment
Prognosis
Endocardial Fibroelastosis
Epidemiology
Etiopathogenesis
Clinical Manifestations
Electrocardiography
X-ray Study
Echocardiography
Treatment
Prognosis
Hypertrophic Cardiomyopathy
Clinical Screening - Strategies in Families
Prevalence
Genetics
Pathology and Pathophysiology
Clinical Manifestations
Infancy
Childhood and Adolescence
Natural History
Evaluation
Management
Medical
Prevention of Sudden Cardiac Death
Surgical
Indications
Procedures
Doxorubicin Cardiomyopathy
Etiopathogenesis
Clinical Manifestations
Evaluation
Management
Prognosis
Restrictive Cardiomyopathy (RCM)
Etiology
Pathology
Clinical Manifestations (Table 11.12)
Differential Diagnosis
Treatment
CHAPTER 12:
Cardiac Infections
INFECTIVE ENDOCARDITIS
Definition
Pathogenesis
Pathology
Microbiology (Table 12.2)
Clinical Features
Laboratory Investigations
Diagnosis
Complications
MANAGEMENT
Antimicrobial Therapy
Staphylococcal Endocarditis
Fungal Endocarditis
Prosthetic Valve Endocarditis
Anticoagulation Therapy
Surgery
Prognosis
Prophylaxis
PERICARDIAL DISEASES
Conditions Affecting Pericardium
Signs and Symptoms of Pericardial Disease
Clinical Features
Electrocardiography (Fig. 12.4)
Radiographic Findings
Echocardiography (Figs. 12.5A and B)
Radionuclide Imaging Technique
Drainage of Pericardial Fluid (Pericardiocentesis)
Complication of Pericardiocentesis
Acute Pericarditis
INFECTIOUS DISEASES OF THE PERICARDIUM
Purulent Pericarditis
Clinical Features
Treatment
Prognosis
Viral Pericarditis
Treatment
Tubercular Pericarditis
Other Infectious Causes of Pericarditis
Constrictive Pericarditis
Etiology
Pathology
Clinical Picture
Management
MISCELLANEOUS CAUSES OF PERICARDIAL EFFUSION
Hypothyroidism
Chylopericardium
Etiology
Diagnosis
Treatment
Intrapericardial Tumors
Radiation Pericarditis
Congenital Pericardial Defects
Treatment
Cardiac Tamponade26
Pathophysiology (Figs. 12.6A and B)
Clinical Features
Investigations
Management
CHAPTER 13:
Primary Prevention of Atherosclerotic Cardiovascular Disease Beginning in Childhood
PATHOGENESIS
Imbibation Hypothesis
Encrustation Theory
Current Hypotheses
Monoclonal Hypothesis of Atherogenesis
RISK FACTORS FOR ATHEROSCLEROSIS
Prevention of Hyperlipidemia
Primary Hyperlipoproteinemias
Secondary Hypercholesterolemia
Causes of Secondary Hypercholesterolemia
Cholesterol Lowering Strategies
Population Based Approach
Triglycerides
Phospholipids
Sterols
Sources
Biological Effects of ω-3 PUFA
Sources
Dietary Advice
Individualized Approach
TREATMENT
Diet therapy
Drug Therapy
Drugs used
INDEX
TOC
Index
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