Approach to CVS Disease

1. Approach to a child with Heart disease in children
 Introduction to CVS diseases
 Cyanotic CHD
 VSD & ASD
 PDA
 Rheumatic fever
 Rheumatic heart disease
 Congestive heart failure
 Infective endocarditis
 Myocarditis and pericarditis

2. Dr. D. Gunsekaran,
Consultant Paediatrician

3. Approach to a child with Heart disease in children
Breathlessness
Bluish extremities
Cough
Chest pain
Fever
Feeding difficulties
Failure toThrive
Frequent RTI
Syncope
Palpitation
Swelling of feet (Pedal edema)
Joint Pain
Dancing movements (Chorea)
Painful swellings in finger pulps

4. Approach to a child with Heart disease in children
Congenital:
Symptoms from infancy
Feeding difficulties FTT
Recurrent hospital admissions
Acquired:
Rheumatic fever:
Fever, joint pain, chorea

5. Approach to a child with Heart disease in children
Why cyanosis occurs?
What are the two types of
cyanosis?
Which one is present in
Cyanotic CHDs?
How to differentiate?

6. Approach to a child with Heart disease in children
Criteria Peripheral cyanosis Central cyanosis
Basic
pathology
Poor circulation in
peripheral parts
Poor oxygenation
in lungs
Areas involved Peripheries (nail beds,
tip of nose & ear lobes)
Peripheries + oral
mucosa & tongue
Clubbing Absent Present
Polycythemia Absent Present
Touch of the
peripheries
Cool Warm
How to reduce
cyanosis
Warming the
peripheries
Administration of
oxygen

7. Approach to a child with Heart disease in children
Cyanotic CHD
PBF PBF
TOF
TRICUSPID ATRESIA
TGA
DORVWITH PS
SINGLEVENTRICLEWITH PS
TRUNCUS ARTERIOSUS
TAPVC
DORIV WITHOUT PS
SINGLEVENTRICLEWITHOUT PS
4. If it is Cyanotic CHD, what is the actual CHD?
Based on murmurs, change in heart sounds  investigations

8. Approach to a child with Heart disease in children
Acyanotic CHD
Volume overload
(Shunt)
Pressure over load
(Obstn)
PS
AS
CoA
ASD
VSD
PDA
5. If it is Acyanotic CHD, what is the actual CHD?
Based on murmurs, change in heart sounds  investigations

9. Approach to a child with Heart disease in children
If so, which valves are involved?
Is there any evidence of pericarditis or myocarditis?

10. Approach to a child with Heart disease in children
CCF
Infective Endocarditis
Pulmonary Hypertension

11. Approach to a child with Heart disease in children
Pulse
Blood Pressure
Apical Impulse
General examination

12. Approach to a child with Heart disease in children
Four information
Which artery you will choose for examination of
pulse?

13. Approach to a child with Heart disease in children
Tachycardia:
Rheumatic fever
Congestive cardiac failure
Arrythmias
Bradycardia:
Arrythmias

14. Approach to a child with Heart disease in children
 NB-2 months: 80 - 200
 3 months -1 year: 80 - 180
 1-8 years: 60 - 180
 >8 years: 60 - 160

15. Approach to a child with Heart disease in children
Observe the pulse for one full minute.
Regularly irregular: Ectopics
Irregularly irregular: Atrial fibrillation

16. Approach to a child with Heart disease in children
High volume pulse:
Low volume pulse:

17. Approach to a child with Heart disease in children
Depends on pulse pressure;What is PP? Normal PP?
High volume: high PP
high SBP: PDA & AR
low DBP: Septic shock (warm shock)
Low volume: low PP
low SBP: AS, MS, CoA, CCF
high DBP: Hypovolemic shock (Vasocons)

18. Approach to a child with Heart disease in children
Slow rising pulse : AS
Collapsing pulse: AR, PDA

19. Approach to a child with Heart disease in children
LV & part of inter ventricular septum
Age Position
Up to 4 years 4th ICS 1 cm lateral to MCL
5-8 years 4th ICS just lateral to MCL
> 8 years 5th ICS 1 cm medial to MCL

20. Approach to a child with Heart disease in children
Shift indicates what?
What are the abnormal types of AI?
What are the conditions causing abnormalAI?

21. Approach to a child with Heart disease in children
What size cuff is preferable?

22. Width:
40% of circumference
Length:
80-100 % of circumference

23. Approach to a child with Heart disease in children
For proper interpretation:
We should refer to the standard charts

24. Approach to a child with Heart disease in children
Average Systolic BP:
At Birth: 60
Neonate: 70
6 months: 85
1 year: 90
Systolic BP for 1-10 years: 90 + (age in yrs X 2)
Diastolic BP : 2/3 of Systolic BP
Pulse pressure:

25. Approach to a child with Heart disease in children

26. Approach to a child with Heart disease in children

27. Approach to a child with Heart disease in children

28. Approach to a child with Heart disease in children

29. Approach to a child with Heart disease in children

30. Approach to a child with Heart disease in children

31. Approach to a child with Heart disease in children

32. Approach to a child with Heart disease in children

33. Approach to a child with Heart disease in children

34. Approach to a child with Heart disease in children

35. Approach to a child with Heart disease in children

36. Approach to a child with Heart disease in children

37. Approach to a child with Heart disease in children
 6-8 per 1000 live births
 1 in 10 still born infants

38. NADAS CRITERIA
MAJOR CRITERIA MINOR CRITERIA
SYSTOLIC MURMUR Grade 3
OR MORE
SYS. MURMUR LESS THAN
Grade 3.
DIASTOLIC MURMUR ABN.SECOND SOUND
CYANOSIS ABN. ECG
CHF ABN. CxR
ABN. BP
DIAGNOSIS OF CHD
For Diagnosis of CHD: 2 Major or 1 Major + 2 Minor

39. Approach to a child with Heart disease in children
 Acyanotic: VSD 32% PDA 12%
PS, ASD, Co A, & AS 6%
 Cyanotic: TOF 6% TGA 5%

40. Approach to a child with Heart disease in children
 Chromosomal anomalies: 8%
Ex:Trisomies-21,18,13;Turner’s
 Environmental teratogens: 2%
Ex: Intrauterine infections,
Maternal drug intake (Phenytoin)
Maternal diseases (Diabetes, SLE)
 Single gene mutations: 90%