Pediatric cardiology.pptx

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Pediatric

cardiologyVijayakumar



Heart



Normal circulation

IVC & SVC – impure blood – reaches- RA

rom RA blood reaches RV !ia tricuspidrom RV blood reaches lun" !ia #A

$%y"enation is takin" place in lun"srom lun"s pure blood reaches A !ia #Vrom A blood reaches V !ia mitral !al!erom V blood reaches systemic circulation

!ia aorta



oetal circulation



' (In )etus ductus !enosus is situated

A* bet+een umbilical !ein and portal !ein

,* bet+een portal !ein and in)erior !ena ca!a

C* bet+een ri"ht atrium and le)t atrium

* bet+een pulmonary artery and aorta



Ans bIn )etal circulation. ri"ht and le)t !entricles

e%ist in parallel circuits/

$%y"enated blood 0o+s to )etus throu"humbilical !ein +hich joins the portal !ein

,ypasses li!er and joins in)erior !ena ca!a !iaductus !enosus/

,lood enters ri"ht atrium. and is directedpre)erentially across the )oramen o!ale to le)tatrium. le)t !entricle and ejected to ascendin"aorta. and per)use upper body



Superior !ena ca!al blood 1 less o%y"enated*enters ri"ht atrium. pre)erentially tra!ersesthe tricuspid !al!e. 0o+s to ri"ht !entricle.and ejected into pulmonary artery/

2ajor portion bypasses the lun"s and 0o+sthrou"h the ductus arteriosus to descendin"aorta. to per)use the lo+er part o) the body/



Ans b



' 3A)ter birth. in a normal neonate. )unctional

closure o) ductus arteriosus occurs

A* 4-( hour a)ter birth,* 5-(4 hours a)ter birth

C* (4-(5 hours a)ter birth

* (5-34 hours a)ter birth



Ans c

6ransition to neonatal circulationAt birth. mechanical e%pansion o) lun"s and hi"h

#$3 causes rapid decrease in pulmonary !ascularresistance

Remo!al o) placenta results in increased SVRuctus !enosus closes. )oramen o!ale closes.

Shunt throu"h ductus arteriosus become re!ersedand becomes le)t to ri"ht/

Hi"h arterial o%y"en tension constricts #A and itcloses. )ormin" li"amentum arteriosum/

Functional closure of ductus is completed by 10-15hours and foramen ovale by 3 months.



' 7A premature in)ant is born +ith #A/ Its

closure can be stimulated by administrationo)

A* prosta"landin analo"ues

,* estro"en

C* anti oestro"en compound

* prosta"landin inhibitor



Ans dIn utero. patency o) ductus is )acilitated by lo+

o%y"en tension and endo"enously producedprosta"landins 1#893*

A)ter birth. +hen #$3 o) o%y"en reaches 54-:4mm H". the ductal +all constricts either due todirect e;ects or due to its inhibitory e;ect onprosta"landin synthesis/

uctus o) preterms are less responsi!e too%y"en. hence #893 remains hi"h/

#rosta"landin inhibitors like indomethacinproduce ductus closure/



Ans- a#rosta"landins pre!ent ductus closure hence

relie!es se!ere cyanosis

In se!ere pulmonary atresia. presence o) a patent

ductus reduce hypo%ia by increasin" -R shunt / In coarctation o) aorta openin" o) ductus re

establish ade=uate blood 0o+ to lo+er e%tremities/

In CCH like 68A. presence o) #A impro!e

o%y"enation/ose – #89( in)usion. 4/45- 4/3 micro"ram>k">min

2ajor complication o) #89( is apnoea



Con"enital heart diseaseCyanotic heart

disease

ecreasedpulmonary blood0o+

allot?s tetrolo"y

allot like physiolo"y

Increased pulmonaryblood 0o+

6ransposition o)

"reat A

Acyanotic heartdisease

e)t-ri"ht shunts

VS

AS

#A$bstructi!e lesions

Aortic stenosis

#ulmonary stenosis



' 5 6he )ollo+in" is true in allot?s tetralo"y

e%cept

A* s=uattin"

,* clubbin"

C* cyanosis

* increased lun" !ascularity



Ans d 6etralo"y o)

allot



#erimembranous VS

RV$6 obstruction-#S

RV hypertrophy$!erridin" o) aorta



' :A : month old child +ith 6etrolo"y o) allot

de!elops cyanotic spell initiated by cryin"/@hich o) the )ollo+in" dru" +ould you like toa!oid

A* sodium bicarbonate

,* propranolol

C* phenylephrine

* isoprenaline



Ans dCyanotic spell is a common complication

durin" the Brst 3 years

,elie!ed to be due to in)undibular spasm/

Spell is due to reduction o) alreadycompromied pulmonary blood 0o+. +hichresults in systemic hypo%ia and metabolic

acidosis/#lacin" the child in knee chest position and

administration o) $3 are the initial steps/



Cyanotic spells dru"s used in cyanotic spells are morphine

14/( m">k"* – minimie an%iety

propranolol 14/( m">k"*- decreasein)undibular spasm

methyl %anthine or phenyephrine-!assopressors

sodabicarbonate – to correct acidosis hematinics – to correct anemia

isoprenaline has b3 a"onist acti!ity. +hich+ill cause !asodilatation and leads to

peripheral poolin" o) blood. a""ra!atin"



' DA neonate is presented +ith cyanosis/ Chest

%-ray re!ealed oli"emic lun" Beld but there+as no cardiome"aly/ 2ost likely dia"nosis is

A* 9bstein?s anomaly

,* #ulmonary atresia +ith VS

C* 6ransposition o) "reat arteries

* 6etrolo"y o) allot



Ans -bCardiac conditions producin" cyanosis in a

neonate are – 68A. 6A#VC. tricuspid atresia.truncus arteriosus and 9bsteins anomaly/

9bstein?s anomaly produce massi!ecardiome"aly

68A. 6A#VC. 6A – produce cardiome"aly

6$ +on?t produce cardiome"aly but it +illnot produce cyanosis in ne+ born period/

Se!ere pulmonary atresia +ith VS mimics 6$ and present in ne+born period



Ans ballot?s 6etralo"y. associated anomalies

Ri"ht sided aortic arch is seen in 35F o) allot?stetralo"y/

Associated #A. AS are common

Anomalies o) pulmonary arch. absent pulmonary!al!e

CA6CH 33- cardiac de)ects. abnormal )acies.

thymic aplasia. cle)t palate. hypocalcemia/VS o) 6$ is- anterior mal ali"nment VS

Cyanosis o) 6$ is directly proportional to – se!erityo) RV out0o+ obstruction



' GA 3 year old child +ith minimal cyanosis has

=uadruple rhythm 1 has s7 and s<*. a systolicmurmur in the pulmonary area. and a mid

diastolic murmur alon" lo+er le)t sternal border/9C8 sho+s ri"ht atrial hypertrophy and a!entricular block pattern in the ri"ht chest leads/2ost likely dia"nosis is

A* Hypoplastic le)t heart syndrome,* 9bstein?s anomaly

C* 6ransposition o) "reat !essels

* 6otal anomalous pulmonary !enous connection



Ans b 9bstein anomalyo+n+ard displacement o)tricuspid !al!e produceatrialiation o) ri"ht !entricleand ri"ht atrial hypertrophy/

Ri"ht !entricle is smalle)ect in the pulmonary

!al!e is a commonassociation/ Very little 0o+to #A

6he increased !olume o) theri"ht atrial blood shuntsthrou"h the )oramen o!aleto the le)t atrium andproduce cyanosis



9bsteins anomaly 6ricuspid re"ur"itationproduce systolic murmur/

usually associated +ith

conduction de)ects like@#@ syndrome#A6.multiple clicks and "alloprhythm are common

9C8 sho+s R,,,. tall #

+a!es. prolon"ed #Rinter!al

-ray – massi!e. bo%

shaped cardiome"aly



' (4A cyanotic neonate is suspected o) ha!in"

con"enital heart disease/ 6he 9C8 sho+s le)ta%is de!iation and le)t !entricular hypertrophy

1VH*/ 6he most likely dia"nosis is

A* transposition o) "reat !essels

,* 6runcus arteriosus

C* 6ricuspid atresia

*6etrolo"y o) allot



Ans c 6$ +ill not mani)est in the neonate

Si"le s3 is seen in 6$.6A. 68A

tricuspid atresia produce A & VH 6A#VC produce cardiome"aly. pulmonary

plethora and typical sno+man appearance. S3is B%ed split

68A +ith intact !entricular system presents+ith early cyanosis. normal sied heart. andnormal lun" Belds

54F o) all 68A +ill ha!e associated VS/ 6hey

may not be se!erely cyanotic



' (3A 5 day old term neonate +as cyanotic at

birth/ #rosta"landin 9 +as administeredinitially and later balloon atrial septostomy

+as done +hich sho+ed impro!ement ino%y"enation/ 2ost likely dia"nosis is

A* tetrolo"y o) allot

,* transposition o) "reat !esselsC* truncus arteriosus

*tricuspid atresia



Ans b-

transposition o) "reat !essels

Aorta arises )rom ri"ht !entricle and pulmonaryartery )rom le)t !entricle/

Systemic and pulmonary circulations consists o) 3parallel circuits

Sur!i!al o) these ne+ borns is pro!ided by eitherpatent )oramen o!ale. #A or associated VS

#rosta"landin 9( – is used to maintain patency o)ductus

Rashkind atrial septostomy produce a hole in theinter atrial septa



Arterial s+itch operation 1Jatene* is thesur"ical treatment o) choice and is per)ormed+ithin 3 +eeks o) deli!ery/

Atrial s+itch operation 1Sennin" 2ustard* isdone in older children/

Corrected transposition is the commonestheart de)ect in cardiac malpositions likede%trocardia

ouble outlet ri"ht !entricle +ithtransposition o) "reat !essels is called –

6aussi" –,in" anomaly/



' (7An adolescent +ith allot?s 6etrolo"ye%periences headache and is unable to mo!ethe le)t side o) the body/ 6he most likely cause

isA* embolic stroke

,* cerebral thrombosis

C* cerebral abscess* mi"raine



Ans cCerebro!ascular accidents are a complicationo) CCH

Commonest CVA in K 3 years is cerebralthrombosis – due to polycythemia anddehydration/

Cerebral abscess is common in L3 years andis due to parado%ical embolism due toabsence o) lun" Blters/



' (<All o) the )ollo+in" are e%amples o) allot likephysiolo"y e%cept

A* complete 68V +ith VS +ith #S

,* ouble outlet ri"ht !entricle +ith #S

C*6icuspid atresia +ith diminished pulmonaryblood 0o+

* 6A#VC



Ans- c 6$ +ill ne!er produce CC unlesscomplicated by se!ere anemia. myocarditis.or systemic hypertension

CC in di;erent a"esFetal CCF anemia, SVT, complete heart block

CC in preterm 0uid o!erload. #A

CC in ne+born- hypoplastic le)t heart syndrome. coarctation o)aorta. CCH like 68A. 6A#VC. 6A. non cardiacconditions like asphy%ia. AV mal)ormation

In)ants VS. #A. SV6

$lder children rheumatic heart disease. A8N. !iral myocarditis



' (:An in)ant comes )or e!aluation o) a murmurdetected )rom outside/ #hysical e%aminationre!ealed a triphalan"ial thumb/ @hich cardiac

disease is more likelyA* atrial septal de)ect

,* !entricular septal de)ect

C* patent ductus arteriosus* tetrolo"y o) allot



Ans aDisease Cardiac anomaly

i 8eor"e Syndrome 1CA6CH 33* 6$

Alla"ille syndrome Ri"ht sided heart diseases

o+n syndrome AV septal de)ects

Noonan syndrome #ulmonary stenosis

9llis Van Cre!eld syndrome.Holt-o-ram syndrome

AS

@illiam syndrome Supra!al!ular aortic stenosis

6risomy (E Ventricular septal de)ect



' (D,lalock and 6aussi" shunt is done bet+een

A* ascendin" aorta to pulmonary artery

,* descendin" aorta aorta to pulmonaryartery

C* subcla!ian artery to pulmonary !ein

* subcla!ian artery to pulmonary artery



Ans d ,lalock – 6aussi"

shunt



Al)red ,lalock & Helen

6aussi"



' (EAll o) the )ollo+in" statements are truere"ardin" total anomalous pulmonary !enousconnection e%cept

A* total pulmonary !enous blood reaches theri"ht atrium

,* al+ays associated +ith VS

C* o%y"en saturation in the pulmonary arteryis hi"her than in aorta

* in)ra cardiac type is al+ays obstructi!e



6A#VC



Ans bIn 6A#VC !enous return )rom pulmonary !einsreaches RA. either joinin" superior !ena ca!a1supra cardiac*. in)erior !ena ca!a 1in)ra

cardiac* or enters directly to RA or coronarysinus/

AS is a usual associated lesion/

In)ra cardiac type is associated +ith neonatalsymptoms



@hich con"enital heart disease in pretermbaby resembles hyaline membrane disease

$bstructi!e type o) in)ra di aphra"matic

6A#VC



' (GCon"enital heart disease +hich cause CC inthe Brst +eek o) li)e

A* VS

,* 6$

C* 9bstein?s anomaly

*Hypoplastic le)t !entricle



Ans dHypoplastic le)t heart syndrome is associated+ith under de!elopment o) le)t side o) heartincludin" ascendin" aorta/

2ild cyanosis is seen soon a)ter birth/

+ithin hours o) li)e. i) ductus start closin".poor systemic circulation produce shock/

si"ns o) CC 1hepatome"aly. tachypnea.tachycarda* de!elops +ithin Brst +eek

All peripheral pulses may be +eak



Hypo plastic le)t heart syndrome



' 34A neonate is bein" e%amined )or some skinlesions/ Her mother is su;erin" )rom systemiclupus erythematosis/ 9%amination re!ealed

heart rate o) :4 per minute and respiratoryrate o) <4 per minute/

A* con"enital heart block

,* prolon"ed '6 syndrome

C* con"esti!e cardiac )ailure

* hypertrophic cardiomyopathy



Ans -aTeratogenic agents Heart disease

S9 Con"enital heart block

Con"enital rubella #A. peripheral pulmonarystenosis

etal !alproate Coarctation. hypoplastic le)t heart

2aternal phenyl ketonuria VS.AS

Retinoic acid embryopathy Conotruncal anomalies

etal alcohol syndrome AS. VS

etal hydantoin syndrome VS. AS



' 3(A child +ith VS presents +ith de!elopment o)cyanosis because o) 9isenmen"er?s physiolo"y/@hat is the correct se=uence o) e!ents +hich leads

to this chan"eA* e)t to ri"ht shunt. pulmonary hyper tension.

ri"ht !entricular hypertrophy. ri"ht to le)t shunt

,* -R shunt. Ri"ht !entricular hypertrophy.pulmonary hyper tension. ri"ht to le)t shunt

C* #ulmonary hypertension.R- shunt.RVH. -Rshunt

* -R shunt.RVH.R- shunt.#ulmonary hypertension



Ans- a



' 33An : month old boy is admitted +ith an 9CH$dia"nosis o) lar"e muscular VS/ 2other "i!eshistory o) )ati"ue. and poor )eedin" be"an 3

months back/ He is not "ainin" +ei"ht/ He istachypnoec and has bilateral +heee and crackleson auscultation/ Abdominal e%amination re!ealedtender hepatome"aly/ ia"nosis is

A*con"enital heart block,* hypertrophic cardiomyopathy

C* con"esti!e cardiac )ailure

* cor pulmonale



R di l i l B di )



Radiolo"ical Bndin"s o)

6$Narro+ base

#ulmonary bay

Normal heart sie

Op tilted apicalshado+

Mcoer-en-sabot

Clear hilar areas#ulmonary oli"emia

Ri"ht sided aorticarch- 34F



Coer – en - sabot



Ans -dadiological !ndings Heart disease

Coer-en- sabot 1rench peasant?s

shoe*

6etrolo"y o) allot

9"" on side appearance 6ransposition o) "reat !essels

Sno+ man in sno+ stormappearance

6otal anomalous pulmonary!enous connection

Sittin" duck appearance 6runcus arteriosus

Ju" handle appearance AS

Susman si"n Coarctation o) aorta

Scimmitar?s si"n #artial anomalous pulmonary!enous connection

i"ure o) E appearance 6A#VC



#ulmonary bay. pulmonary

prominence



68A



Susman si"n – coarctation o) aorta



Scimitar syndrome



' 35A child presented +ith headache. diiness.intermittent claudication +ith occasionaldyspnoea/ 6he most probable dia"nosis is

A* AS,* #A

C* 6$

* Coarctation o) aorta



Coarctation o) Aorta



Ans dGEF o) coarctation occurs just belo+ theori"in o) le)t subcla!ian artery at the ori"in o)ductus arteriosus 1ju%ta ductal coarctation*

Shone comple% – +hen C$A is associated +ithother le)t sided obstructi!e lesions/

#A +ith re!ersal o) shunt i) associated +ithC$A produce di;erential cyanosis/

I) le)t subcla!ian is in!ol!ed in coarctation. ,#o) le)t upper limb K ri"ht upper limb



Ans c,icuspid aortic !al!es seen in E4F o) C$A

VS is seen in <4F

Associatedhypoplasia o) le)tsided structures

In se!ere stenosis#89( administrationis li)e sa!in"



6urner?s syndrome

Short stature – 100%

Short neck - 54F

@ebbin" - 35F

Short <th metacarpals cubitus !al"us - 54F

o+ posterior hair line

#tosis - -35F

CVS anomaly – 55F



' 3DCardiac condition in +hich M torsades depointes comes as o)ten )atal complication

A* con"enital heart block

,* paro%ysmal atrial tachycardia

C* @#@ syndrome

* lon" '6 syndrome



Ans d 6orsade de pointes is a se!ere type o)!entricular arrhythmia seen in children +ithlon" '6 syndrome

Romano – @ard syndrome is A. andassociated +ith con"enital dea)ness

ru"s producin" lon" '6 inter!al –ter)enadine. astemiole

Commonest symptom is syncopial attack

'6c inter!al L 4/<D sec is su""esti!e

$C – beta blockers



on" '6 syndrome



'-6c – corrected '6inter!al P '6> s=uare

root o) RR inter!al/Normal K 4/<5 sec

'6c is prolon"ed in

Hypokalemia

hypocalcemia



AS



Ans bIn AS. there is -R shunt at atrial le!el/Hence hypertrophied chambers are RA & RV/

increased pulmonary 0o+ leads to RVH and

parasternal hea!e@ide and B%ed split is characteristic o) AS

Since there is only minor pressure di;erence.0o+ across atria doesn?t produce a murmur/An ejection systolic 0o+ murmur is obtainedat pulmonary area/



AS7 types –

secundum. primum.sinus !enos secundum- D5FAsymptomatic in

childhood/Associated

syndroms – Holt-$ram?s. 9llis !anCre!eld 6+ice common in

"irls



' 3GA (5 year old boy is ha!in" +ei"ht 35th centileo) e%pected and hei"ht abo!e G5th centile/#hysical e%amination re!ealed a tall lean boy

+ith spectacles/ He +as ha!in" hi"h archedpalate. and mild scoliosis/ @hich is the commonheart disease associated +ith this condition

A* coarctation o) aorta

,* aortic aneurysmC* aortic stenosis

* patent ductus arteriosus



Ans bDisease Cardiac lesions

2ar)an syndrome Aortic aneurysm. aortic rootdilatation. 2V#

#atau syndrome 1 trisomy (7* VS

6urner?s syndome ,icuspid aortic !al!e. coarctationo) aorta

ra"ile 2itral !al!e prolapse

eletion 5p- 1cri du chat

syndrome*

VS

CHAR89 association VS

6recher Collins syndrome VS



' 74 6ype o) AS usually associated +ith partialanomalous pulmonary !enous connection

A*$stium secundum AS

,*$stium primum ASC*Sinus !enosus AS

*9ndocardial cushion AS

A



Ans -cSinus !enosus AS is

associated +ithanomalous pulmonaryconnections

$stium primum AS isassociated +ith cle)t inanterior mitral lea0et

Scimitar syndrome –

anomalous !eindrainin" into IVC

S i it d



Scimitar syndrome



' 7(Name the chromosomal anomaly associated+ith atrio !entricular septal de)ect

A* o+n syndrome

,* 6urner syndromeC* 9d+ards syndrome

* #atau?s syndrome



o+n syndrome. AV Canal de)ect



Ans aAV septal de)ect 1AV canal de)ect* is a "roupo) conditions in +hich there is a de)ect in theAV septum or endocardial cushion

1endocardial cushion de)ect*Consists o) a combination o) (* AS situated

in the lo+er portion o) atrial septum1ostiumprimum*3* inlet VS 7* common sin"le atrio

!entricular !al!e/<4F o) children +ith o+n syndrome are

associated +ith AV canal de)ect and D4F o)in)ants +ith AV canal de)ects ha!e o+n

s ndrome



Superior >north+est>e%treme RA



' 73AS is seen in all e%cept

A* 6urner?s syndrome

,* 9llis Van Cre!ald syndrome

C* o+n syndrome

* Holt-oram syndrome



Ans a

6ypical cardiacanomalies in 6urner?ssyndromes arebicuspid aortic !al!eand coarctation o)aorta

H lt $ d



Holt-$ram syndrome

1heart-hand syndrome*



' 77i;erential cyanosis is seen in

A* 68V

,* 6A#VC

C* #A

*VS



Ans cIn #A +ith re!ersal o)shunt deo%y"enated bloodreaches the lo+er limb butupper limb +ill be pink –

di;erential cyanosisIn corrected 68A +ith #A

cyanosis is seen in upperlimb. lo+er limb +ill bepink

#resence o) coarctation

accelerates di;erentialcyanosis

#A



#A

Auscultation –continuousmachinery murmur– 8ibson?s murmur

9C8 – A. VH

– ray – VH. AH



' 7<A child +ith kno+n VS +ith con"esti!ecardiac )ailure de!elops clubbin"/ @hat is thedia"nosis

A* ri"ht to le)t shunt,* le)t to ri"ht shunt

C* in)ecti!e endocarditis

* pulmonary edema



Ans cStreptococcus !iridans is the commonestor"anism )ollo+in" dental procedures

8roup enterococci are seen a)ter lo+er

bo+el or "enitourinary procedures#seudomonas is seen in IV dru" abusers

Coa"ulase ne"ati!e staph aureus is seen inchildren +ith central IV catheter/

VS is the commonest heart lesion producin!"#



' 75In)ecti!e endocarditis is dia"nosed by

A* NAA?s criteria

,* uke?s criteria

C* John?s criteria

* Heath 9d+ards criteria



Ans buke criteria /

2ajor (* t+o positi!e blood cultures

3* positi!e 9cho cardio"raphic

Bndin"s/2inor –)e!er. Roth spot. $sler?s nodes. splinter

bleed. splenome"aly. pallor. clubbin".arthritis. one positi!e culture. hi"h 9SR

1 3 major or ( major & 7minor or 5 minor*

NAAS criteria – to dia"nose CH

Heath 9d+ard – to dia"nose pulmonary

hypertension



' 7:Con"esti!e cardiac )ailure in an in)ant isdia"nosed by

A* basal crepitations

,* ele!ated JV#C* pedal edema

* li!er enlar"ement



Ans dCommonest symptom in an in)ant +ith CC is)ailure to "ain +ei"ht. associated +ithe%cessi!e s+eatin" and suck rest cycles +hile

)eedin"/Commonest si"ns are hepatome"aly +ith

tachypnea. tachycardia and cardiome"aly

Cardiome"aly is dia"nosed by measurin"

cardiothoracic ratio/ C6 ratio L 54 issu""esti!e o) cardiome"aly/



Cardiome"aly



' 7D9ndocarditis is not seen in +hich o) the)ollo+in" conditions

A* AS

,* VSC* #A

* 6$



Ans a #atients +ith heart lesions in +hich blood isejected at hi"h !elocity throu"h a hole orstenotic oriBce are most susceptible to

endocarditisVe"etations usually )orm at the site o) the

endocardial erosion

AS- there is not much pressure di;erence

and hence not much turbulant 0o+ across theopenin"/



' 7EIn rapid di"italiation. total dose o) di"o%in ina child in m">k" is

A* 4/43- 4/4<

,* 4/47-4/45C* 4/4<-4/4:

* 4/4:-4/4E



Ans c 6otal di"italiin" dose is 4/4<-4/4: m">k" andhal) "i!en initially. a)ter (3 hr and a)ter3< hours/ o) the total di"italiin" dose is

"i!en as the daily maintenance dose/3>7 o) the dose o) oral di"o%in is "i!en as IV

Hypokalemia and hypercalcemia e%acerbatedi"o%in to%icity



' 7G@hich o) the )ollo+in" is not characteristic o)

ri"ht sided )ailure

A* pulmonary edema

,* ascitiesC* hepatome"aly

* dependent edema



' <4Oncommon Bndin" in con"esti!e cardiac

)ailure in a neonate is

A* tachycardia

,* tachypnoeaC* hepatome"aly

* pedal edema



Ans depended edema is seen in sacral re"ion in

an in)ant/ In older children. pedal edema iscommon

9n"or"ed ju"ular !enous pulsation is not areliable si"n in neonates/

Hepatome"aly is more sensiti!e/



Ans c

Carey coomb?s murmur is seen in acute R

$ccurs due to in0ammation o) mitral !al!e

cuspsOsually associated +ith 2R



' <3Rheumatic nodules

A* are pain)ul

,* are attached to skin

C* commoner in adults than in children* rarely occur unless acti!e carditis is

present



Ans dRheumatic nodules are seen more commonly

in children. 6hey are painless nodules and areusually associated +ith acti!e carditis



' <7Steroids are deBnitely indicated in rheumatic

)e!er +hen there is

A* carditis

,* carditis +ith cardiome"alyC* chorea

*se!ere arthritis



' <<In patients +ith rheumatic heart disease. )ull

dose o) steroid is "i!en )or

A* 7 +eeks

,* : +eeksC* G +eeks

* (3 +eeks



Ans aull dose o) prednisolone 13m">k">day* is

"i!en )or 7 +eeks/ It is then tapered andstopped/

Aspirin started +hen predisolone is tapered inthe dose D5 m">k">day in di!ided doses/

6otal duration o) anti in0ammatory dru"treatment is )or (3 +eeks/



' <5A 7 year old "irl is presented +ith )e!er )or D

days and irritability/ 9%amination re!ealederythematous macular e%anthem all o!er the

body. bulbar conjuncti!itis. dry and cracked lips.red throat. and cer!ical lymphadenopathy/ Ablood sho+ed hi"h 9SR. predominant neutrophilsand increased platelets/ 6he most likelydia"nosis is

A*scarlet )e!er ,* rheumatic )e!er

C* ka+asackie disease * in)ectiousmononucleosis



Ans c-a+asaki diseaseA leadin" cause o) ac=uired heart disease. a;ectin"

mainly children less than 5 years/

In addition to )e!er. 5 characteristic )eatures o) are

,ilateral bulbar conjuncti!al injection. no e%udate

9rythema o) ton"ue- stra+berry ton"ue. cracked lips

9dema and erythema o) hands and )eet

Rash – maculopapular- accentuation in the "roin

Non suppurati!e cer!ical lymphadenopathy L(/5 cm

#eriun"ual des=uamation o) Bn"ers be"in (-7 +eeksa)ter the onset o) illness



a+asaki diseasee!elopment o) coronary artery aneurysm is

the most important se=uel causin" suddendeath/

$i!hest liely hood of developin! coronaryartery disease in infants.

IVI8 and hi"h dose aspirin are initialtreatment )ollo+ed by lo+ dose aspirin )or :-E

+eeks/In0i%imab is a monoclonal antibody. )ound to

be use)ul in



Stra+berry ton"ue & peelin" in



#easles $a%asaki

9%udati!e conuncti!itis Non e%udati!e- bulbarconjuncti!itis

opliks spot Stra+berry ton"ue. cracked lips

Rash be"ins on the )ace andbehind ears

Accentuated in "roin. around ,C8scar

eucopenia Neutrophilic eucocytosis

9SR. CR# are normal Very hi"h 9SR. and CR#

#latelets normal 6hrombocytosis

No des=uamation es=uamation



' <:9isenmen"er syndrome is characteried by all

e%cept

A* return o) le)t !entricle and ri"ht !entricle to

normal sie,* pulmonary !eins not distended

C* prunin" o) peripheral pulmonary arteries

* dilatation o) central pulmonary arteries



Ans a9isenmen"er?s syndrome usually occurs in

VS +hich later de!elops pulmonaryhypertension

#ulmonary !essels are enlar"ed in hilarre"ions and taper rapidly 1prunin"* in theperipheral branches

Ri"ht atrium and !entricle are hypertrophied

#eripheral lun" Belds are oli"emic & centralBelds. plethoric/



#eripheral prunin" in #AH



b



Ans b HHS produce shock +ith +eak peripheral

pulses

#89( maintains patency o) ductus

' E



' <EIn transposition o) "reat !essels. all are true

e%cept

A* aorta arises )rom ri"ht !entricle

,* 2itral !al!e is continuous +ith aortic !al!eC* they are born as lar"e )or "estational a"e

* delayed closure o) #A may be li)e sa!in"

A b



Ans b

In 68A aortaori"inates )romanatomic ri"ht!entricle andpulmonary artery)rom anatomic le)t!entricle – !entriculoarterial discordance/

' <G



' <GA 7 day old presents +ith poor )eedin"/

9%amination re!ealed a heart rate o) 354/ 9C8re!eals a rate o) 354. a 'RS o) 4/4D seconds

and no !isible # +a!es/ ia"nosis isA* con"esti!e cardiac )ailure due to VS

,* !entricular tachycardia

C* supra!entricular tachycardia

* con"enital heart block



' 54



' 54#ulses parado%icus is associated +ith

A* pericarditis

,* endocarditis

C* myocarditis* rheumatic )e!er

A



Ans a$ther causes

Cardiac tamponade

Se!ere asthma

' 5(



' 5(@hich heart disease is associated +ith use o)

)en0uramine

A* heart block

,* aortic stenosisC* cardiomyopathy

* pericarditis

A b



Ans bDrug Heart disease

en0uramine Aortic stenosis

ithium carbonate 9bstein?s anomaly

Vitamin Supra !al!ular aortic stenosis

Vitamin A. Retinoic acid Conotruncal anomalies

Alcohol VS

,arbiturate VS

Hydantoin VS

' 53



' 53All o) the )ollo+in" are true about ostium

secundum atrial septal de)ect 9C9#6

A* )emales outnumber males

,* symptoms usually be"ins in in)ancyC* +ide and B%ed splittin" o) second heart

sound is present

* de!ice closure is no+ used as treatment

A b



Ans b

' 57



' 57All o) the )ollo+in" are true about a small VS

9C9#6

A* spontaneous closure is common especially

in muscular VS,* there is no risk o) endocarditis

C* pulmonary pressure are normal

* sur"ical repair is not recommended

Ans b



VS us the 2ostcommon CH-34 Fo) all/

e)ects !ary in

sie-

6ypes –membranous. inlet.

outlet. muscular/Small VS –

remainsasymptomatic/

VS



ar"e VS –repeated RI. 66.CC. #H

Cardiome"aly

#ansystolic murmur

oud S3 in #H

9C8 – ar"e . ,VH

- ray –cardiome"aly

9cho - dia"nostic

' 5<



' 5<: month old boy presents +ith )eatures o)

heart )ailure/ #hysical e%amination re!ealed acontinuous machinery murmur and a +ide

pulse pressure/ @hich is the ideal treatmentoption

A* intra!enous indomethacin

,* sur"ical closure

C*catheter coil closure* di"o%in until lesion closes spontaneously

#A



2ana"ement#reterm –

indomethacin

6erm

Sur"ical – trippleli"ation and di!ision

Catheter de!ice

closure – coil.umbrella



Ans d



Ans-dA pulse rate L 354 su""est the presence o)

tachyarrhythmia

commonest predisposin" conditions are

in)ections. use o) sympathomimetic dru"s .theophyllin.or conduction de)ects like @#@syndrome

9bstein?s anomaly is usually associated +ith

@#@S@#@S is characteried by short #R inter!al

and slo+ upstroke o) the 'RS – delta +a!e/

Verapamil should not be used in in)ants

@#@ syndrome



@#@ syndrome



Ans d



Ans - dVS and #A usually present +ith CC at <-:

+eeks

68V and 6$ are cyanotic heart disease/

6$ +ill ne!er produce con"esti!e cardiac)ailure

68V. hypoplastic le)t heart syndrome are usualheart diseases producin" CC in Brst +eek/

pan systolic murmur may not be audible inlar"e VS +ith CC

Commonest type o) VS – membranous type/

' 5D



A ten year old boy presents to the pediatricemer"ency unit +ith seiures/ ,lood pressurein the upper e%tremity measured as 344>(<4mm H"/ emoral pulses +ere not palpable/

6he most likely dia"nosis amon"st the)ollo+in" isT

A/ 6akayasu aortoarteritis

,/ Renal parenchymal disease

C/ 8randmal seiures* coarctation o) aorta

Ans d



Ans d



' 5G



' 5G2aladie –de- ro"er is

A* small VS

,* medium sied VS

C* lar"e VS* multiple muscular VS

Ans a

&ame Heart disease

2alade- de-Ro"er Small VS



Ans aS+iss cheese appearance 2ultiple muscular VS

8essule VS VS o) 6$ be)ore in)undibular spasm

at +alschel phenomenon ,i!entricular enlar"ement in VS19C8*

8ibson?s murmur #A

8raham steel murmur #ulmonary hypertension

Carey Coomb?s murmur Rheumatic )e!er - diastolic

' :4



' :4A one year old boy accidentally in"ests an

unkno+n =uantity o) di"italis/ 6he mostimportant non cardiac mani)estation o)

to%icity in this in)ant isA* )e!er

,* diiness

C* !omitin"

* !isual disturbances

Ans c



Ans -cVomitin" is the most common symptom

Commonest 9C8 chan"e is sinus bradycardia

6herapeutic blood le!el o) di"o%in is 3n">d

#R inter!al prolon"ation is a use)ul 9C8marker/ It should be ( U times normal/



9%treme )orm o) intra uterine con"esti!eheart )ailure – hydrops )etalis

Amon" causes o) chest pain in children.

cardiac causes constitute – (-7F

Pediatric cardiology.pptx

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