CVS short cases

1. Recognize anomaly: If Cyanotic/ Acyanotic

structural/ functional 1. Cyanosis Decide on murmur
2. Polycythemia
3. Clubbing
2. Site/ extent of If cyanotic: Fallots? Or not?
structural anomaly If Fallots
1. No cardiomegaly
2. Soft P2
3. No heart failure
3. Complications 1. Pulm.HTN Loud P2
Palpable P2
Parasternal heave/RVH
ECG: prominent R wave in R
chest lead
Peak P wave
CXR: perip prunning
2. Cardiomegaly Shifted apex
3. Ventricular Heaving apex
hypertrophy
4. Heart failure Tachycardia
Tachypnea
Gallop rhythm
Sweating while feeding
Cardiomegaly/
hepatomegaly
Rapid/unexplained wt gain
Lung crepts
FTT
Edema
5. Failure to thrive Crossing centile in 1-2 yr old
child
No wt gain
6. Growth failure Stunting in bigger child
Wasting
Cong ht dx can cause
hepatomegaly,, unexplained
wt gain
7. Shunt reversal Cyanosis + loud P2
8. Bact. endocarditis Janeway/ Oslers/ splinter
hrrhage, hematuria
9. Embolic phenomenon hemiparesis earliest sign
to elicit would be pronator
drift
12. Association VACTERL
CHARGE
CATCH
13. Cause Syndrome Downs, Turners, Noonas,
Digeorge, Velocardio facial
Cong. infection Rubella
Toxoplasmosis:
hepatomegaly, skin rash,
cataract, microcephaly,
deafness
15. Evidence of
intervention

Yapa Wijeratne M/07/189

Effect on growth
Comment on current wt centile
Growth pattern: flattening, crossing centiles
FTT BMR is due to symp overactivity
Difficulty in feeding/ frequent vomiting/ recurrent chest infection/ associated other
anomalies

Reasons for tachypnea

Cong ht dx are associated with tachypnea
1. HF: rapid shallow breathing/ not much effort of breathing/ fine crepts/
cardiomegaly/ hepatomegaly/ m/
2. RTI: recession/ effort/ noises
3. Or both

Size & extent of the lesion

1. ANY complication means lesion is large needs Sx
2. Intensity of heart M does NOT correlate with size of the lesion. (loud M does not
mean that lesion is small or large)
3. Apical mid diastolic M [(functional M) in large VSD/ PDA] indicates pulm circulation
is twice the systemic circulation: blood is shunted to R/S(pulm vasculature)
comes back to LA LV. Sx is needed. So with VSD comment that no mid diastolic
M in mitral area.

Comprehensive diagnosis
1. Complex cyanotic ht dx with growth failure probably has had a embolism in brain.
2. Large VSD or AV canal defect with pulm HTN & FTT in a child with trisomy 21,
probably has LRTI also. [If young mother is nearby, young mothers have higher
chance of having translocation than older mothers, therefore I offer this mother
karyotyping bcz of the usefulness of that information in the process of
counseling. ]

Yapa Wijeratne M/07/189