Congenital Heart Disease nysaap先天性心脏病.ppt

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Congenital Heart Disease nysaap先天性心脏病.ppt

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PediatricBoardReview

2014

PediatricCardiologyPremaRamaswamy,M.D.Co-Director,PediatricCardiology,MaimonidesInfantsandChildrensHospitalofBrooklyn

PEDIATRICCARDIOLOGYInnocentMurmursCongenitalstructuralheartdiseaseRhythmproblems,syncopeetc.Peri,myo,endocarditis,RheumaticfeverSyndromesKawasakiDisease

InnocentMurmursDiastolicmurmursareneverinnocentInnocentmurmursarepresentinatleast50%ofnormalchildrenStill’smurmur:lowpitched,vibratory,systolicejection,increaseswiththesupineposition.Venoushum:continuousmurmurinsupraclavicularregion,reducesonlyingdownorwithpressureonneck.

Uponphysicalexaminationofa3yearoldgirlwhoisnewtothepractice,younoteacontinuousgrade2tograde3murmurattheupperrightsternalborderwhilesheissitting.Inthesupineposition,younoteonlyagrade2lowpitchedsystolicmurmurattheapex.MeasurementsofBP,pulsesandprecordialpalpationsaswellastheauscultationisnormal.Ofthefollowing,theMOSTappropriatenextstepisto:

reassuretheparentsaboutthebenignprognosisrequestacardiologyconsultationrequestchestradiographyrequestechocardiographyrequestelectrocardiography6

CongenitalHeartDisease-StructuralPINKShunts(LtoR):ASDVSDPDAStenosis:ASPSCoarctationHLHSBLUETOFTGATricuspidatresiaTruncusTAPVREbstein’sSingleventricle

NormalCardiacPressures120/825/558120/8025/15

ATRIALSEPTALDEFECT58

ATRIALSEPTALDEFECTS(ASD)Threetypesexist:primum,secundumandsinusvenosusThemostcommonisthesecundumtypeSymptoms:Noneinchildhood,arrhythmiasinthe3rddecade

ASD-cont...Clinicalsignsincludea2-3/6SEMattheULSBandafixedwidesplitS2AlargeASDcausesrightventricularenlargementEKG:RADandIRBBB

ASD-cont...ECHO:DiagnosticNaturalHistory:Arrhythmiasandpulmonaryobstructivevasculardiseaseinthe3rdand4thdecade.Treatment:Surgicalvs.transcatheterclosure

VENTRICULARSEPTALDEFECT120/825/5

VENTRICULAR

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Congenital Heart Disease nysaap先天性心脏病.ppt