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Short cases in CVS: in paediatrics-final MBBS
1. CVS short cases
1.
Recognize
anomaly:
structural/ functional
2.
Site/ extent of structural
anomaly
3.
Complications
If Cyanotic/
1. Cyanosis
2. Polycythemia
3. Clubbing
If cyanotic: Fallots? Or not?
If Fallots
1. No cardiomegaly
2. Soft P2
3. No heart failure
1. Pulm.HTN
Acyanotic
Decide on murmur
2.
3.
Failure to thrive
Growth failure
7.
Shunt reversal
Tachycardia
Tachypnea
Gallop rhythm
Sweating while feeding
Cardiomegaly/ hepatomegaly
Rapid/unexplained wt gain
Lung crepts
FTT
Edema
Crossing centile in 1-2 yr old child
No wt gain
Stunting in bigger child
Wasting
Cong
ht
dx
can
cause
hepatomegaly,, unexplained wt
gain
Cyanosis + loud P2
8.
Bact. endocarditis
9.
Cause
Heart failure
6.
5.
Heaving apex
5.
Association
Ventricular hypertrophy
4.
4.
Cardiomegaly
Loud P2
Palpable P2
Parasternal heave/RVH
ECG: prominent R wave in R chest
lead
Peak P wave
CXR: perip prunning
Shifted apex
Embolic phenomenon
VACTERL
CHARGE
CATCH
Syndrome
Cong. infection
6.
Evidence of intervention
Yapa Wijeratne M/07/189
Janeway/
Osler’s/
splinter
h’rrhage, hematuria
hemiparesis→ earliest sign to
elicit would be pronator drift
Downs,
Turner’s,
Noonas,
Digeorge, Velocardio facial
Rubella
Toxoplasmosis:
hepatomegaly,
skin rash, cataract, microcephaly,
deafness
2. 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