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Cardiology Conference

Cardiology Conference. Gatchalian , Gaw , Geraldoy , Geronimo, Geronimo, Geronimo December 22, 2010. C.F. 2 months old / male CC: Fever. C.F. 2 months old / male CC: Fever. C.F. 2 months old / male CC: Fever. Review of Systems. General: (-) noticeable weight loss

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Cardiology Conference

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  1. Cardiology Conference Gatchalian, Gaw, Geraldoy, Geronimo, Geronimo, Geronimo December 22, 2010

  2. C.F. 2 months old / maleCC: Fever

  3. C.F. 2 months old / maleCC: Fever

  4. C.F. 2 months old / maleCC: Fever

  5. Review of Systems • General: (-) noticeable weight loss • Cutaneous: (-) rashes, (-) discoloration • HEENT: (-) ear discharge, (-) epistaxis, (-) gum bleeding • Respiratory: refer to HPI • Cardiovascular: refer to HPI • GI: (-) diarrhea, (-) constipation • GUT: yellow urine, (-) edema of the hands and feet • Extremities: (-) swelling, (-) joint swelling • Nervous/Behaviour: (-) tremors, (-) convulsions • Hematopoietic: (-) pallor, (-) easy bruisability

  6. Immunization History • Received the following at a local health center: • BCG 1 • Hepatitis B 1 • DTP 1 • OPV1 • Next dose due on December 27, 2010

  7. Family Profile

  8. Family History • (+) Rheumatic Heart Disease – maternal grandmother • (-) HPN • (-) Diabetes Mellitus • (-) Pulmonary Tuberculosis • (-) Allergies

  9. Socioeconomic and Environmental History • Four bedroom house made of wood and concrete • Well lit and well ventilated • Garbage is collected daily, no segregation • Purified water from a water refilling station. • Baby bottles also sterilized • Stray cats • Second hand smoke

  10. Physical Examination • General Survey: awake, alert, in respiratory distress with alar flaring, ill looking, well-nourished, well-hydrated • Vital Signs: HR 140 bpm, RR 70 cpm Temp 36.0 °C Wt 4.7 kg (z=below 0 normal) Ht: 49 cm (z= below -3 severely stunted) BMI: 19.58 (z= above 2 overweight) • Head circumference 37 cm, chest circumference 36 cm, abdominal circumference 40 cm • Skin: Warm, moist skin, pink in color, good skin turgor, no rashes, no jaundice

  11. Physical Examination • HEENT: normocephalic, anterior fontanel open, symmetric head, (-) scalp lesions, symmetric face; Eyeballs not sunken, pink palpebral conjunctiva, anictericsclerae, pupils 2-3 mm ERTL; Midline nasal septum, (+) whitish nasal discharge; Moist buccalmucosae, nonhyperemic posterior pharyngeal wall; Supple neck, (-) palpable lymph nodes

  12. Physical Examination • Lungs/Chest: Symmetric chest expansion, (+) subcostal retractions, (+) crackles on both upper lung fields • Cardiovascular: adynamicprecordium, no precordial bulge, (-) Harrison’s groove, (+) holosystolic murmur at the lower left parasternalarea grade 3/6 • Abdomen: globular abdomen, normoactive bowel sounds, soft, non tender, no masses • Spine: midline, (-) sacral dimpling, (-) tufts of hair • Genitalia: Penis 2cm, testes descended bilaterally, no phimosis, no discharge • Extremities:full peripheral pulses, no cyanosis, no clubbing

  13. Neurologic Examination • Cerebrum: alert • Cranial nerves: Pupils isocoric, 2-3mm ERTL, (+) direct and consensual light reflex, (-) gross facial asymmetry, (+) gag reflex • Cerebellum: (-) no involuntary movements • Motor: (-) rigidity, (-) spasticity, (-) Flaccidity • Meningeal Signs: (-) nuchal rigidity, (-) Brudzinski’s, (-) Kernig’s, (-) tonic neck reflex

  14. Subjective Salient Features

  15. Objective Salient Features

  16. Clinical Impression Congenital Heart Disease Pneumonia

  17. Differential diagnosis

  18. Difficulty breathing (dyspnea) Frequent respiratory infections in children Sensation of feeling the heart beat (palpitations) in adults Shortness of breath with activity Abdominal distention Cyanosis in some patients Chest pain Fainting Fatigue Poor weight gain or failure to thrive in infants with severe blockage Shortness of breath Sudden death Bounding pulse Fast breathing Poor feeding habits Shortness of breath Sweating while feeding Tiring very easily Poor growth Dizziness or fainting Shortness of breath Pounding headache Chest pain Cold feet or legs Failure to thrive Poor growth Breathlessness with activity Chest pain Fainting, weakness, or dizziness with activity Palpitations Shortness of breath Fast breathing Hard breathing Paleness Failure to gain weight Fast heart rate Sweating while feeding Frequent respiratory infections

  19. Ventricular septal defect

  20. Ventricular Septal Defect • most common ACHD (25%) • SYNONYMS * Roger’s disease * Interventricularseptal defect * Congenital cardiac anomaly

  21. Ventricular Septal Defect • Physical size of the VSD is a major determinant of the size of the left-to-right shunt • Restrictive VSD (usually <0.5 cm2) - right ventricular pressure is normal • Large nonrestrictive VSDs (usually >1.0 cm2)- right and left ventricular pressure is equalized

  22. AnatomicalClassification • Membranous/ perimembranousVSD • Most common CHD (males>females) • • Muscular VSD • “Swiss cheese” VSD • SupracristalVSD • Least common

  23. The contribution of pulse oximetry to the early detectionof congenital heart disease in newborns Romaine Arlettaz, Andrea SerainaBauschatz, Marion Mönkhoff , Bettina Essers, Urs Bauersfeld Eur J Pediatr (2006) 165: 94–98

  24. Objectives • To determine the effectiveness of a pulse-oximetric screening performed on the first day of life for the detection of congenital heart disease in otherwise healthy newborns • To determine if a pulse-oximetric screening combined with clinical examination is superior in the diagnosis of congenital heart disease to clinical examination alone

  25. Methods • Study design: prospective multi-centre study • Zurich, Switzerland; May 2003 to May 2004 • Population: infants above 35 weeks of gestation (n=3,262)

  26. Methods

  27. Results

  28. Results

  29. Conclusion • Postductalpulse-oximetric screening in the first few days of life is an effective means for detecting cyanotic congenital heart disease in otherwise healthy newborns

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