1. Heart diseases in children, specifically congenital heart diseases (CHDs), are not as rare as once thought, occurring in 8-10 out of every 1,000 live births and representing the most common birth defect. 2. CHDs can present in a variety of ways from cyanosis and congestive heart failure in neonates to symptoms appearing later in childhood. Determining if a CHD is present, whether it involves cyanosis, and the specific malformation involved requires consideration of various clinical criteria and tests. 3. Proper diagnosis and management is important as some CHDs depend on persistent ductal circulation after birth for survival, requiring treatment with prostaglandins to keep the ductus arteriosus

1. HEART DISEASES
IN CHILDREN
OCT, 24, 2020
DR KAMAL MURTAZA
MD, DNB, DNB SS (PEDS
CARDIOLOGY)
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2. Scope of the talk…
Fetal circulation
When and how to suspect congenital heart diseases (CHDs)
Common CHDs: Cyanotic and Acyanotic differentiation
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3. A dialemma…
2 days term, good wt neonate presented in emergency room (ER)
Tachypnic, no clinical cyanosis, sats: 90%
Tachycardia, not sure of any murmur, liver 2cm below costal margin
Dialemma…
CHD or not??? Is it so rare?? No: 8-10/1,000 live births:
Most Common birth defect
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4. Basic Questions to be
answered…
1. Is it a CHD??
2. If yes: Cyanotic or acyanotic??
3. Pulmonary Blood flow: Increased??
4. Malformation arising in left or right heart?
5. Dominant ventricle??
6. PAH: +/-??
7. Duct dependent lesion??
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5. Fetal
Circulation…

6. CHD or not??
Hyperoxia test??
Nada’s Criteria??
ECG/ CXR/ Echocardiography
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7. Hyperoxia test…
ABG (PO2 and not SPO2)
100% O2 X 10 mins
Rpt ABG (PO2)
PO2> 200—> Points towards respiratory pathology
< 150—> Points towards Cyanotic CHD
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8. NADA’S CRITERIA…
(1M/ 2mi)
Major:
Cyanosis
CHF
Systolic murmur grade 3 or more
Diastolic murmur
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Minor:
Abnormal BP
Abnormal 2nd heart sound
Systolic murmur Grade 1 or 2
Abnormal CXR
Abnormal ECG

9. Cyanotic/ Acyanotic??
Wonder numbers for spo2:
<94% (Desaturation)
<85% (Cyanosis picked up by eyes)
Acyanotic:
Shunt/ Obstructive/ Regurgitant lesions
Cyanotic
Decreased PBF/ Increased PBF/ Normal
PBF
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10. Presentation of CHD
Can present at ant age: Neonates, infants, pre school age, toddler,
school age, adolescents or adults
Congestive Heart failure: Tachypnea, tachycardia, suck rest suck
cycle, excessive sweating, failure to thrive or gain appropriate weight
Cyanosis: Clinical cyanosis, cyanotic spells, squatting, clubbing,
polycythemia
Absence of lower limb pulses

11. Sub categories of acyanotic CHDs…
Shunt lesions:
Pre- tricuspid
Post- tricuspid
Obstructive lesions
Regurgitant lesions

12. Acyanotic Congenital Heart Diseases…
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13. Sub categories of Cyanotic CHDs…
Cyanotic CHD with decreased pulmonary blood flow with no PAH
Cyanotic CHD with decreased pulmonary blood flow with PAH
Cyanotic CHD with increased pulmonary blood flow: Admixture physiology
Cyanotic CHD with increased pulmonary blood flow: Transposition physiology
Cyanotic CHD with near pulmonary blood flow

14. Cyanotic CHD with
decreased PBF…

15. Cyanotic
CHD with
increased
PBF and
Near
normal
PBF:

16. PBF increased??
CHF (Tachypnea, tachycardia, hepatomegaly)
Suck rest suck cycle
Excessive sweating
FTT
Repeated chest infections
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17. PAH??
Pressure= Flow x resistance
Hyperkinetic or obstructive??
Hyperkinetic: Reversible by stopping flow
Obstructive: Irreversible…
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18. Duct dependent lesions…
Depends on the latency of ductus arteriosus after birth for child’s survival
3 types:
Duct dependent systemic circulation: IAA, Aortic atresia, Critical COA
Duct dependent pulmonary circulation: Pulmonary atresia
Duct dependent mixing circulation: TGA with intact inter ventricular
septum

19. Duct dependent lesion
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20. So whom to refer???
All cyanotic babies
Duct dependent lesions
Absent pulses
CHF
Feeding difficulty, excessive sweating, FTT, failure to gain
appropriate weight
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21. Role of prostin (E1)in duct dependent lotions…
1 vial of 1ml has 500micrograms; Dose of prostin: 5-100 ng/kg/min
Eg: A baby of 1kg is to be started on pristin at 10ng/kg/min= 10x 1x 60= 600 ng/hr
Mix 1 ml of Prostin in 49 ml of D5, then 50 ml has 500 microg= 500x 1000 ng, So 500x 1000ng is in 50ml
of solution
1ng will be in 50ml/ 500 x1000= 1/ 10,000 ml; So, 600 ng will be in= 1/10,000 x 600= 0.06 ml
So, to this child of 1 kg to start Prostin @ 10ng/kg/min—> You need to give 0.06ml/hr of this solution
So, a child of 3 kg to start Prostin @ 10ng/kg/min—> You will give 0.06 x 3= 0.18 ml/hr (approx 0.2 ml/hr)
FORMULA: 0.06 X wt (kg)/ hr OF THIS DILUTION—> WILL GIVE THE CHILD@ 10ng/kg/min
Precaution: Causes apnea
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22. Take home …
So, CHD is not so rare: MC birth defect
Always keep an high index of suspicion
Look for signs of CHF, cyanosis, murmur, pulses…
Spo2 assessment of pre and post ductal parts of neonates advisable
Discuss the case with your pediatric cardiology friend…
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23. Thank you…