CATH STUDY: PRE FONTAN CATH
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- Baby V is an 11-year-old female with tricuspid atresia, restrictive VSD, and PS who underwent a right-sided BDG at 10 months of age for cyanosis. She now presents with exertional dyspnea and increasing cyanosis. - Examination found cyanosis, clubbing, and oxygen saturation of 50%. Echo showed patent glenn shunt and small restrictive VSD with moderate ASD, no forward flow across PA, and good ventricular function. - Cardiac cath was performed to assess PA pressures, collaterals, and suitability for Fontan. It found elevated PA pressures but improved Qp/Qs ratio, making her a candidate for Font
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This document discusses the case of a 2 year old male child presenting with recurrent lower respiratory tract infections. On examination, a systolic murmur was heard. Echocardiogram showed a patent ductus arteriosus (PDA) of size 8mm with left to right shunting. Cardiac catheterization found a Qp/Qs ratio of 1.83, confirming a left to right shunt. Post oxygen, the Qp/Qs ratio increased to 2.94, and PVR decreased, indicating reactivity. The document then discusses two other cases and provides information on indications for catheterization in PDA, angiographic views, classifications of PDA, and factors affecting shunting through a PDA
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The document summarizes a patient's medical report during hemodialysis treatment. It includes information on the patient's medical history, physical examination findings, lab results, dialysis monitoring, diagnosis of end stage renal disease due to diabetes and hypertension, and treatment plan to address issues like intradialytic hypotension and anemia management through diet, medication, and ensuring adequate dialysis.
POMR Ny. Khiptiyah TAVB_ edited by KIT, CIK + condition this morning.pptx
Mrs. K, a 68-year-old woman, presented with worsening dizziness, near syncope, and chest discomfort. Her ECG showed third-degree atrioventricular block with a ventricular rate of 20-30 bpm. She underwent transvenous pacemaker implantation and was admitted to the CVCU for management and monitoring. Her hospital course was notable for uncontrolled hypertension, obesity, and minor coronary artery disease on angiography.
Case Presentation in SOAP format on Ischemic Heart Disease with Acute Coronar...
Case Presentation in SOAP format on Ischemic Heart Disease with Acute Coronar...Umme Habeeba A Pathan
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The morning report summarizes 3 patients scheduled for procedures. The first is a 4 year old boy scheduled for a brain evoked response auditory procedure for delayed speech. The second is a 12 year old boy with transposition of the great arteries scheduled for tracheostomy and stenosis release for impending airway obstruction. The third is a 58 year old man scheduled for diagnostic laryngoscopy and T-tube placement for subglottic stenosis.
case presetation
This document presents a case study of a 38-year-old male patient who presented with shortness of breath, easy fatigability, cough, fever, puffy eyelids, and lower limb edema. Initial tests found decreased kidney function, blood in the urine, low albumin and complement levels. A differential diagnosis was made which included glomerulonephritis and vasculitis. The patient was started on antibiotics, diuretics, and steroids. Follow up labs showed improved kidney function and edema resolution, with rheumatoid factor now positive, suggesting the diagnosis is rheumatoid vasculitis.
Functional ECHO.pptx
The document discusses using echocardiography to assess cardiac function and hemodynamics in sick newborn infants. It provides basics of echocardiography, standard views used, and how echocardiography can be used to diagnose conditions like patent ductus arteriosus, pulmonary hypertension, and neonatal shock. Key indicators are discussed such as ductal features, pulmonary overflow measurements, and signs of systemic hypoperfusion that can demonstrate the severity and hemodynamic effects of various conditions.
Houseofficer teaching-paeds:shock
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Preventable ICU admissions at community level - Interactive Cases
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Pulmonary Embolism FINAL 2.pptx
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matrn mortility (3).pptx
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More from Dr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
PEDIATRIC SUDDEN CARDIAC DEATH, SYNCOPE, INHERITABLE ARRHYTHMIAS
PEDIATRIC SUDDEN CARDIAC DEATH, SYNCOPE, INHERITABLE ARRHYTHMIASDr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
Syncope refers to a sudden, transient loss of consciousness due to decreased blood flow to the brain. In children and adolescents, cardiac abnormalities causing syncope are rare, and the most common causes are autonomic syncope, vasovagal syncope, and postural hypotension. Evaluation of syncope in children aims to determine if there is an increased risk of sudden cardiac death. Factors suggesting a cardiac cause include lack of prodrome, palpitations, exercise-induced syncope, family history of cardiac issues or early death, and prior known cardiac disease. These patients should be referred to a cardiologist to evaluate for potential inherited cardiac conditions like Brugada syndrome or long QT syndrome.FETAL CARDIAC SCREENING
The document outlines a talk on fetal cardiac screening. It discusses the impact of screening from both a health and parental perspective. Screening allows for planning delivery at centers equipped for any needed care. It can identify life-threatening conditions for in utero treatment or help avoid unnecessary post-birth testing and transport. Parents benefit from informed decisions and preparation. The talk explores current practices and potential future directions for improving screening.
SYNCOPE, SUDDEN CARDIAC DEATH AND INHERITED ARRHYTHMIAS
This document discusses syncope in children and adolescents, providing definitions of syncope and sudden cardiac death. It notes that cardiac abnormalities are a rare cause of syncope in children unlike in adults. Various types of autonomic syncope are described including vasovagal, postural hypotension, and dyautonomia. Evaluation for cardiac syncope is recommended to determine risk of death. Specific cardiac conditions like Brugada syndrome, long QT syndrome, short QT syndrome, and catecholaminergic polymorphic ventricular tachycardia are discussed. The take home message is to consider arrhythmias with any exertional or unexplained syncope and to evaluate family history of sudden cardiac death or arrhythmias.
PEDIATRIC CARDIOLOGY CASE SCENARIOS
This document discusses two case scenarios involving pediatric cardiology patients. The first scenario is about a 12-year-old boy who is overweight due to a sedentary lifestyle involving online schooling, TV watching, and eating fast and junk food. The second scenario describes a 14-year-old active boy whose grandfather died at age 49 and who has elevated cholesterol and LDL levels. The document discusses the long-term cardiovascular risks of obesity and high cholesterol in childhood, including increased blood pressure, lipids, and future risk of atherosclerosis. It recommends addressing these risks through lifestyle changes, physical activity, healthy eating, and early screening and treatment when needed, including behavioral interventions and statin prescriptions in rare cases of familial hyper
PERCUTANEOUS DEVICE CLOSURE OF AORTO- PULMONARY WINDOW (RESIDUAL)
PERCUTANEOUS DEVICE CLOSURE OF AORTO- PULMONARY WINDOW (RESIDUAL) Dr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
This document discusses the percutaneous closure of a residual aortopulmonary window in a 2-year-old boy using a second occlusion device. The boy was originally treated for an aortopulmonary window at 2 months of age, but follow up showed a residual 4mm window. A second device, an ADO-II 6x6, was successfully deployed above the original device with no residual shunt seen. The boy was discharged the next day with both devices in position and no complications. The summary demonstrates the feasibility of using a second occlusion device to treat residual defects after an initial device closure procedure.LONG TERM OUTCOMES OF POST OPERATIVE CHILD WITH CONGENITAL HEART DISEASES
LONG TERM OUTCOMES OF POST OPERATIVE CHILD WITH CONGENITAL HEART DISEASESDr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
Long term Post operative care of a child with CHD involves monitoring for potential issues like reintervention due to lesion recurrence, arrhythmias, and thromboembolism. It also requires assessing schooling, neurodevelopment, exercise capacity, and providing guidance on marriage, pregnancy, and contraception. Children with repaired lesions are most at risk for reintervention and arrhythmias compared to those with completely corrected or palliated lesions. While outcomes have improved, lifelong multidisciplinary care is generally needed due to the risk of ongoing medical, developmental, and social issues.WHEN TO REFER TO A PEDIATRIC CARDIOLOGIST
This document discusses the timing of interventions for congenital heart defects (CHDs) in pediatric patients. It involves balancing factors like hemodynamic severity, natural history of the defect, procedural outcomes, and institutional experience. There is a trend toward early correction which avoids adverse consequences and is now feasible and realistic in Indian centers with excellent results. The document then discusses scenarios involving ventricular septal defects, atrial septal defects, and patent ductus arteriosus, when intervention is recommended based on symptoms, size of defect, and age/weight of the patient. It notes most CHDs can now be corrected with long-term survival and without need for reintervention in 85-90% of cases.
PEDIATRIC ECHOCARDIOGRAPHY: APICAL AND PARASTERNAL VIEWS
PEDIATRIC ECHOCARDIOGRAPHY: APICAL AND PARASTERNAL VIEWSDr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
This document provides an overview of various echocardiographic views used to visualize cardiac structures and diagnose pathologies. It describes the apical and parasternal views including the 4-chamber, 5-chamber, 2-chamber, and short-axis views. Each view is explained in terms of the structures seen and pathologies that can be identified. Measurement techniques like Simpson's method for ejection fraction are also summarized.WHEN TO REFER A CHILD TO A PEDIATRIC CARDIOLOGIST FOR INTERVENTION
WHEN TO REFER A CHILD TO A PEDIATRIC CARDIOLOGIST FOR INTERVENTIONDr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
This document discusses the timing of interventions for various congenital heart defects (CHDs) in pediatric patients. It provides several case scenarios to illustrate the decision-making process. The key factors in determining when to intervene include the hemodynamic severity of the defect, its predicted natural history, procedural outcomes, and institutional experience. Early correction is generally preferred to avoid complications, and is now feasible in selected centers with excellent results. The document reviews timing guidelines for specific defects such as ventricular septal defects and patent ductus arteriosus. It also describes treatment options such as surgical closure or transcatheter device closure for different CHDs.PEDAITRIC OBESITY AND HYPERLIPEDEMIA
A 12-year-old child is overweight with a BMI of 31 kg/m2 due to a sedentary lifestyle. Obesity increases the risk of high blood pressure, diabetes, and cardiovascular disease over the long term. Management involves promoting outdoor physical activity and healthy eating habits.
A 14-year-old boy has a family history of early death from cardiovascular disease. Though active, he has elevated cholesterol levels placing him at risk for future cardiovascular problems. Early detection and lifestyle modifications can help prevent disease progression.
Screening children's cholesterol levels starting at age 10 and 19 allows for early identification of risk and targeted prevention and treatment approaches like lifestyle changes and low-dose statin therapy for those at highest risk
Micronutrient deficiency In Children
Micronutrient deficiency is common among children globally. At least 50% of children aged 6 months to 5 years suffer from one or more micronutrient deficiencies such as iron, iodine, folate, and vitamin A. The reasons for the high prevalence include inadequate intake of nutritious foods, poor absorption of minerals and vitamins, frequent infections, and consumption of refined foods. Micronutrients play an important role in brain development during the first 1,000 days of life. Complementary feeding starting at 6 months is important to meet increased nutrient needs but current practices in India are often inadequate. Ensuring adequate nutrition through home-made preparations, breastfeeding, and fortified complementary foods can help bridge nutrition
DYSBIOSIS IN CHILDREN BORN BY CAESAREAN SECTION
1. Caesarean section delivery disrupts the normal pattern of microbial colonization in infants, dominating their gut with bacteria from the human skin and oral cavity rather than vaginal and enteric bacteria acquired during a vaginal birth.
2. Microbial dysbiosis resulting from C-section delivery has been associated with increased risk of conditions like asthma, obesity, food allergies, and inflammatory bowel disease later in life.
3. Restoring a healthy gut microbiota in infants born by C-section through breastfeeding and probiotic supplementation may help reduce the risk of these long-term health issues, though more research is still needed.
PEDIATRIC CARDIAC SERVICES IN INDIA: WHERE DO WE ACTUALLY STAND?
PEDIATRIC CARDIAC SERVICES IN INDIA: WHERE DO WE ACTUALLY STAND?Dr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
This document discusses the current state of pediatric cardiac services in India. It notes that India has a high birth prevalence of congenital heart disease (CHD), with approximately 242,390 children born with CHD each year. However, the availability of advanced cardiac care is very limited, with only 9 high-volume centers performing over 500 surgeries per year. While an estimated 43,000 children are born annually with serious forms of CHD requiring treatment, only around 8,500 (20%) currently receive optimal cardiac care. The document outlines several challenges facing the improvement and expansion of pediatric cardiac services in India, including limited resources, infrastructure, and trained staff. It proposes various strategies to address these issues, such as establishing more specializedHeart diseases in children
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
ICCU ECGs
1. A 65-year-old woman presented with a fall and hip fracture. Her ECG showed complete heart block with a ventricular rate of 45 beats per minute, requiring a permanent pacemaker.
2. A 50-year-old woman with rheumatic heart disease was in atrial fibrillation with a controlled ventricular rate of 60-65 beats per minute on her ECG. The ECG showed signs of digoxin use and possible hypokalemia, requiring questions about appetite and potassium levels.
3. A 20-year-old woman presented with chest pain and her ECG showed a pattern consistent with Wolff-Parkinson-White syndrome type B with right posterior accessory pathway location
CONGENITAL HEART DISEASES: A SIMPLIFIED APPROACH
This document provides an overview of congenital heart diseases (CHDs):
1. CHDs are defects in heart structure and function that exist at birth, though symptoms may not appear until childhood or later. They occur in approximately 1% of live births and are a leading cause of birth defect mortality.
2. CHDs can be acyanotic (without cyanosis) or cyanotic (with cyanosis) and include defects such as ventricular septal defects (VSD), atrial septal defects (ASD), patent ductus arteriosus (PDA), tetralogy of Fallot, and transposition of the great arteries.
3. While the exact causes of most CHDs are unknown
Examination of Cardio Vascular System (CVS): Pediatrics+ APPROACH TO A CHILD ...
Examination of Cardio Vascular System (CVS): Pediatrics+ APPROACH TO A CHILD ...Dr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
This document provides an overview of examining the cardiovascular system in pediatric patients and approaching a child with suspected congenital heart disease (CHD). It discusses taking a history, performing a general physical exam, assessing vital signs, inspecting the precordium, palpating pulses and heart sounds, and auscultating for murmurs. The key steps in approaching a child with possible CHD are determining if it is cyanotic or acyanotic, assessing pulmonary blood flow and pulmonary artery pressure, and identifying any duct-dependent lesions.TACHYPNIC NEOANTE: IS IS A CHD: APPROACH TO A CHILD WITH CONGENITAL HEART DIS...
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A 2 day old term neonate presented with tachypnea and a heart rate of 90%, raising suspicion of a congenital heart disease (CHD). To determine if the neonate had a CHD, the doctor considered performing a hyperoxia test, applying Nada's criteria, and conducting an echocardiogram. If a CHD was confirmed, the next steps would be to determine if the child had cyanotic or acyanotic heart disease, increased or normal pulmonary blood flow, pulmonary arterial hypertension, and duct dependency to guide referral to a pediatric cardiologist.Cath meet 25020202 (TGA, VSD, PS FOR PA PRESSURES)
- The document summarizes a cardiac catheterization report for a 16-month-old female patient with a history of cyanosis, murmur, and failure to gain weight appropriately who was diagnosed with congenital heart disease.
- Examination findings included cyanosis, low oxygen saturation, murmur, and signs of right ventricular hypertrophy. Previous echocardiogram showed dextro-transposition of the great arteries, ventricular septal defect, and pulmonary stenosis.
- The cardiac catheterization measured pressures in the heart chambers and major vessels. It found elevated pulmonary artery and right-sided heart pressures consistent with pulmonary hypertension. Calculations from the data determined abnormal pulmonary and systemic vascular resistances and a low ratio of
THALASSEMIA: VENTRICULAR DYSFUNCTION ASSESSMENT
This study assessed 33 multi-transfused thalassemic children with iron overload using tissue Doppler imaging (TDI), strain imaging (SI), and conventional 2D echocardiography compared to 32 healthy controls. While 2D echocardiography showed higher left ventricular dimensions and mass in thalassemic children, ejection fraction and diastolic parameters were normal. TDI velocities were normal at the septum but lower at the lateral wall in thalassemic children. SI and strain rate imaging parameters were significantly lower in thalassemic children across all measured segments. The study concludes that while ejection fraction remains normal with 2D echocardiography, TDI and SI can detect early and regional myocardial involvement not seen with conventional
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WHEN TO REFER A CHILD TO A PEDIATRIC CARDIOLOGIST FOR INTERVENTION
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PEDIATRIC CARDIAC SERVICES IN INDIA: WHERE DO WE ACTUALLY STAND?
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Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
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10. Define the mean QRS vector
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2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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CATH STUDY: PRE FONTAN CATH
- 1. CATH MEET: Pre Fontan Cath 07/09/2019 Murtaza Kamal murtaza.vmmc@gmail.com 1
- 2. Patient’s details • Baby V 11y/ F: Diagnosed CHD ante- natal period • Tricuspid atresia, restrictive VSD, PS in neonatal period: Cyanosis: Told for 2 stage surgeries 2nd after some years • Underwent rt. sided BDG at 10 months of age: I hospital (2010) • Cyanosis decreased • Irregular follow up • Exertional dyspnea since last 6 months- Class 2 symptoms, No othopnea/ PND, Not gaining weight properly, Increasing cyanosis 2
- 3. Examination • Conscious, oriented, thin built • PR: 92/ min, RR: 18/min, BP: 100/70 mm hg, Afebrile • BMI: 15kg/m2 • Cyanosis with grade 3 pandigital clubbing (spo2: 50%) • JVP: Not raised • LV apex- 5th ICS at MCL, midline scar +nt, silent chest, S1: Normal, S2: Single, No S3, S4, No murmur or additional sounds 3
- 4. CXR 4
- 5. ECHO • SS, levocardia, levoposition • S/P Rt BDG for Tricuspid atresia Type 1b • Patent glenn shunt, Unobstructed flow in glenn shunt • Small restrictive VSD with moderate sized OS ASD • No forward flow across PA • No AVVR • Good ventricular function 5
- 6. Cardiac cath • Indication: Assessment of PA pressures and anatomy, collaterals (arterio- venous and veno venous), and suitability for Fontan completion • Access: 5F RFA, 6F RFV, 5F RIJV • 100U/kg heparin iv, seldinger technique for access • Hardware: 5F MPA endhole, 5F Pigtail angiographic catheter, regular and terumo wires • Vitals:HR: 92/ min, RR: 18/ min,BP: 110/74mm hg, Temp:, spo2: • Wt: 20 kg, O2 consumption: 144ml/min /m2 • Hb: 11.9g/dl 6
- 7. GLENN 7
- 8. FA 8
- 10. LV-EDP 10
- 11. Oxymetry Chamber Po2 Spo2 Aorta 35.2 53.6 SVC/ Glenn 34.7 53.8 IVC 29.7 38.4 Lt PV 233 100 Rt PV 44.6 44.6 11
- 12. Calculations Parameters Values-01 Values-02 Qp 1.92 4.75 Qs 6.02 6.02 Qp/Qs 0.31 0.78 PVR 1.56 0.63 PVRi 1.23 0.49 12
- 13. Angios • RPA: -2.01 • LPA: -1.99 • DA at diaphragm: -1.63 • Mc Goon’s ratio: 1.7 13
- 14. Thank you • Images on 04/09/2019 14