Test associate with cardiac illness in child

1. TEST ASSOCIATED WITH CARDIAC
ILLNESS
PE 23.13
2ND YEAR MBBS
DR.SURAJ PATEL

2. SIGNS ANDSYMPTOMS:
 Chest pain.
 Dyspnea with or
without orthopnea.
 Paroxysmal
nocturnal dyspnea.
 Cyanosis.
 Fatigue.
 Palpitations.
 Cough.
 Edema.
 Syncope.
 Abnormal
heart sounds.

3. DIAGNOSIS OF CARDIAC
DISORDERS:















4. HEART SOUNDS:
Stethoscope is the commonest instrument
used.
 FIRST SOUND: (L-U-B-B)
 Occurs at the onset of ventricular systole.
o DURATION: 0.1 – 0.17 sec
o CAUSES:
Occurs due to sudden closure of the AV
valves.
Ejection of blood from the ventricles & the
vibration transmitted to the walls of the
pulmonary artery & aorta.

5. o SIGNIFICANCE:
 Indicate the condition of myocardium.
 Indicates proper closing of AV valves.
o CLINICAL IMPLICA
TIONS:
 INCREASED FIRST SOUND:
 Hypertrophy.
SHORT & LOW PITCHED FIRST
SOUND:
 Myocardial weakness.

6.  SECOND SOUND: (DUP)
 Occurs at the onset of the diastole.
o DURATION: 0.1 -0.14 sec
o CAUSES:
 Caused by the sudden closure of the semi lunar valves in the
aorta & pulmonary artery.
o SIGNIFICANCE:
 Indicates the end of systole & beginning of diastole.
 Its pitch is directly proportional to the BP.
 Indicates proper closing of semilunar valves.
o CLINICAL IMPLICA
TIONS:
 DECREASED DIASTOLIC PERIOD: ( PAUSE)
 Increased heart rate.

7.  THIRD SOUND:
o DURATION: 0.04 sec
o CAUSES:
 Sudden rush of atrial blood.
o SIGNIFICANCE:
 Indicates ventricular filling.
 FOURTH SOUND:
o DURATION: 0.01 sec
o CAUSE:
 Contraction of atria
o SIGNIFICANCE:
 Indicates the ending of ventricular filling.

8. LABORATORY TESTING :
1. BLOODTESTS:
 SERUM CHOLESTROL :
o Total cholesterol : 150 – 200 mgs
o TGL
o HDL
o LDL
o VLDL
: Up to 170 mgs
: 35 – 55 mgs
: Up to 170 mgs
: 20 – 40 mgs

9. 2. ENZYME TESTS :
ENZYME NORMAL
LEVEL
DISEASE
CONDITION
SGOT Up to 40 U/LT Myocardial
Infarction
LDH M→82-285 U/LT
W→103-227
U/LT
Congestive cardiac
failure
CPK M→<190 U/LT
W→>165 U/LT
Various
heart disease

10. AST / SGOT :
 NORMAL VALUES:
 MEN : 14 –20 U/L
 WOMEN : 10-36 U/L
 CLINICAL IMPLICATIONS:
 Increased AST levels occur in MI:
 Increased to 4-10 times the normal value.
 AST level reaches a peak in 24 hrs & returns to normal
by post MI day 3-7.
 Secondary rise in AST levels suggest extension or
recurrence of MI.

11.  Increased AST levels occur in liver diseases:(10-100
times normal)
 Acute hepatitis & chronic hepatitis ( ALT > AST)
 Active cirrhosis( drug induced ; alcohol induced :(
AST >ALT)
 Hepatic necrosis & metastasis
 Primary or metastatic carcinoma
 Alcoholic hepatitis
 Reye’ssyndrome
 Other diseases with elevated AST levels:
 Hypothyroidism
 Trauma & irradiation of skeletal muscle

12.  Shock
 Hemolytic anemia
 Decreased AST levels:
 Azotemia
 Chronic renal dialysis
 Vitamin B6 deficiency

13. LDH ( LACTATE DEHYDROGENASE)
 NORMAL VALUES:
 MEN : 82-285 U/L
 WOMEN : 103-227 U/L
 CLINICAL IMPLICATIONS:
 Increased LDH levels:
 High levels occur within 36-55 hrs after MI &
continue longer than elevations of SGOT or CPK (
3-10 days)
 In pulmonary infarction increased LDH occurs
within 24 hrs of pain onset . The pattern of normal
SGOT & elevated LDH levels of 1-2 days after an
episode of chest pain –pulmonary infarction.

14.  Congestive heart failure
 Liver diseases ( cirrhosis, alcoholism, acute viral
hepatitis )
 Cancer , leukemia
 Hypothyroidism
 Lung diseases
 Skeletal muscle diseases
 Megaloblastic & pernicious anemias , hemolytic
anemia, sickle cell disease
 Seizures
 Shock, hypotension
 Renal infarction

15. ⬥ First diagnostic test in cardiac work shop.
⬥ Provides global information about position
& size of the heart & chambers &
surrounding anatomy.
⬥ The stdCXRs for evaluation of lungs &
heart are standing posteroanterior & lateral
views taken at maximal inspiration.
⬥ PortableCXRs – less satisfactory.

16. ⬥ The PACXR outlines superior vena cava , right
atrium on the right & left sides , aortic knob
,main pulmonary artery, left atrial appendage
& left ventricle.
⬥ In the lateral view CXR visualizes right
ventricle , inferior vena cava & left ventricle.
⬥ Cardiac enlargement is determined by cardio
thoracic ratio.

18. ELECTROCARDIOGRAM ( ECG ) :





19. 




20. 





22. NORMAL DURATIONS:





25. 12 lead ECG
6 limb leads & 6 precordial (chest ) leads
6 limb leads
1. Standard bipolar lead
2. Standard unipolar lead
STANDARD BIPOLAR LEAD

26. STANDARD UNIPOLAR LEAD :
6 CHEST LEADS :

28. STANDARD BIPOLAR LEADS:

29. STANDARD UNIPOLAR LEADS:

30. CHEST LEADS:

31. CLINICAL IMPLICATIONS :
1)
2)
3)
4)
5)
TYPICAL ABNORMALITIES :

32. CLINICAL IMPLICATION ASSOCIATED WITH
WAVES,COMPLEX &INTERVALS OF
ELECTROCARDIOGRAPHY :
I. P WAVE

 NORMAL VALUE :
 CLINICAL IMPLICATIONS:



33. II. PR INTERVAL :

 NORMAL VALUE :
 CLINICAL IMPLICATIONS :

III. QRS COMPLEX :




34. ECHOCARDIOGRAM
Ultrasound imaging of the heart
Transducer
reflection refraction

36. DOPPLER ECHOCARDIOGRAPHY
Depends on the principle that sound
waves reflected from moving objects such
as intra cardiac red blood cells undergo
frequency shift.
The greater the frequency faster the blood
is moving.
Used for studying the pressure changes on
either side of the valve & abnormal
directions of blood flow.

37. ⬥ An ultrasound probe in the shape of an
endoscope is passed into the oesophagus and
positioned immediately behind the left
atrium.
⬥ Helps in detecting
⬥ *patient with valve dysfunction.
⬥ *congenital abnormalities .
⬥ *patient with systemic embolism.

38. ANGIOGRAPHY :




39. COMPUTEDTOMOGRAPHY :







40. ⬥ Very expensive.
⬥ Technician places a small sticky electrode
patches on your chest and back.
⬥ These electrodes are attached to ECG
monitor.
⬥ Used for detecting
⬥ -CHF
⬥ -MI

41. RADIOLOGY :
Chest radiograph is useful for
determining the size and shape
of the heart.
Cardiothoracic ratio should be
less than 0.5.
Transverse cardiac diameter
should be less than 15.5cm.