PEDIATRIC CARDIOLOGY

Prof Dr H Widagdo, SpA, MBA

Trisakti Medical Faculty
JAKARTA
EVALUATION OF CARDIOVASCULAR
SYSTEM
 REFERRENCES
• 1. Bernstein, D: Evaluation of the
Cardiovascular System. Kliegman RM,
Behrman RE, Jenson HB, Stanton BF (Editors)
Nelson Textbook of Pediatrics. 18th Edition,
Saunders, Philadelphia, 2007. pp 1857-1877
 ANAMNESIS 1
• PERINATAL PERIOD : CYANOSIS, RESPIRATORY
DISTRESS, PREMATURITY
• MATERNAL : GESTATIONAL DIABETES,
MEDICATIONS, SLE, SUBSTANCE ABUSE
• HF IN INFANTS : FEEDING DIFFICULTY (LESS
VOLUME/FREQUENT, DIAPHORETIC,
DYSPNEIC), NASAL FLARING, CHEST,
RETRACTIONS, CYANOSIS
 ANAMNESIS 2
• HF IN OLDER CHILDREN: EXERCISE INTOLERANCE, POOR GROWTH,
FATIGUE, ABILITY IN SOME ACTIVITIES (STAIR CLIMBING, WALKING,
BICYCLE RIDING, CLASS OF PHYSICAL EDUCATION, COMPETITIVE
PORTS, ORTHOPNEU, NOCTURNAL DYSPNEA), EDEMA (PALPEBRA,
LIMBS, ASCITES
• CYANOSIS AT REST, DURING CRYING OR EXERCISE, BLUE AROUND
THE LIPS, MOCOUS MEMBRANE, NEWBORN HAVE ACROCYANOSIS
DURING COLD OR UNDRESSED MUST BE CAREFULLY
DIFFERENTIATED WITH TRUE CYANOSIS.
• CHEST PAIN, IS UNUSUAL MANIFESTATION OF CV IN CHILDREN
• ASSOCIATION OF CV-DEFECT WITH OTHERS CONGENITAL DEFECTS
 PHYSICAL EXAMINATION 1
• GENERAL PHYSICAL EXAMINATION INCL. SEVERITY OF
ILLNESS, NUTRITION AND GROWTH, BLOOD PRESSURE,
HEART/PULSE RATE, RESPIRATION RATE, BODY
TEMPERATURE, HEIGHT AND WEIGHT, CYANOTIC AND
ANEMIC APPEARANCES.
• SPECIFIC EXAMINATION OF ORGAN OR SYSTEM ESP. CV.
• HEAD AND NECK: FACIAL APPEARANCE, BLUISH
CIRCUM-ORAL AREA, NASAL FLARING, CONJUNCTIVAL
ANEMIA, JUGULAR VENOUS
DISTENSION/PRESSURE/REFLUX, RETRACTION,
PULSATION, BRUITS.
 PHYSICAL EXAMINATION 2
• THORAX: 1)HEART: PRECORDIAL BULGING, PULSATION,
ICTUS (APICAL IMPULSE), SUBSTERNAL HEAVE
(THRUST), THRILL, CARDIOMEGALY, CARDIAC WAIST,
HEART SOUND, GALLOP RHYTHM, EJECTION CLICK,
MURMUR AND ITS QUALITY, PERICARDIAL FRICTION
RUB; 2) LUNGS: SYMMETRICITY, RALES AND RONCHI,
PLEURAL FRICTION RUB.
• ABDOMEN: EPIGASTRIC PULSATION, ASCITES,
HEPATOMEGALY, RADIATING MURMUR, PISTOL SHUT
• EXTREMITIES: CYANOSIS, EDEMA, ARTHRITIS,
CLUBBING FINGERS
• ETC, ETC
 LABORATORY EXAMINATION
• HEMATOLOGY: WBC, RBC & HT
(POLYCYTHEMIA), ESR,
• CRP,
• ASO, PHARYNGEAL SWAB CULTURE
• BLOOD GAS ANALYSIS
 IMAGING
• RADIOGRAPHY: cardiac shape and size (CTR), lung vascularity, lung
edema, skeletal anomalies.
• ECG: rate & rhythm, P waves (atrial hypertrophy), QRS complex
(ventricular hypertrophy), PR & QT intervals, ST segment & T wave
abnormalities
• ECHOCARDIOGRAPHY (M-MODE, TWO-DIMENSIONAL, DOPPLER,
and TRANSESOPHAGEAL): evaluate cardiac structure, estimate
intracardiac pressure & gradients, cardiac contractility function,
direction of flow across the defect, integrity of coronary vessels,
vegetation from endocarditis, pericardial fluid, cardiac tumor, and
chamber thrombi.
• DIAGNOSTIC & INTERVENTIONAL CATHETERIZATION.
• OTHERS
 DIAGNOSIS / DIFFERENTIAL
DIAGNOSIS
• DIAGNOSIS INCL. DD OF CV DISEASES BASED
ON 1) ANAMNESIS, 2) PHYSICAL FINDINGS,
AND 3) SUPPORTED BY RESULT OF
LABORATORY AND IMAGING EXAMINATION.
 TREATMENT & PREVENTION
• TREATMENT OF CV PEDIATRIC INCL. MEDICAL
CAUSATIVE, SUPPORTING AND OR
SYMPTOMATIC; AND SURGERY OF PALLIATIVE
OR CORRECTION, SUCH AS IN CHD.

• PREVENTION OF CVD IS VARYING ACCORDING

TO THE RESPECTIVE DISEASES.
 PROGNOSIS
• PROGNOSIS OF MOST CV CASES WITH
APROPRIATE TREATMENT ARE QUITE GOOD,
AND DETERMINED BY THE SEVERITY OF THE
DISEASE.
 FOLLOW UP & EDUCATION
• THE PATIENTS AND THEIR FAMILIES SHOULD
HAVE THE IN DEPTH INFORMATION
EVERYTHING ABOUT THE DISEASE, AND
SHOULD FOLLOW THE SUGGESTION GIVEN BY
THEIR CARDIOLOGIST.