Pediatrics

DR. AHMED YASINI

Cardiology
 Sign of cardiac & Respiratory
disease

• Easy fatigue
• Sweating while feeding
• Feeding difficulties
• Rapid respirations
Fetal circulation
 Ventricular septal defect
• Most common congenital cardiac lesion
• Perimembranous VSDs are the most common of all VSDs (67%)
• 33% of all VSDs close spontaneously. Small VSDs usually close spontaneously
• Large VSDs can be closed by cardiac catheterization.
• Dx.
• Holosystolic murmur
- Chest X-ray (large heart, pulmonary edema)
- ECG- LVH
- echocardiogram is definitive.
Complications
- Pulmonary hypertension
- Endocarditis
- Large defects lead to heart failure, failure to thrive
indications for Surgery in first year
- Failure to thrive or unable to be corrected medically
- Infants at 6–12 months with large defects and pulmonary artery hypertension
Question
 Eisenmenger syndrome

• shunt becomes right to left

• Uncorrected left-to-right shunt
• (VSD, ASD, PDA)→increase pulmonary blood flow→
pathologic remodeling of vasculaur→ pulmonary arterial
hypertension
Causes late cyanosis, clubbing , polycythemia
02.2022
 Artrial septal defect
- Defect in interatrial septum.
- May lead to paradoxical emboli
(systemic venous emboli use ASD to bypass
lungs and become systemic arterial emboli).
Ostium secundum defects is most common
• Dx. ECG, CXR, Echocardiogram
Wide fixed splitting of S2 (pulmonary valve needs more time to close)

Complications:-
- Dysrhythmia
- Low-flow lesion ( does not require endocarditis prophylaxis)

TX. Usually no treatment needed.

• If a significant shunt is still present at around 3 years of age, closure is
usually recommended.
Question
 Endocardial cushion defect
(atrioventricular canal defect)
- ASD + VSD + abnormal valves
• Most common cardiac anomaly in DOWN syndrome (usually complete)
DX.
Chest x-ray: heart enlargement , increased pulmonary vessel markings
edema
- ECG: Right-axis deviation and RVH
- Echocardiogram definitive
- TX.
diuretics (± digoxin) and afterload reduction for HF
• Surgical repair of the defect ultimately is required.
- Without surgery death from heart failure.
- With surgery ;arrhythmias, congenital heart block
 Patent ductus arteriosus (PDA)
- The ductus arteriosus a lows blood to flow from the pulmonary artery to the aorta during fetal life.
- PDA left-to-right shunting of blood and increased pulmonary blood flow
• Risk Factors
• More in girls.
• Associated with maternal rubella infection.
• premature infants

- Machinery sound , wide pulse pressure

-Tx. Indromethacin to close it, Prostaglandins to keep it open.

- If PDA bursitis beyond the first week, it is unlikely to close spontaneously.
-Can be closed by catheterization (coli embolization).
-Ventilation and O2 supplementation can cause acute decompensation
-In newborns with PDA- dependent defects. O2 stimulate PDA constriction (closure).
Complications
• Congestive heart failure
• Infective endocarditis
 Pulmonary stenosis Vs Aoritic
stenosis
Pulmonary stenosis
• Systolic murmur
• Incrased blood flow through PFO
• RV hypertrophy- signs of RV failure
• CXR showing decreased pulmonary vasculaur
• Tx. Balloon valvuloplasty
• Neonate with critical pulmonary stenosis
- emergent surgery
Aoritic stenosis
- Most are bicuspid aortic valve
- Tx. Balloon valvulopathy
 Coarctation of the aorta
• BP in lower extremities (femoral) is lower than
upper extremities (radial), Brachial femoral del
• Risk factor : Turner syndrome.
• Dx. Nothching of inferior borders of ribs.
• -Preductal:- infantile, upper body pink , loweris cyanotic.
Tx. prostaglandin E1 , surgery
Complications :
• cerebral hemorrhage (berry aneurysms)
• aortic rupture (aneurysms)
• endocarditis.
• HF
Cyanosis
 Tetralogy of Fallot
- The most common cyanotic congenital heart defect
• Abnormal septation of the truncus arteriosus into the aorta and pulmonary artery.
• PROVa
1. Pulmonary stenosis
2. Right ventricle hypertrophy
3. Overriding aorta
4. VSD

• The child will squat to decrease the RL shunt, increasing pulmonary blood flow.
• Tet spells:- paroxysmal hypercyanotic attacks- they can lead to convulsions and
LOC. Treated by oxygen and Knee- chest position.
• Gasping causes syncope.
• Complications: Brain Abscess , cerebral hemorrhage.
CXR: boot-shapped heart
boot-shapped heart
Question
 Tricuspid atresia
• Pulmonary blood flow will depend on the size of ASD
• Hypoplastic RV
• Increased left ventricular impulse
• (contrast to most others with right ventricular impulse)
holosystolic murmurs along left sternal border.

• Tx. PGE1, surgical correction (redirect systemic VR directly to the

pulmonary arteries).
• 1. Subclavian artery- to- pulmonary shunt (Blalock Taussig procedure)
• 2. Bidirectional cavopulmonary shunt (bidirectional Glenn)
• 3. Fontan procedure
02.2022
 TOTAL ANOMALOUS
PULMONARY VENOUS RETURN
• All of the pulmonary veins fail to connect to
the left atrium and return abnormally via the
right side of the heart.
• Dx. ECG, Echo
Xray. “snowman” appearance
• Tx . PGE , surgery.
 HYPOPLASTIC LEFT HEART
SYNDROME
• It is the most common cause of death from
cardiac defects in the first month of life.
• A small LV which is unable to provide blood
to systemic circulation-> diminished cardiac
output.
• 1. Norwood procedure
• 2. Bidirectional Glenn
• 3. Fontan procedure
 Ebstein anomaly

• Associated with lithium

• More blood through ASD
• CXR: decreased pulmonary markings
murmur of tricuspid regurgitation
(Systolic Murmur in pulmonic area) and
middiastolic murmur at the lower left sternum
 Transposition of great arteries
TGA
• Cyanosis in newborn”24h of life”
• More common in infant with diabetic mothers.
• It needs PFO and PDA
• PGE1 to keep PDA
• Balloon atrial septostomy improves mixing
between the two circulations.
• The arterial switch usually is performed within
2 week.
Egg on a string sign.
02.2022
06.2021
01.2021
 Truncus arteriosus
• Failure of septation of truncus
• Associated with CATCH-syndrome (Di George)
• Both ventricles have same pressure

• Di- George syndrome:-

• - Cardiac anomalies
• - Abnormal faces
• - Thymic hypoplasia
• - Cleft palate
• - Hypocalcemia
• - Chromosome 22
 Hypertension

- Renal stenosis
• Fibromuscular dysplasia:- most common cause
in children
• Dx. Renal ultrasound, angiography. Renin,
angiotensis.
• -Neurofibromatosis causes renal hypertension
(pigmented brown skin)
 Kawasaki
• Mucocutaneous lymph node syndrome
- Fever
- Conjunctivitis
- Rash genital, lips, palms
- Cervical lymphadenopathy
- Strawberry tongue
- Sore throat/ diarrhea
• Leads to coronary artery aneurysm, MI
Tx. High dose aspirin, IVIG
Acute Rheumatic Fever
• Diagnosis of RHD is made with a history of recent streptococcal
infection and either the presence of 2 major criteria
or 1 major with 2 minor criteria
Acute RF treatment:
10 days of oral amoxicillin/ penicillin or 1 dose of IM benzathine
penicillin.
If allergic 10 days of erythromycin, 5 days of azithromycin, or 10 days
of clindamycin.
Carditis – Corticosteroids for 2–3 weeks, then taper
start aspirin for 6 weeks
Aspirin in patients with arthritis/carditis without CHF
Chorea - Phenobarbital then Haloperidol/ chlorpromazine
 RHD
• Rheumatic heart disease remains the most
common form of acquired heart disease.
• The most common manifestation of ARF is
arthritis.
• The most common affected valve is Mitral
valve (MR/MS) then aortic
Chemoprophylaxis
Long QT syndrome
06.2021