Congenital Heart Disease: Recognition & Early Diagnosis for Pediatricians

By maitri

Congenital Heart Disease: Recognition & Early Diagnosis

By : DR MAITRI CHAUDHURI

Background:

The incidence of Congenital Heart Disease (CHD) is 4-8/1000 live births while the incidence of critical heart disease in children is 3/1000 live births. If we extrapolate these values to the current Indian annual birth rate , it is immediately obvious that we are sitting at the  “Tip of An Iceberg”. The challenge is to recognize and identify these babies at the earliest.

Recognition of Congenital Heart disease:

The manifestations of CHD are subtle and also different among neonates, infants and children. Also many of these presentations can be picked up by an alert pediatrician and also sometimes these features might overlap with those of non cardiac diseases. I wish to tabulate the       “Danger Signs” for quick recognition. I call it the ASK, LOOK & LISTEN approach.

ASK

PREGNANCY & DELIVERY

1. Maternal infections (Rubella), Maternal drugs(Lithium, OCP, Anti epileptics etc) ,   Gestational Diabetes, Hypothyroid, SLE

2. Maternal Smoking (including Passive), Alcohol

3. Birth Weight, Prematurity, Birth Asphyxia

4. ‘Test Tube’ Babies, Repeated Abortions, Child Loss

NEONATAL PERIOD

1.   CENTRAL CYANOSIS(Sats <90%), Positive Hyperoxia Test
2.   Difficult/ fast Breathing (Respiratory Rate Persistently More than 60/min)
3.   Murmur
4.   Poor Weight Gain
5.   Evidence of Genetic Syndromes(Down’s etc)
6.   Other Major Malformations like Tracheo-esophageal Fistula, Anorectal malformations etc

OLDER CHILDREN

1.   Repeated Chest Infections(>2 in six months or >3 in one year)
2.   Fast Breathing / Difficult breathing
3.   Sweating of Forehead
4.   Central Cyanosis , Cyanotic Spell
5.   Poor Weight Gain (<5^th Percentile For Age)
6.   Delayed development(delay in sitting/standing/ walking)
7.   Easily gets tired than playmates
8.   Detection of Murmur
9.   Hypertension
10.  Unexplained Chest Pain, Syncope, Palpitations
11.  Fever and  migratory joint pain, joint swelling esp. beyond 5yrs of age
12.  Positive Family History For Heart Disease, Sudden Death in Young

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Published by maitri in Early Diagnosis of Congenital Heart Disease, ongenital Heart Diseases guide for Pediatricians, Recognising Congenital Heart Diseases