Presentation is loading. Please wait.

Presentation is loading. Please wait.

Paediatric Cardiology- after one year of age Jon Skinner.

Similar presentations


Presentation on theme: "Paediatric Cardiology- after one year of age Jon Skinner."— Presentation transcript:

1 Paediatric Cardiology- after one year of age Jon Skinner

2 Topics to cover Murmur in a well four year old ECG in diagnosis of CHD CXR in diagnosis of CHD

3 Murmur in a well four year old What are the possibilities?

4 Murmur in a well four year old What are the possibilities? –Innocent murmur

5 Murmur in a well four year old What are the possibilities? –Innocent murmur –Atrial septal defect

6 Murmur in a well four year old What are the possibilities? –Innocent murmur –Atrial septal defect –Ventricular septal defect

7 Murmur in a well four year old What are the possibilities? –Innocent murmur –Atrial septal defect –Ventricular septal defect –Valvar stenosis

8 Murmur in a well four year old What are the possibilities? –Innocent murmur –Atrial septal defect –Ventricular septal defect –Valvar stenosis –Aortic coarctation

9 Murmur in a well four year old What are the possibilities? –Innocent murmur –Atrial septal defect –Ventricular septal defect –Valvar stenosis –Aortic coarctation –Patent arterial duct

10 Murmur in a well four year old What are the possibilities? –Innocent murmur –Atrial septal defect –Ventricular septal defect –Valvar stenosis –Aortic coarctation –Patent arterial duct –Miscellaneous rare stuff- HCM, valvar regurg etc

11 Murmur in a well four year old No. 1 What is this? –Pulses normal, BP 95/60 –RV lift –2-3/6 ESM at upper LSE –ECG- –CXR

12 Murmur in a well four year old No. 1

13 Murmur in a well four year old No. 1

14 Murmur in a well four year old No. 1 What is this? –Pulses normal, BP 95/60 –RV lift –2-3/6 ESM at upper LSE –ECG- normal axis IRBBB –CXR-mild cardiomeg, plethora, prominent PA

15 Murmur in a well four year old No. 2 No. 2 What is this? –Pulses normal, BP 95/60 –Normal precordium –2-3/6 vibratory ESM at upper and lower LSE –ECG- normal axis IRBBB –CXR-normal

16 Murmur in a well four year old No. 2- murmur disappears doing this

17 Murmur in a well four year old No. 2 No. 2 What is this? –Pulses normal, BP 95/60 –Normal precordium –2-3/6 vibratory ESM at upper and lower LSE –murmur disappears on stretching the neck –ECG- normal axis IRBBB –CXR-normal

18 Murmur in a well four year old No. 3 What is this? –History of recurrent chest infections –Pulses normal, BP 100/65 –RV lift. –2-3/6 ESM at upper LSE, fixed split of second sound –ECG- IRBBB –CXR- Cardiomeg, plethora, prominent PA

19 Murmur in a well four year old No. 3

20 No. 3 What is this? –Pulses normal, BP 100/65 –RV lift. Harrisons sulci –2-3/6 ESM at upper LSE, fixed split of second sound –ECG- IRBBB –CXR- Cardiomeg, plethora, prominent PA –Diagnosis--

21 Murmur in a well four year old No. 4 No. 4 What is this? –Pulses normal, BP 100/65 –Parasternal thrill –4/6 PSM at lower LSE, –ECG- –CXR- Normal

22 Murmur in a well four year old No. 4

23

24 No. 4 What is this? –Pulses normal, BP 100/65 –Parasternal thrill –4/6 PSM at lower LSE, –ECG- Borderline LVH –CXR- Normal –Diagnosis?

25 Murmur in a well four year old No. 5 No. 5 What is this? –Slim child, recurrent chest infections –Pulses normal, BP 95/60 –Overactive precordium –2/6 low pitched PSM at lower LSE, 2/4 diastolic murmur at apex –ECG- –CXR-

26 Murmur in a well four year old No. 5

27

28

29 No. 5 What is this? –Slim child, recurrent chest infections –Pulses normal, BP 95/60 –Overactive precordium –2/6 low pitched PSM at lower LSE, 2/4 diastolic murmur at apex –ECG- RVH, LVH –CXR- Cardiomegally and plethora –Diagnosis?

30 ECG diagnosis of atrial hypertrophy?

31 Lead II

32 Conditions causing Atrial hypertophy on the ECG RAH LAH

33 Murmur in a well four year old No. 6 No. 6 What is this? –BP 130/90 –Soft ESM at upper RSE –ejection click –ECG- LVH with strain –CXR- unavailable

34 Murmur in a well four year old No. 6 No. 6 What is this? –BP 130/90 –Soft ESM at upper RSE –ejection click –ECG- LVH with strain –CXR- unavailable –What do you wish to examine now?

35 Murmur in a well four year old No. 6 No. 6 What is this? –BP 130/90 –Soft ESM at upper RSE –ejection click –ECG- LVH with strain –CXR- unavailable –What do you wish to examine now? –Diagnosis?- what might the CXR show?

36 Boys Girls Paediatrics (suppl) 59:797, 1977 Normal blood pressure values in children

37 Murmur in a well four year old No. 7 What is this? –Pulses normal, BP 90/65 –RV lift. –2-3/6 ESM at upper LSE, fixed split of second sound –ECG- –CXR-

38 Murmur in a well four year old No. 7

39

40 Murmur in a well four year old No. 7 What is this? –Pulses normal, BP 90/65 –RV lift. –2-3/6 ESM at upper LSE, fixed split of second sound –ECG- LAD IRBBB –CXR- CM plethora –Diagnosis?

41 Types of ASD

42 What does this ECG show? 2 year old, loud systolic murmur, mild cyanosis (88%)

43 What does this CXR show? 3 month cyanotic infant

44 What does this CXR show?

45 Topics we have covered (superficially!) Murmur in a well four year old ECG in diagnosis of CHD –chamber hypertrophy –QRS axis –RBBB in ASD CXR in diagnosis of CHD –L-R shunts-> cardiomegally and plethora –oligaemia –chamber hypertrophy

46 Useful texts Essential paediatrics- Hull and Johnstone, Church Liv Pediatric Cardiology for practitoners- Myung K Park, Mosby How to Read Pediatric ECGs- Park and Guntheroth, Mosby Heart Disease in Paediatrics- Jordan and Scott, Butterworths

47 Paediatric ECGs the rules Jon Skinner Green Lane Hospital

48 Criteria for chamber enlargement RA p wave amp >3mm LA bifid p wave and prolonged >.10 secs - ie 2.5 squares (.08 secs in infants) RV - use Davignon charts. R in V1>20v (4 squares) >25v in neonates or S in V6 >7v. OR upright T wave in V1 after 72 hours and up to 5 years. Severe RVH- ST and T wave now invert with ST depression, and small Q wave in lead V1. LV R in V6 >25v (5 squares). Severe- ST depression and T wave inversion V6.

49 Q- waves Are allowed (usual) in 1,2, 3 and aVf, V5 and V6 and are narrow and up to 7mm deep in 2 and 3 Are pathological in V1 (except occasional newborns) and indicate LTGA, single ventricle, severe RVH or anterior MI (deep and wide).

50 QT interval QTc = QT (ms)/ sq root R-R interval (ms) is less than 0.45sec Refer to Normal reference values Measure in lead 2 and V5 (and particularly not in V2- V4)

51 Abnormal ST segment (up or down) Up to 1mm is normal Up to 2 mm is normal in V2- V4 Causes?


Download ppt "Paediatric Cardiology- after one year of age Jon Skinner."

Similar presentations


Ads by Google