Congenital Heart Disease CHD : Clinical Presentation,Clinical Symptoms

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

Cardiology in Children

Congenital Heart Disease : General Aspects

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CONGENITAL HEART DISEASE: GENERAL ASPECTS

Related topics

Definition and Incidence of CHD

Etiology of CHD

Investigations,
Classification and Diagnosis of CHD

Dr N.C.Joshi
Consultant Pediatrician,
Consultant at Nanavati Hospital,
Ex Dean:-B.J.Wadia Children's Hospital.

CLINICAL PRESENTATION :

Despite a large number of cardiac defects that exist, there are only a limited number of physiological disturbances that can be produced. Congenital heart disease usually presents in infancy as cyanosis or heart failure or a combination of both, heart murmur, circulatory shock, stridor, hypercyanotic spells, different respiratory tract infections and growth failure.

Cyanosis

Cyanosis is blue discoloration of the skin, mucus membranes and nails due to presence of desaturated hemoglobin more than 5 gm/dl percent in arterial blood. Those cardiac anomalies in which systemic venous return reaches systemic circulation without passage through lungs, presents with central cyanosis and clubbing of fingers.

Cyanosis occurs under following circumstances :

Reduced pulmonary blood flow in defects with right ventricular outflow tract obstruction
Right to left shunts as in Tetralogy of Fallot
Discordant ventriculoarterial connections as in transposition of great arteries, and
Mixing of venous and arterial blood as in truncus arteriosus or single ventricle.

Heart Failure

When heart cannot supply the blood flow demanded by tissues, a clinical syndrome of symptoms and signs manifest from elevated atrial pressure. It manifests with rapid and labored breathing due to pulmonary edema, pallor with peripheral cyanosis due to poor cardiac output, tachycardia and excessive sweating due to increased sympathetic activity and feeding difficulties.

Heart failure occurs in following situations:

Volume overload in all defects with left to right shunt like ventricular septal defect, atrial septal defect, patent ductus arteriosus,
Pressure overload in pulmonary and aortic valve stenosis
Intrinsic myocardial diseases as in cardiomyopathies, and
Decreased or increased diastolic fillings as in tachyarrhythmias and bradyarrhythmias.

Heart Murmurs

In older children and in infants, congenital heart disease presents as a heart murmur detected on routine examination. The murmurs are produced due to abnormal pressure gradient across laminar or nonlaminar pathways. The murmur is continuous in patent ductus arteriosus, pansystolic in ventricular septal defect and pulmonary stenosis and diastolic in atrioventricular valve stenosis.

Shock

Cardiac malformations resulting in a hypoplastic ascending aorta, aortic atresia result in low cardiac output. Child appears extremely ill with cold extremities, diminished pulses, low blood pressure, peripheral cyanosis and is semicomatose.

Hypercyanotic Spells

In cardiac malformations with pulmonary infundibular stenosis, the obstruction is of dynamic variety. Whenever the muscular outflow tract contracts, blood flow to pulmonary circuit diminishes and patient gets intense cyanosis. It occurs in Fallot's tetralogy and defects with Fallot's physiology.

Stridor

Malformations leading to compression of trachea and bronchi causing obstruction of the airways, present with stridor, as seen in vascular rings and in dilated pulmonary artery due to increased pulmonary blood flow.

Chest Pain

Malformations like anomalous origin of left coronary artery, severe aortic stenosis lead to myocardial ischemia and patient presents with episodes of screaming, pallor and chest pain.

Recurrent Respiratory Tract Infections

In cardiac defects with left to right shunt, as seen with ventricular septal defect and patent ductus arteriosus, there is a decreased lung compliance which leads to frequent respiratory tract infections.

Growth Failure

Growth failure is a very common manifestation of heart defects due to poor oxygen saturation in the growing tissues, persistent heart failure, and frequent respiratory infections with undernutrition.

Next : Investigations,Classification and Diagnosis of CHD

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