history taking in congenital heart disease docx - كتابة الطلاب

--Hx of CCHD:-

Ask about:-
1-Dyspnea on extertion like feeding,crying
2-orthopnea:-on lying down
3-cyanosis:-when Hb >50g/l --Hb>5g/dl
Normal physiological cyanosis occurs in :- cold there will be bluish discoloration of skin but NOT mucous membrane

--why do we examine for cyanosis in mucous membrane ?

1)rich of BVs
2)transparent
3)one layer
4)no melanin

4-sweating:-by exertion

5-edema :-on exam
Swelling in Hx
**where we examine it ?
On non –walking child above sacral area"Plz remove the diaper"
In walking child2 fingers above medial melleoullos in the leg.

6-fainting: Syncope is a faint with loss of consciousness

7-in exam :-clubbing

**in TOF no H.F:bec pulmonary stenosis will prevent pulmonary edema
**hypercyanotic speels:-relieved by squatting position :knee chest position

**characters in Tof:from lec

*we give them B-blocker to help them relieve the stenosis
**fever occurs in Tofblood is hyperviscouspolycythemia-so dehydration will influence them
O2 +rehydration ---imp

**characters of innocent murmers?

1-soft:grades1-3 in intensity & often mid systolic
2-localized
3-poorly conducted
4-Not usually conducted posteriorly
5-variable with respirarion & position

Causes of edema :-

Unilateral edema
Bilateral edema
1-DVT
2-hemiplegia
3-lymphatic obstruction
1-chronic venous insufficiency
2-H.F
3-inf.vena caval obstruction
4-thiamine deficiency
5-kwashiorker
6-drugs:fludrocortisones

**murmers
Most murmer in pediatric is ejection systolic murmer
1-innocent murmer
2-fever
3-Atrial septal defect
4-severe anemia
5-aortic stenosis
6-pulmonary stenosis
7-aortic regurgitation

**pansystolic murmer

1-VSD
2-mitral regurgitation
3-tricuspid regurgitation

**always ask detailed about ht ,wt of pt

Degree of murmers:-in next lec

history taking in congenital heart disease

**2nd heart sound varieties:-

Wide split:-inspiration
1)VSD
2)pulmonary stenosis
3)pulmonary hypertension

Fixed splitting:-

ASD

Wide split:-in expiration

Aortic stenosis
Lt bundle branch block

Varities of 1st heart sound:-

1)quiet
2)variable
3)loud

Causes of 3rd heart sound:-

1)m.regurgitation
2)pregnany
3)fever
4)athlets

**causes of increased pulse volume?
1-fever
2-thyrotoxicosis
3-anemia
4-aortic regurgitation
5-paget's dis of bone

Causes of reduced pulse volume?

1-shock
2-aortic stenosis
3-H.F

---pulsus alternas:-H.F"LT"

--always try to palpate lower edge of liver coz it is enlarged in H.F

--how u differentiate murmers "true"from innocent?

1-symptoms
2-radiation
3-thrill

Causes of AF:-

1-H.F
2-thyrotoxicosis
3-infection
4-mitral valve di
5-hypertension

Pulse volume - decrease in inspiration ?

Due to the raised intrathoracic pressure affects the venous return to the heart .

Pulse volumeincrease in expiration

If the variability is exagerratedpulsus paradoxicus

Occurs in :- ASTHMA

How to be sure :-measure SBP in inspiration + expiration if more than 15mmhgpathological

On exam after the general :-

Assess H.R
1)rate
2)rhythm
3)character
4)state of blood vessel
5)radiofemoral delay
6)volume

**in coarctation of aorta:-congenital narrowing of aorta distal to lt subclavian artery
Upper limbs pulses normal ,,lower limb pulses reduced " radiofemoral delay"in children
In adults
1)hypertension
2)H.F

**collapsing pulse:-AR+av malformation

Peak of pulse arrives early & then there is rapid fall or descent
Maneuvre :-raise the pt's hand above the level of heart

**slow rising pulse :-gradual upstroke with reduced peak

Aortic stenosis(late in systole)

**bisferiens pulse:-2 systolic peaks separated by one mid systolic dip

AS+AR
**every murmer u hear ,u should analyze the:-
1-timing
2-site
3-intensity
4-radiation
5-pitch
6-duration

For ex:-
I heard 1st & 2nd heart sound with pansystolic murmer concamittant with the first heart sound localized in the apex ,loud ,blowing in character ,maximal intensity at apex & radiated to axilla

history taking in congenital heart disease