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Essential Paediatric Cardiology for Primary Care

This comprehensive guide by Dr. J. Cyriac covers acquired and congenital heart diseases in children, with a focus on referrals, red flags, and management approaches. Explore types of structural and acquired heart diseases, severity classifications, and presentations at different age groups. Learn about critical and serious heart lesions, common symptoms, and the importance of early detection. The guide emphasizes the significance of clinical evaluation, including monitoring respiratory distress, heart sounds, and peripheral pulses. Gain key insights on recognizing potential risk factors and genetic influences on heart health.

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Essential Paediatric Cardiology for Primary Care

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  1. Essential Paediatric Cardiology for Primary Care Dr J Cyriac Consultant Paediatrician Special Interests: Cardiology, Nephrology Mid Essex Hospitals NHS Trust Chelmsford Ramsay Springfield Hospital Chelmsford GPSTP

  2. Vast Topic Acquiredheart disease Cyanotic heart disease Tachyarrhythmia Acyanotic heart disease Familial Late onset heart disease Brady arrhythmia GPSTP

  3. Classification GP Update

  4. “You have the potential for heart disease, but currently you are okay !” Risk Factor and Genotype Heart Disease

  5. Scope of this presentation • General Overview • Based on type, severity and age of presentation • GP perspective :Common referrals • Red flag signs • My approach to cardiac diseases • Illustrations of common CHD GPSTP

  6. Presentations Cong Structural Heart Disease • Antenatal Scanning • Newborn check • Six week check • Cardiorespiratory collapse • Cyanosis • Congestive cardiac Failure • Associated Symptoms • Incidental murmur

  7. Structural Acquired Heart Disease • Hypertrophic Cardiomyopathy: Intrinsic and extrinsic • Dilated Cardiomyopathy: Intrinsic and extrinsic • Infective heart disease • Immune mediated heart disease • Consequential Heart Disease: chemotherapy, injury, radiation, metabolic etc.

  8. My classification of CHD based on severity • Critical: Sudden death, Collapse, Shock Emergency Intervention: Prostaglandin, Catheter, cardiac operation • Major: Significant symptoms: Device intervention or operation • Moderate: Some symptoms: Medical or device intervention • Mild: minimal consequence GP Update

  9. Presentations based on age groups GP Update

  10. Pre-Antenatal Scan Era-----------------------------------Post Antenatal Scan Era GP Update

  11. Heart Disease in Infancy Critical and Serious 1-4 months Serious and Significant 4-8months Significant and Important 8-12months

  12. Timing of Presentation GPSTP

  13. Types of Presentation • Antenatal Diagnosis • Postnatal Ward • Cyanotic episodes • Incidental murmur • Absent Femoral pulse • Collapse/Shock/Sudden Death( Critical Heart Lesion) • Incidental detection of tachycardia (SVT) • Incidental Detection of Bradycardia (Complete Heart Block) Breathlessness, Poor feeding etc. (CCF) GPSTP

  14. Types of Presentation • Neonatal period following discharge • Cyanotic episodes • Poor feeding, weight faltering, breathlessness (CCF) • Collapse/ Sudden Death (Critical heart lesion) • Funny Turn (SVT) • 8 week check • Weight Faltering, Poor feeding, breathlessness (CCF) • Incidental Murmur • Cyanotic Episodes • Absent or feeble femoral pulses • Funny Turn GP Update

  15. Presentation in Infancy • Weight faltering, Poor Feeding, Breathlessness (CCF) • Recurrent respiratory infections • Delayed recovery with chest infection • Incidental detection of murmur • Funny Turn (SVT) • Incidental detection of absent femoral pulse • Cyanotic episodes (infrequent) GP Update

  16. Presentation in Toddler and Preschool period • Recurrent chest infections • Delayed recovery from chest infection • Incidental detection of murmur • Blue episodes • Funny turn/Palpitation (SVT) • Breathlessness on exertion GP Update

  17. Presentation in school age children • Breathlessness on exertion • Incidental detection of murmur • Palpitations • Chest Pain • Blue Episodes GP Update

  18. Presentation in Teenagers • Syncope • Chest Pain • Exertional Breathlessness • Palpitations • Sudden Collapse/Death GP Update

  19. Essential Clinical Evaluation • Signs of respiratory distress • Oxygen saturation lower limb • Peripheral pulses • Precordial activity • Murmur • Heart Sounds • Liver size

  20. Questions? GP Update

  21. Conclusion and take home messages • Antenatal diagnosis is not foolproof • Critical CHD presents in the first few weeks of life • Don’t diagnose innocent heart murmurs in infancy! • In infancy significant heart disease can be present even without significant murmurs GP Update

  22. Conclusion and take home messages • In each patient at least once feel femoral pulse • Invest in a paediatric probe for oxygen saturation monitor • Watch out for exertional chest pain and exertional syncope • Family history of sudden death (especially if <30 years of age), prolonged QT syndrome or HOCM. GP Update

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