Review Pediatrik

8/18/2019 Review Pediatrik

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Review kardiologi anak

Debora

FAKULTAS KEDOKTRAN N


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Children are not little adults Adults are not big chi


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DIAGNOSIS PENYAKIT JANTUNG

1. Diagnosis Kausal

2. Diagnosis Anatomis

3. Diagnosis Fungsional


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DIAGNOSA KAUSAL


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DIAGNOSIS KAUSAL

Penyakit Jantung pada Anak TIDAK SAMA dengan Pe

Jantung pada Dewasa

Penyebab : 80 % bawaan (kongenital)

Gejala : sangat tidak jelas

Tatalaksana : 75 % surgical intervention


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Etiologic Basis of Congenital Heart

Diseases

1. Primary genetic factors 10%

1) Chromosomal 5-10%

2) Single mutant gene 3%

2. Genetic-environmental interaction 90%

1) Multifactorial inheritance (majority)

2) Risks to offspring of an affected parent

3) Environmental contribution

Drugs

Infections

Maternal conditions


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8/55 T R

A N S I T I O N

A L C I R C U

L A T I O N


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DIAGNOSIS ANATOMIS


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ATRIAL SEPTAL DEFECT


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COARCTATION OF THE AORTA PULMONIC STENOSIS AORTIC S


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DIAGNOSIS FUNGSIONAL


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CHD

ACYANOTIC

↑Pulmonary Blood

Flow

ASD,

VSD,

PDA

Obstruction to

blood flow fromventricles

Coartation ofaorta,

Aortic stenosis,Pulmonic Stenosis

CYANOTIC

↓ Pulmonaryblood flow

ToF,Trikuspid atresia

Mixed bloodflow

TGA,Truncus arteriosus

Hipoplastic left hea


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Diagnosa Fungsional

PINKShunts ( L to R) :

• ASD

• VSD

• PDAStenosis:

• AS

• PS

• Coarctation

• HLHS

BLUE

• TOF

• TGA

• Tricuspid atresia

• Truncus

• TAPVR

• Ebstein’s

• Single ventricle


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Presentation of CHD

1. Shock like symptoms

2. Cyanosis

3. Congestive symptoms

4. Exercise intolerance

5. Asymptomatic heart murmur

6. Abnormality in routine chest PA

7. Chest pain

8. Syncope/ seizure/ fainting

9. Airway obstruction/ dysphagia


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CARDIAC CYANOSIS

1. Kebiruan mukosa mulut, lidah, kelopak mata,ya

bertambah jelas saat menangis.

2. Tidak timbul segera setelah lahir

3. Takipnea tanpa distres pernafasan

4. Suhu tetap hangat.

5. Tes hiperoksia positip

AWAS : anemia, pigmen kulit, hipotermi,asfiksia


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PEMERIKSAAN FISIK


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CARDIAC AUSCULTATION AREAS


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HEART SOUND

• Ejection click = AS or PS

• Loud S2 = Pulmonary HTN

• Single S2 = one semilunar valve (truncus), anterior aorta (TGA), pulmo

• Fixed, split S2 = ASD, PS

• Gallop (S3) – may be due to cardiac dysfunction/ volume overload

•

Muffled heart sounds and/or a rub = pericardial effusion ± tamponad

Types of Murmurs

• Systolic Ejection Murmur (SEM) = turbulence across a semilunar valve

• Holosystolic murmur = turbulence begins with systole (VSD, MR)

• Continuous murmur = pressure difference in systole and diastole (PDA


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FOTO POLOS DADA


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ELEKTROKARDIOGRAFI


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8 STEP IN ECG

Step 1 : Rate

Step 2 : Rhythm

Step 3 : Axis

Step 4 : Precordial leads

Step 5 : Hyperthrophy

Step 6 : Block

Step 7 : Ischemia, injury etc

Step 8 : Miscelaneous


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KEGAWATAN JANTUNG

PADA BAYI DAN ANAK


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PEDIATRIC

CARDIAC

EMERGENCY

PROBLEMS

DYSRHITHMIA

HYPERTENSIVE

CRISIS

TAMPONADE

THROMBO

EMBOLIC

CYANOTIC

SPELS

SHOCK

HEART FAILURE


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PRESENTASI KLINIS YG SELALU ADA PADAGAWAT JANTUNG

1. Takipnea

2. Sianosis3. Renjatan


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GAGAL JANTUNG


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Pemahaman gagal jantung

Gagal jantung bukanlah suatu keadaan klinis

hanya melibatkan satu sistem tubuh melainka

SINDROMA KLINIK akibat kelainan jantung yan

ditandai dengan suatu bentuk respons hemod

ginjal, syaraf dan hormonal yang nyata.


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Adaptation in heart failure

BP = CO x SVR

BP = SV x HR x SVR

Frank-Starling

Remodelling

SA system

SA system SA system

RAAS


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Kompetensi

katup

Preload Afterload

Kontraktilita

Heart rate

Sinergistik

Kontraktilitas

viskositas darah

endotel

CONTRACTILITY


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STROKEVOLUME

PRELOAD

CONTRACTILITY

AFTER

-SYNERGISTICCONTRACTION

-VALVULARCOMPETENCE

HEARTRATE

CARDIACOUTPUT


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HEMODYNAMICSMyocardiContracti

Stroke Volume Preload

Cardiac Output Afterload

Blood Pressure Heart Rate

Systemic Vascular Resistance


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presents immediately at birthanemia, acidosis, hypoxia, hypoglycemia, hypocalcemia, sep

presents at 1 day (congenital)PDA in premature infants

presents in first month (congenital)HPLV, aortic stenosis, coarctation, VSD presents later

presents later (acquired)myocarditis, cardiomyopathy (dilated or hypertrophic), SVT, serheumatic fever

The causes of CHF depend on “the ag


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Neonatal congestive heart failure

Dysfunction• Myocarditis

• Cardiomyopathy — think inborn error of metabolism

• Coronary artery anomaly

• Arrhythmias

Volume

•

Unrestrictive ventricular septal defect(s)• Truncus arteriosus

Pressure — think ductal-dependent left-sided obstruction

• Hypoplastic left heart syndrome

• Critical aortic stenosis

• Critical coarctation of the aorta


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Hypertension, Anemia, sepsis

Bronchoplumonary dysplasia in premature

Acute corpulmonle due to airway obstruction

Toxins: digitalis, calcium channel blockers, Beta blockers

Pediatric CHF – Non Cardiac Etiology


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KLINIS

infants:

irritable, poorfeeding (earlyfatigue), failure tothrive, respiratorysymptoms

*always considerin patients withrespiratorysymptoms

LABORATORY

-CBC: anemia orinfection

-Blood gas:respiratoryalkalosis ormetabolicacidosis

-Renal and

hepatic function

Thorax RÖ

-Cardiomegaly isalmost alwayspresent-Increasedpulmonary bloodflow

PENUNJANG

ECG

ECHO

Pulse oxymetri

Hyperoxia test

2. Block the


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Activates the

RAAS

Sympathetic NervousSystem

salt & fluidretention

workload weakness of heart muscle

Inssuficientblood pump

blood vesselsContractility

workload

1. Increase force

of contraction

3. Block the SNS

RAAS

4. Increase urine

production


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CARDIAC CYANOSIS


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Central Cyanosis vs. Acrocyanosis


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Newborn Problems - Cyanosis

Cardiac Cyanosis

Does not respond to oxygen

Does not respond to ventilation

Usually no respiratory distress


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Differential Diagnosis of cyanosis

1. Not enough oxygen in

Apnea : neurologic and drugs

Diffusion barrier : RDS, aspiration, pneumonia

Obstruction: pneumothorax, head position

2. Oxygen “mal-absorption” Shunting lesions : cardiac

non-cardiac : PPHN, Hematologic

Methemoglobinemia : carboxyhemoglobinemia

3. Too much oxygen out

sepsis

low flow, high extraction

acrocyanosis

hyperviscosity/polycythemia

extravasated (e.g. bruising)


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squating


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Treatment of CYANOTIC SPELLS

Knee-chest or squatting positioning (increases afterload thus

decreasing R to L shunting)

Manual external aortic compression be low level of renal art

Morphine, 0.1-0.2 mg/kg IV or SC (to treat hyperpnea and

decrease systemic catecholamines)

Oxygen (perhaps limited value)

Intravenous volume expansion, 10 cc/kg isotonic


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Treatment of CYANOTIC SPELLS

Sodium bicarbonate 1-2 mEq/kg/dose

Propanolol, 0.15-0.25 mg/kg IV over 2-5 minutes(to block be

in infundibulum therefore lessening RV outflow obstruction

Phenylephrine, 0.1 mg/kg IM or SC(increases afterload there

decreasing R to L shunt)

General anesthesia (if severe/prolonged spells)

interim prophylactic treatment with propranolol while await

Knee chest


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Knee chest


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Thank You

Review Pediatrik

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