cardemerg - Cardiacemergencies andthePediatrician Thomas R....

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Cardiac emergencies  and the Pediatrician Thomas R. Burklow, MD Asst C., Pediatric Cardiology Walter Reed Army Medical Center National Capital Consortium
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Cardiac emergencies Congestive heart failure Hypercyanotic spells Tachyarrhythmias Hypertensive crisis
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How do you know you are dealing with a cardiac emergency?
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Case Presentation #1 4 month old presents to ER with cc: “cold symptoms” 5 day history of increasing cough; afebrile, no rhinorrhea, no ill contacts. PMH: unremarkable. vigorous feeder (25- 30oz/d) until the last couple of days. FHx: father had a “leaky valve” but was cleared to join the Marines
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Physical Examination VS: HR 165, RR 60, normal BP throughout; RA O 2 sat mid 80’s, increases to 97% on 1/4 L/ O 2 Small for age male, nondysmorphic, mild cyanosis, moderate increased work of breathing Left chest prominent Prominent PMI, RRR, S 2 obscured by murmur, gr III pansystolic SRM over apex to left axilla Liver edge 4 cm below RCM 1+ pulses throughout
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Electrocardiogram
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Chest X ray
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What is the pathological condition which is present in this infant? What information supports this supposition? What do you do?
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Clinical manifestations Infant feeding difficulties failure to thrive diaphoresis tachycardia tachypnea Child breathlessness tachycardia tachypnea peripheral edema cardiomegaly
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What causes congestive heart failure? Excessive work load: pressure or volume Normal workload faced by a damaged myocardium
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Etiologies Neonate dysfunction volume pressure Infant Volume Dysfunction Child Palliated congenital heart disease AV valve regurgitation Acute rheumatic fever Myocarditis Endocarditis
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Neonatal congestive heart failure Dysfunction
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cardemerg - Cardiacemergencies andthePediatrician Thomas R....

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