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Neonate in Cardiac Distress Clinical Recognition

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Presentation on theme: "Neonate in Cardiac Distress Clinical Recognition"— Presentation transcript:

1 Neonate in Cardiac Distress Clinical Recognition
Savitri Shrivastava Director - Pediatric & Congenital Heart Diseases Fortis Escorts Heart Institute New Delhi, India

2 Why Important ? Congenital Heart Disease Infant Mortality
New Born in Cardiac Distress - 1% Live Births - 2 % in Premature infant 30% need Urgent Attention Infant Mortality - 25 % due to Heart Defects Early recognition and prompt management can save most of them Congenital Heart Disease

3 Neonatal Heart Disease
New Born in Cardiac Distress Neonatal Heart Disease High index of suspicion Prompt recognition Early stabilization Timely referral “ Crucial for an optimal outcome”

4 New Born in Cardiac Distress
Fetal Diagnosis

5 Is the Neonatal Distress due to Heart Disease?
Bed side evaluation has limitations! Some important clinical clues are useful - History/Physical Examination - X Ray Chest - EKG - Pulseoximeter/Hyperoxia test Echocardiogram

6 Sudden deterioration in symptoms (Duct dependant Lesions)
New Born in Cardiac Distress Neonate in Cardiac Distress Presentation Symptoms:- Lethargy , Irritability Difficulty in feeding Fast respiration Increased precordial activity Bluish discoloration Sudden deterioration in symptoms (Duct dependant Lesions) Contd..

7 Neonate in Cardiac Distress
New Born in Cardiac Distress Neonate in Cardiac Distress Physical Examination Pallor , Mottled Skin, Cyanosis Respiratory distress, Grunting Weak /unequal pulses Low/ unequal B.P.

8 Cyanosis - Hyperoxia Test
New Born in Cardiac Distress Cyanosis - Hyperoxia Test 100% O2~10 min.. < 150 >200 150 to 200 < 70 CHD likely CHD unlikely CHD very likely PO2 (mmHg) 8

9 Severe Cyanosis with Cardiomegaly
New Born in Cardiac Distress Duct Dependent Mixing Severe Cyanosis with Cardiomegaly Tachypnoea, Tachycardia Hypatomegaly, Gallop Insignificant murmur X Ray Chest – CE / narrow pedicle / pulmonary plethora Most likely dTGA Intact septum, without PS

10 Duct Dependent Pulm. Circulation Severe Cyanosis PBF
New Born in Cardiac Distress Duct Dependent Pulm. Circulation Severe Cyanosis PBF No CHF, No Cardiomegaly Single Second Sound Ejection murmur + Continuous murmur + No S3, No mdr Pulm. Atresia / Severe RVOTO with TOF physiology Pulmonary atresia Intact septum

11 Duct Dependent Syst. Circulation
New Born in Cardiac Distress CHF, Shock Duct Dependent Syst. Circulation Weak femoral pulses B.P. - Right Upper Limb - Lower Limb Saturation - Right Upper Limb Normal - Lower Limb Low Severe Coarctation Arch Interruption HLHS - Unequal

12 Respiratory Distress , Cyanosis, PAH TAPVC with Obstruction
New Born in Cardiac Distress Respiratory Distress , Cyanosis, PAH CHF Cardiomegaly + No murmur or TR murmur P2 loud, S3 Chest X ray TAPVC with Obstruction Contd….

13 Respiratory Distress , Cyanosis, PAH
New Born in Cardiac Distress Respiratory Distress , Cyanosis, PAH Marked  in PO2 • PA Chest Hyperoxia Test No Significant  in PO2 Pulm. Lesion PPHN

14 CHF, Severe Cyanosis, No PAH
New Born in Cardiac Distress CHF, Severe Cyanosis, No PAH CE, PBF, CHF Multiple Heart Sounds TR murmur Ebstein’s Anomaly Contd..

15 CHF, Severe Cyanosis, No PAH
New Born in Cardiac Distress CHF, Severe Cyanosis, No PAH Ejection Syst. Murmur TR Murmur S3, S4 Critical PS + TR

16 CHF, Mild Cyanosis Cardiomegaly Flow murmurs Admixture Lesions
New Born in Cardiac Distress CHF, Mild Cyanosis Cardiomegaly Flow murmurs Admixture Lesions TGA Physiology without PS TAPVC without Obstruction AR murmur - Patent Trunkus Arteriosus

17 Respiratory Distress, Mild Cyanosis Absent Pulmonary Valve Syndrome
New Born in Cardiac Distress Respiratory Distress, Mild Cyanosis Ejection systolic murmur PR murmur X Ray Chest Absent Pulmonary Valve Syndrome

18 Acyanotic, CHF, Shock Lethary/Irritability CHF MR murmur ALCAPA
New Born in Cardiac Distress Acyanotic, CHF, Shock Lethary/Irritability CHF MR murmur ALCAPA Contd..

19 Acyanotic, CHF,Shock Weak Pulses Cardiomegaly
New Born in Cardiac Distress Acyanotic, CHF,Shock Weak Pulses Cardiomegaly Ejection Syst. Murmur , S3, S4 X Ray Chest – Cardiomegaly EKG Critical AS

20 Acyanotic with CHF Cardiomegaly Flow murmurs - Associated
New Born in Cardiac Distress Acyanotic with CHF Cardiomegaly Flow murmurs - Multiple sites of shunts - Associated * LVOT Obstruction * Regurgitant lesion

21 Acyanotic CHF Primary myocardial disease
New Born in Cardiac Distress Acyanotic CHF Primary myocardial disease Secondary myocardial dysfunction Hypocalcaemia/Hypoglycemia/Diabetes Perinatal asphyxia, Sepsis Adrenal insufficiency Metabolic and Genetic Disorders Glycogen Storage Disease( Pompe’s disease) Contd..

22 Arrhythmia resulting in Myocardial Dysf. & CHF
New Born in Cardiac Distress Arrhythmia resulting in Myocardial Dysf. & CHF Tachyrrhythmia - SVT Bradyarrhythmia - CHB

23 Acyanotic CHF with High Output State
New Born in Cardiac Distress Acyanotic CHF with High Output State Bounding Pulses Term Baby - No significant cardiac murmur - Continuous murmur over head A-V Fistula – Cerebral Premature Baby - Good volume pulses - Pulsation 2LIC space, arch - Continuous murmur + - Ejection murmur below left clavicle PDA in premature babies Severe Anemia

24 Neonate in Cardiac Distress
New Born in Cardiac Distress Neonate in Cardiac Distress Cyanotic Mild Cyanosis Severe Cyanosis PA Chest * PBF – PS *  PBF – TGA * Severe PVH Obst. TAPVC Shock, Weak Fenorals * Coarct. * AA Interruption * HLHS Resp. Distress PA Chest - Hilar Pas ++ * APV CHF PA Chest PBF * Admixture Lesions

25 Neonate in Cardiac Distress
New Born in Cardiac Distress Neonate in Cardiac Distress Acyanotic, CE, CHF PA Chest – CE, NPBF High Output State Cerebral AVM PDA Premature NB Severe Anemia ALCAPA Critical AS Critical Coarct. Arrhythmia Myocardial diseases Primary Secondary

26 Take Home Message High Index of Suspicion
New Born in Cardiac Distress Take Home Message High Index of Suspicion Systematic approach without panic Careful evaluation of Bedside Clues, Chest X ray and EKG gives enough information to plan emergency management and prompt referral, to tertiary care centre resulting in excellent results.

27 Thanks

28 Neonate with Cyanosis ↓ PBF
New Born in Cardiac Distress Neonate with Cyanosis ↓ PBF

29 Regurgitant lesions with CHF (AV/Semilunar valves)
New Born in Cardiac Distress Regurgitant lesions with CHF (AV/Semilunar valves) MR / TR murmur » AVSD Isolated TR murmur » Ebstein’s / Dysplastic TV Isolated MR murmur » DCM, ALCAPA, Cleft MV AR murmur » PTA Medical Stabilization ALCAPA - Urgent Surgery

30 Neonate in Distress without Cyanosis
New Born in Cardiac Distress Neonate in Distress without Cyanosis Gross CHF  Myocardial diseases  ALCAPA  LVOT Obstruction  Arrthymia

31 CHF Acyanotic with High Output State
New Born in Cardiac Distress CHF Acyanotic with High Output State Bounding Pulses Term Baby - No significant cardiac murmur - Continuous murmur over head A-V Fistula – cerebral Premature Baby - Good volume pulses - Pulsation 2LIC space, arch - Continuous murmur + - Ejection murmur below left clavicle PDA in premature babies Severe Anemia

32 CHF, Cyanosis PBF Multiple heart sounds TR murmur PA Chest EKG

33 Indicators of Heart Disease
New Born in Cardiac Distress Indicators of Heart Disease Dysmorphic features Poor Feeding, Weight  Lethargy / Irritability Tachypnoea, Tachycardia, CHF Respiratory Distress, Cyanosis Abnormal pulses / Shock

34 New Born in Cardiac Distress
Severe Pulmonary Stenosis

35 New Born in Cardiac Distress
Figure-12 b& c Critical AS

36 TOF Physiology Tricuspid atresia,PS LAD (-30 to –60 )
Rt atrial overload LVH

37 TOF Physiology Single ventricle,PS
Discordant axis and ventricular hypertrophy Monomorphic QRS complexes

38 TOF Physiology TOF RAD upto +150 RVH Abrupt change to rS pattern in V2
Extreme rt axis > 150 / Abnormal quadrant DORV / D-TGA ,VSD,PS

39 ALCAPA Deep Q wave in left sided leads Evidence of ischemia/infarction

40 Pompe’s Disease Short PR interval Tall QRS complexes

41 Neonate with Shock HLHS/ Arch interruption/ critical Coarctation
Immediate resuscitation and urgent transportation

42 Neonate in Distress Cyanosis
New Born in Cardiac Distress Neonate in Distress Cyanosis Duct Dependant * Pulmonary Circulation * Mixing * Systemic Circulation Cyanosis with Severe PAH Severe Respiratory distress * Cardiac * Pulmonary

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