Gangguan Sistem Kardiovaskuler Pada Anak

GANGGUAN SISTEM
KARDIOVASKULER PADA ANAK

Anak tidak sama dengan
orang dewasa
Structures of the heart
120/80
25/15
5
120/8
25/5
Normal Heart
Heart disease in children
 Congenital heart disease
 Acyanosis congenital heart disease
 Cyanosis congenital heart disease
 Acquired heart disease

 Acute rheumatic fever
 Chronic rheumatic heart disease
 Kawasaki disease
 Cardiac involvement in systemic disease
 Thalasemia
 Kidney disease
 etc

 Thalasemia
 Kidney disease
 etc

 Thalasemia
 Kidney disease
 etc
Congenital Heart Disease
Incidence of Congenital
Heart Disease
 The incidence: 8-10 in 1000 live birth
 Indonesia:
 Total population : ± 235,000,000
 Birth rate: 2.3 %
 Incidence CHD per year: 50,000 cases

Classification of CHD
 Acyanosis
 Normal pulmonary blood flow
 Pulmonary Stenosis (PS)
 Aortic Stenosis (AS)
 Coarctatio Aorta (CoA)
 Increased pulmonary blood flow

 Patent Ductus Arteriosus (PDA)
 Atrial Septal Defect (ASD)
 Ventricular Septal Defect (VSD)
 Cyanosis
 TGA without PS

 TGA with VSD
 Truncus arteriosus
 Total anomaly pulmonary vein drainage
 Decreased pulmonary blood flow

 ToF
 Pulmonary atresia
 Ticuspid atresia
Classification of CHD
 Ventricular SeAcyanosis
 Pulmonary Stenosis (PS)
 Aortic Stenosis (AS)
 Coarctatio Aorta (CoA)
 Patent Ductus Arteriosus (PDA)
 Atrial Septal Defect (ASD)
 ptal Defect (VSD)
 Cyanosis
 Transpositioon of the Great Arteriousus (TGA) without PS

 TGA with VSD
 Truncus arteriosus
 Total anomaly pulmonary vein drainage
 Decreased pulmonary blood flow

 Tetralogy of Fallot
 Pulmonary atresia
 Ticuspid atresia
PDA
Located between aorta

and pulmonary artery
ASD
Defect between LA and RA

VSD
Tetralogy Fallot
Syndrome consist of
4 items:
 VSD
 Pulmonary
stenosis
 Aortic over-riding
 RVH
Transposition of Great artery
Fetal vs. Neonatal Circulation
Persistent pulmonary
hypertension of newborn
Etiology
 Genetic 10 %
 Chromosome 7%
 Monogenic 3%
 Environment 3%
 Multifactor 90 %
Sign and Symptom of CHD
 Cyanosis
 Dyspneu
 Exercise intolerance
 Infant Feeding problem
 Intermittent feeding
 Prolonged feeding
 Big children  Dyspneu on exertion
 Orthopneu
 Recurrent respiratory tract infection
 Poor weight gain
 Asymptomatic murmur
 Others
Diagnosis
 Clinical manifestation
 Supporting examination
 Level 1
 Periphery blood examination
 Arterial blood gas analysis
 Chest X ray
 Electrocardiography
 Level 2
 Echocardiography
 Level 3
 Cardiac catheterization
 Diagnostic
 Therapeutic
 Others
 CT Scan
 MRI
Clinical Manifestations
History
A complete birth history: maternal history;
prenatal, perinatal, and postnatal complications;
history of labor and delivery.
Neonatal course, especially the exact time when
the cyanosis developed, because certain CHD
present at birth, while others may take as long
as one month to present themselves.
General Physical examination

Initial physical examination should focus
on vital signs and cardiac and
respiratory examinations
Evaluate for rales, stridor, grunting,
flaring, retractions, and evidence of
consolidation or effusion on pulmonary
examination.
General Physical examination….

 Extremities: strength and symmetry of
the pulses in the upper and lower
extremities, edema, and cyanosis of the
nail beds.
Hepatosplenomegaly may be consistent
with right ventricular or biventricular
heart failure.
Biru normal dan biru pada PJB
 Akrosianosis
 Sering pada
bayi baru lahir
 Kedinginan
Lefkowitz B, 2000
Cardiac Physical examination……

 Inspection: precordial impulse
 Palpation: thrill, left precordial lift, right
ventricular heave
 Percussion: not to determine edge of heart in
small children
 Auscultation:
 Heart sound: S1, S2, S3, S4, gallop,
ejection click, opening snap, or rub.
 Murmurs: timing, type, intensity,
location, transmission, changing with
position or respiration, quality
 No murmur does not exclude CHD
 The presence of murmur does not
mean that there is CHD

Gangguan Sistem Kardiovaskuler Pada Anak

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GANGGUAN SISTEM

KARDIOVASKULER PADA ANAK

 Cyanosis congenital heart disease

 Acquired heart disease

 Chronic rheumatic heart disease

 Cardiac involvement in systemic disease

 Cyanosis congenital heart disease

 Acquired heart disease

 Chronic rheumatic heart disease

 Cardiac involvement in systemic disease

 Cyanosis congenital heart disease

 Acquired heart disease

 Chronic rheumatic heart disease

 Cardiac involvement in systemic disease

 Total population : ± 235,000,000

 Birth rate: 2.3 %

 Incidence CHD per year: 50,000 cases

 Aortic Stenosis (AS)

 Coarctatio Aorta (CoA)

 Increased pulmonary blood flow

 Atrial Septal Defect (ASD)

 Ventricular Septal Defect (VSD)

 Increased pulmonary blood flow

 Total anomaly pulmonary vein drainage

 Decreased pulmonary blood flow

 Pulmonary Stenosis (PS)

 Aortic Stenosis (AS)

 Coarctatio Aorta (CoA)

 Increased pulmonary blood flow

 Patent Ductus Arteriosus (PDA)

 Atrial Septal Defect (ASD)

 ptal Defect (VSD)

 Increased pulmonary blood flow

 Total anomaly pulmonary vein drainage

 Decreased pulmonary blood flow

Located between aorta

Defect between LA and RA

 Big children  Dyspneu on exertion

 Arterial blood gas analysis

General Physical examination

General Physical examination….

Cardiac Physical examination……

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