Pediatrics
Cardiovascular System and Heart Disease
Paediatric cardiovascular disease for NEET-PG: acyanotic and cyanotic congenital heart disease, heart failure, rheumatic and infective heart disease, mapped to NMC PE23 codes.
MedNext Academy | 3 min read
Cardiovascular System and Heart Disease
Paediatric cardiovascular disease for NEET-PG: acyanotic and cyanotic congenital heart disease, heart failure, rheumatic and infective heart disease, mapped to NMC PE23 codes.
This chapter covers paediatric cardiology from acyanotic and cyanotic congenital heart disease through heart failure, rheumatic and infective heart disease, cardiomyopathy, pericardial disease and arrhythmias, alongside a structured approach to the child with a murmur. It repeatedly contrasts innocent from pathological findings.
High-yield: Cardiovascular System and Heart Disease
- Murmur loudness does not equal severity; a small restrictive ventricular septal defect can be loud, while a large defect becoming quieter with a loud pulmonary component can mean rising pulmonary vascular resistance.
- Tetralogy of Fallot is reduced pulmonary blood flow with hypercyanotic spells, whereas transposition of the great arteries is parallel circulation with inadequate mixing.
- A cyanosed neonate whose saturation does not improve with oxygen may have a duct-dependent lesion needing prostaglandin E1 at about 0.01 to 0.05 mcg/kg/min while it is evaluated.
- During a hypercyanotic spell a softer murmur is dangerous, not reassuring, because less flow is crossing the obstructed right ventricular outflow tract.
- In infants, feeding history is functional-class assessment: a baby who sweats, pauses and fails to finish feeds is describing exertional dyspnoea.
- Hepatomegaly is the paediatric equivalent of raised venous pressure, while pedal oedema is a late and unreliable sign of heart failure in infants.
- In rheumatic heart disease, prevalence of about 2 to 8 per 1000 in high-risk Indian settings should prompt prevention, with secondary prophylaxis adherence as the central life-course intervention.
- Modified Duke criteria support infective endocarditis diagnosis, but culture-negative disease is often doctor-made when antibiotics precede blood cultures.
- Do not diagnose idiopathic dilated cardiomyopathy until correctable mimics such as anomalous left coronary artery from the pulmonary artery and tachycardia-induced cardiomyopathy are excluded.
- Raised venous pressure with clear lungs should suggest pericardial tamponade or constriction rather than pure myocardial failure, and tamponade is a physiology diagnosis based on impaired filling.
- Adenosine is diagnostic and therapeutic for many narrow-complex re-entry tachycardias, but an unstable rhythm gets synchronised cardioversion before pharmacology.
- Innocent murmurs are soft, systolic, short, symptom-free and sensitive to position, with a normal second heart sound and normal growth, saturation and femoral pulses.
- The fastest safe screen for serious congenital heart disease is oxygen saturation, femoral pulses and the second heart sound before focusing on murmur grade.
- Coarctation of the aorta is missed by a murmur-focused examination, so femoral pulses and four-limb blood pressure must be checked in every infant with heart failure.
- Obstructed total anomalous pulmonary venous return presents as a cyanosed newborn with pulmonary oedema and a small heart and needs emergency surgical repair.
Cyanotic lesion snapshots
- **Tetralogy of Fallot:** Reduced pulmonary blood flow with hypercyanotic spells; a softer murmur in a spell is dangerous.
- **Transposition of great arteries:** Parallel circulation; prostaglandin keeps the duct open but does not replace balloon septostomy or surgery.
- **Obstructed TAPVR:** Cyanosed newborn with pulmonary oedema and a small heart needing emergency repair.
- **Duct-dependent lesions:** Cyanosis or shock not improving with oxygen; give prostaglandin E1 and arrange transfer.
NMC competencies in this chapter
- **PE23.1:** Acyanotic Congenital Heart Disease: VSD, ASD and PDA
- **PE23.2:** Cyanotic Congenital Heart Disease: Tetralogy of Fallot and Transposition of the Great Arteries
- **PE23.3:** Congestive Heart Failure in Children
- **PE23.4:** Rheumatic Heart Disease
- **PE23.5:** Infective Endocarditis and Modified Duke Criteria
- **PE23.8:** Cardiac Arrhythmias: Supraventricular Tachycardia and Heart Block
- **PE23.10:** Approach to a Child With Murmur
Frequently Asked Questions
Why is a softer murmur during a cyanotic spell a bad sign?
In tetralogy of Fallot a hypercyanotic spell reduces the flow crossing the obstructed right ventricular outflow tract, so the murmur becomes softer. A quieter murmur therefore signals worsening, not improvement.
What is the fastest way to screen an infant for serious congenital heart disease?
Check oxygen saturation, femoral pulses and the second heart sound. This simple screen detects duct-dependent lesions and coarctation faster than focusing on the grade of a murmur.
How do you distinguish an innocent murmur from a pathological one?
Innocent murmurs are soft, systolic, short, symptom-free and sensitive to posture, with a normal second heart sound and normal growth, saturation and femoral pulses. Any diastolic, harsh or continuous murmur, cyanosis, abnormal pulses or poor growth is not innocent.
What should you give a cyanosed neonate whose saturation does not improve with oxygen?
Suspect a duct-dependent lesion and start prostaglandin E1, around 0.01 to 0.05 mcg/kg/min, to keep the ductus arteriosus open while urgent specialist assessment and transfer are arranged.
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