Pediatric cardiology : the essential pocket guide

402 Pages·2014·4.184 MB·English

by  Walter H. Johnson, James H. Moller

Pediatric
Cardiology
TheEssentialPocketGuide

Pediatric
Cardiology
The Essential Pocket Guide
THIRD EDITION
Walter H. Johnson, Jr., MD
ProfessorofPediatrics
DepartmentofPediatrics
DivisionofPediatricCardiology
UniversityofAlabamaatBirmingham
Birmingham,AL,USA
James H. Moller, MD
ProfessorEmeritusofPediatrics
AdjunctProfessorofMedicine
UniversityofMinnesotaMedicalSchool
Minneapolis,MN,USA
Thiseditionfirstpublished2014
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LibraryofCongressCataloging-in-PublicationData
Johnson,WalterH.,Jr.,author.
Pediatriccardiology:theessentialpocketguide/WalterH.JohnsonJr.,JamesH.Moller.–Thirdedition.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN978-1-118-50340-9(pbk.)
I.Moller,JamesH.,1933–author.II.Title.
[DNLM:1.HeartDiseases–Handbooks.2.Child.WS39]
RJ421
618.92′12–dc23
2013043842
AcataloguerecordforthisbookisavailablefromtheBritishLibrary.
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1 2014
Contents
Preface,vii
1. Toolstodiagnosecardiacconditionsinchildren,1
2. Environmentalandgeneticconditionsassociatedwithheartdiseasein
children,73
3. Classificationandphysiologyofcongenitalheartdiseaseinchildren,86
4. Anomalieswithaleft-to-rightshuntinchildren,95
5. Conditionsobstructingbloodflowinchildren,148
6. Congenitalheartdiseasewitharight-to-leftshuntinchildren,186
7. Unusualformsofcongenitalheartdiseaseinchildren,233
8. Uniquecardiacconditionsinnewborninfants,245
9. Thecardiacconditionsacquiredduringchildhood,259
10. Abnormalitiesofheartrateandconductioninchildren,291
11. Congestiveheartfailureininfantsandchildren,315
12. Ahealthylifestyleandpreventingheartdiseaseinchildren,329
Additionalreading,373
Index,375
v

Preface
Since the first printing of this text 50 years ago, pediatric cardiac catheteriza-
tion,echocardiography,andmagneticresonanceimaginghavedevelopedandless
emphasishasbeenplacedonthemoretraditionalmethodsofevaluatingacardiac
patient.Mostpractitioners,however,donothaveaccesstotheserefineddiagnos-
tictechniquesorthetrainingtoapplythem.Toevaluateapatientwithafinding
thatcouldsuggestacardiacissue,apractitionerthereforereliesuponeitherthe
combinationofphysicalexamination,electrocardiogram,andchestX-ray,orrefer-
raltoacardiacdiagnosticcenter.
This book formulates guidelines by which a practitioner, medical student, or
houseofficercanapproachthediagnosticproblempresentedbyaninfantorchild
withacardiacfinding.Throughproperassessmentandintegrationofthehistory,
physical examination, electrocardiogram, and chest X-ray, the type of problem
canbediagnosedcorrectlyinmanypatients,andtheseverityandhemodynamics
correctlyestimated.
Eventhoughapatientmayultimatelyrequirereferraltoacardiaccenter,the
practitionerwillappreciateandunderstandbetterthespecifictypeofspecialized
diagnosticstudiesperformed,andtheapproach,timing,andresultsofoperation
ormanagement.Thisbookhelpsselectpatientsforreferralandoffersguidelines
fortimingofreferrals.
Thebookhas12chapters:
Chapter1(Toolstodiagnosecardiacconditionsinchildren)includessections
onhistory,physicalexamination,electrocardiography,andchestradiography,and
discusses functional murmurs. A brief overview of special procedures, such as
echocardiographyandcardiaccatheterization,isincluded.
Chapter2(Environmentalandgeneticconditionsassociatedwithheartdisease
inchildren)presentssyndromes,geneticdisorders,andmaternalconditionscom-
monlyassociatedwithcongenitalheartdisease.
Chapters3to7are“Classificationandphysiologyofcongenitalheartdiseasein
children,”“Anomalieswithaleft-to-rightshuntinchildren”(acyanoticandwith
increasedpulmonarybloodflow),“Conditionsobstructingbloodflowinchildren”
(acyanoticandwithnormalbloodflow),“Congenitalheartdiseasewitharight-
to-leftshuntinchildren”(cyanosiswithincreasedordecreasedpulmonaryblood
flow), and “Unusual forms of congenital heart disease in children.” This set of
chapters discusses specific congenital cardiac malformations. The hemodynam-
icsofthemalformationsarepresentedasabasisforunderstandingthephysical
vii
viii Preface
findings,electrocardiogram,andchestradiographs.Emphasisisplacedonfeatures
thatpermitdifferentialdiagnosis.
Chapter8(Uniquecardiacconditionsinnewborninfants)describesthecardiac
malformationsleadingtosymptomsintheneonatalperiodandinthetransition
fromthefetaltotheadultcirculation.
Chapter9(Thecardiacconditionsacquiredduringchildhood)includescardiac
problems,suchasKawasakidisease,rheumaticfever,andthecardiacmanifesta-
tionsofsystemicdiseaseswhichaffectchildren.
Chapter10(Abnormalitiesofheartrateandconductioninchildren)presents
thepracticalbasicsofdiagnosisandmanagementofrhythmdisordersinchildren.
Chapter 11 (Congestive heart failure in infants and children) considers the
pathophysiology and management of cardiac failure in children. Medical and
surgical(includingtransplantation)treatmentsarediscussed.
Chapter 12 (A healthy lifestyle and preventing heart disease in children) dis-
cussespreventiveissuesforchildrenwithanormalheart(thevastmajority),includ-
ingsmoking,hypertension,lipids,exercise,andotherriskfactorsforcardiovascular
diseasethatbecomemanifestinadulthood.Preventionandhealthmaintenance
issuesparticulartochildrenwithheartdiseasearealsodiscussed.
Thisbookisnotasubstituteforthemanyexcellentandencyclopedictextson
pediatriccardiology,orfortheexpandingnumberofelectronicresources.Theref-
erencessectionsaccompanyingsomechaptersandtheadditionalreadingsection
attheendofthebookincludebothtraditionalandonlineresourceschosentobe
ofgreatestvaluetoreaders.
Certaingeneralizationsaremade.Inpediatriccardiology,asinallfields,excep-
tions occur. Therefore, not all instances of cardiac abnormality will be correctly
diagnosedonthebasisofthecriteriasetforthhere.