(Anatomy+ Pediatrics +Cardiology)
A mother is referred to the pediatric clinic with her 6 months old baby girl. The infant has a history of poor feeding and failure to thrive. Her mother also reports she is ‘a colicky baby’ and cries frequently. Later her mother has noticed that her infant’s lips and face acquire a bluish color when she cries or feeds. The pediatrician performs a very thorough physical examination, paying close attention to the fingers and toes. He spends a long time on auscultation of heart and lungs. During examination, the child begins crying and observes cyanosis of lips and face. Her mother pushes the infant’s knees up towards the chest and explains that this seems to afford her daughter some relief during her ‘colicky episode’. The pediatrician makes a specific note of this.
One should know the normal cardiac development along with anatomical birth defects related to heart and lungs.
- What is the probable cause of bluish color in this case?
- What would be the effect of VSD (Ventricular septal defect); ‘HOLE’ in the wall separating the right and left ventricles, on the blood flow in the heart? In what way would blood flow direction vary with ventricular pressure?
- In what way would pulmonary outflow tract stenosis (narrowing) affects right ventricular pressure? What would be the consequence of this for VSD, mentioned above?
- If the aorta overlies the VSD, what are the consequences for systemic circulation?
- Why there is right ventricular hypertrophy?
- Would you expect the lungs to be normal in this case? If not, why?
- Why cyanosis worsens, when the infant cries or feeding?
- Can you explain why the ‘Knee to chest’ maneuver would afford the infant some relief? ( Hint: Compression of the femoral arteries raises systemic vascular pressure)
- Where the pulmonary trunk is very severely constricted, what anatomical shunt (which normally closes shortly after birth) enables some blood to reach the lungs.
Case scenario for CBL 1 & 3:
A 55 years old male, known hypertensive for the last 15 years was brought to emergency with complaints of severe chest pain, breathlessness and vomiting for the last 1 hour.
VITALS: General Physical Examination:
B.P.: 110/70 mm Hg Anemia: Nil
Pulse: 80/min Jaundice: Nil
Resp. Rate: 18/min Edema; Nil
Temperature: Afebrile JVP: Not raised
Normal vesicular breathing
No added sounds
S1 & S2 audible in all four areas.
ECG: Normal P wave & QRS complex, ST segment elevation
CBC: CARDIAC ENZYME:
Hb: 14.2 gm./dl CPK: 410 IU/L (10-50)
TLC: 16400/cumm AST: 67 IU/L (5-45)
N: 83% LDH: 315 IU/L (50-200)
M: 0 LIPID PROFILE:
E: 01% Total lipids: 1130
B: 0 S. Cholesterol: 250 LDL: 58
LEARNING OBJECTIVE OF SKILL LAB CURRICULUM
- Introduction To Cardiovascular System Examination:
Diseases of cardiovascular system are one of the most common causes of morbidity and mortality, both in adults and children. Cardio vascular system examination is performed as an integral part of physical examination, or when a patient presents with cardio vascular problems (for example: chest pain).
At the end of the session students should be:
- Enumerate the steps of examination of the cardiovascular system (CVS)
- To demonstrate correct technique of auscultation of heart.
Time: 12:20 PM – 2:30 PM (Namaz break: 1:15 PM – 1:30 PM)
Venue: BDS LECTURE HALL 2 (First Floor)