01 First check-up

ID  :    0803051132	Name   :   Baby KAVYASHREE·P
Age :    3 Yrs	Sex    :   Female

DEPARTMENT OF CARDIOLOGY

OUT-PATIENT CLINIC PAEDIATRIC NEW CASE RECORD - 16/03/2005

BODY HEIGHT: 100CentiMeters

BODY WEIGHT: 14Kilograms

FAMILY HISTORY:-

AGE OF FATHER: 32 YRS,  OCCUPATION  TEACHER    

AGE OF MOTHER: 27 YRS OCCUPATION  HOUSEWIFE  ,    RANK OF CHILD: 1 ST

BIRTH HISTORY:-

BIRTHWEIGHT:   2·7 KG   ,     DELIVERY: Normal,     FETAL GESTATION AT DELIVERY: Full term

DIETARY HISTORY: Mixed

DEVELOPMENT MILESTONES:-      NORMAL:

IMMUNISATION:- Complete for the age

PRESENTING COMPLAINTS:

3 YRS 8 MONTHS OLD KAVYA SHREE IS THE ONLY CHILD BORN TO NON-CONSANGUINOUS PARENTS· FTND· NO H/O BIRTH ASPHYXIA· H/O RECURRENT RTI· NO H/O CYANOSIS/SPELLS/CONVULSIONS· DIAGNOSED CASE OF MULTIPLE ASDs· HERE FOR OPINION REGARDING FURTHER MANAGEMENT·             ( FATHER UNDERWENT ASD CLOSURE AT 13 YRS OF AGE )·

RESPIRATORY PROBLEMS: Recurrent respiratory tract infection

PRESENT MEDICATIONS: DIGOXIN 1/2 OD 5/7 DAYS, LASIX 1/4TH OD, CARVETREND 3·125 MG 1/2 OD, ENVAS 2·5 MG 1/2 BD

PHYSICAL EXAMINATION:-

     APPEARANCE AND BUILD: Normal,     EXTREMITIES: Normal

CARDIOVASCULAR SYSTEM:-

     ARTERIAL PULSES:-

     RATE: 110beats/min,     RHYTHM: Regular,     PERIPHERAL PULSES: FELT

     BLOOD PRESSURE: systolic blood pressure  RA 100/64, RL 118/74, LA 98/66, LL 108/74 mm Hg

AUSCULTATION:-

S1: Normal,     A2: Normal,     P2: Loud,

 

CARDIAC MURMURS AND OTHER CARDIAC SOUNDS: Grade 3/6 SYSTOLIC MURMUR AT LSB

PRECORDIUM:-

LV IMPULSE: Normal,     RV IMPLUSE: Normal

INVESTIGATIONS:-PULSE OXYMETER SATURATION: 98%

CONSULTANT COMMENTS:

3 YRS 8 MONTHS OLD BABY KAVYASHREE PRESENTS WITH RECURRENT RESPIRATORY TRACT INFECTION SINCE CHILDHOOD AND DYSPNOEA NOTICED OVER THE PAST 6 MONTHS·

O/E : SATURATION 98%

BP : 118/74 MM HG

CVS : WIDELY SPLIT S2

ESM AT UPPER LSB

PSM AT APEX

RS CLEAR

ABD LIVER ~ 6·8 CM

ECG : SR, BAE, LV DOMINANCE, rSR IN V1

CXR : 75% CTR, INCREASED PBF, PULMONARY VENOUS CONGESTION

ECHO : MULTIPLE ASD WITH LEFT TO RIGHT SHUNT

VENTRICULAR NON COMPACTION INVOLVING BOTH RV AND LV WITH COMPROMISED BIVENTRICULAR FUNCTION

MILD MR

PLAN  : HOLTER MONITORING

CARDIAC CATHETERISATION WITH BALLOON OCCLUSION TO DECIDE ABOUT FEASIBILITY OF ASD CLOSURE IN VIEW OF NON COMPACTION OF THE VENTRICLES

TO CONTINUE ANTI-FAILURE MEDICINES TILL THEN

DR·J·VIMALA, MD·,DM(CARD)·,

JR·CONSULTANT PAED· CARDIOLOGIST

            

DEPARTMENT OF CARDIOLOGY

 

PAEDIATRIC ECHO - 16/03/2005

 

M MODE & 2 D PARAMETERS:

Parameters	Patient Value	Normal Range	Z - Score
LVID(D)	43·6
LVID(S)	35·4
IVS(D)	5·5
RVID	22·5
LVFS	18·9%

OTHERS: OTHER 

{S,D,S}

NORMAL SYSTEMIC & PULMONARY VENOUS RETURN

8·6 MM OSTIUM SECUNDUM ASD WITH L-R SHUNT

ADDITIONAL 6·3 MM OSTIUM SECUNDUM ASD WITH L-R SHUNT

 2 AV VALVES , MILD TR WITH PEAK GDT OF 34 MM HG

TRICUSPID ANNULUS 27 MM, MITRAL ANNULUS 22·3 MM

MILD MR

GLOBAL HYPOKINESIA

IVS INTACT

RA & RV VOLUME OVERLOAD

NORMAL AORTIC VALVE, AORTIC ANNULUS 15·7 MM

NO LVOT OBSTRUCTION, NO AR

MILD FLOW ACCELERATION ACROSS THE PULMONARY VALE WITH PEAK GDT OF 17 MM HG

MILD PAH

DILATED CONFLUENT PA ANATOMY

RPA 13·9 MM, LPA 15·7 MM

LEFT AORTIC ARCH, NORMAL CORONARIES

NO PDA/COA

DILATED LV WITH COMPROMISED BIVENTRICULAR FUNCTION

 

SUMMARY:

TWO MODERATE SIZED OSTIUM SECUNDUM ASD WITH L-R SHUNT

MILD PAH

RA/RV VOLUME OVERLOAD

GLOBAL LV HYPOKINESIA, DILATED LV

COMPROMISED BIVENTRICULAR FUNCTION

 

DR·J·VIMALA, MD·,DM