Pediatric Cardiology: The Essential Pocket Guide

402 Pages·2014·4.51 MB·English

Pediatric
Cardiology
The Essential Pocket Guide
Pediatric
Cardiology
The Essential Pocket Guide
THIRD EDITION
Walter H. Johnson, Jr., MD
Professor of Pediatrics
Department of Pediatrics
Division of Pediatric Cardiology
University of Alabama at Birmingham
Birmingham, AL, USA
James H. Moller, MD
Professor Emeritus of Pediatrics
Adjunct Professor of Medicine
University of Minnesota Medical School
Minneapolis, MN, USA
This edition first published 2014
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Library of Congress Cataloging-in-Publication Data
Johnson, Walter H., Jr., author.
Pediatric cardiology : the essential pocket guide / Walter H. Johnson Jr., James H. Moller. – Third edition.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-118-50340-9 (pbk.)
I. Moller, James H., 1933– author. II. Title.
[DNLM: 1. Heart Diseases–Handbooks. 2. Child. WS 39]
RJ421
′
618.92 12–dc23
2013043842
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be
available in electronic books.
Cover image: courtesy of Robb L. Romp, M.D.
Cover design by Andy Meaden
Set in 8/10pt Frutiger Light by Laserwords Private Limited, Chennai, India
1 2014
Contents
Preface, vii
1. Tools to diagnose cardiac conditions in children, 1
2. Environmental and genetic conditions associated with heart disease in
children, 73
3. Classification and physiology of congenital heart disease in children, 86
4. Anomalies with a left-to-right shunt in children, 95
5. Conditions obstructing blood flow in children, 148
6. Congenital heart disease with a right-to-left shunt in children, 186
7. Unusual forms of congenital heart disease in children, 233
8. Unique cardiac conditions in newborn infants, 245
9. The cardiac conditions acquired during childhood, 259
10. Abnormalities of heart rate and conduction in children, 291
11. Congestive heart failure in infants and children, 315
12. A healthy lifestyle and preventing heart disease in children, 329
Additional reading, 373
Index, 375
v
Preface
Since the first printing of this text 50 years ago, pediatric cardiac catheteriza-
tion, echocardiography, and magnetic resonance imaging have developed and less
emphasis has been placed on the more traditional methods of evaluating a cardiac
patient. Most practitioners, however, do not have access to these refined diagnos-
tic techniques or the training to apply them. To evaluate a patient with a finding
that could suggest a cardiac issue, a practitioner therefore relies upon either the
combination of physical examination, electrocardiogram, and chest X-ray, or refer-
ral to a cardiac diagnostic center.
This book formulates guidelines by which a practitioner, medical student, or
house officer can approach the diagnostic problem presented by an infant or child
with a cardiac finding. Through proper assessment and integration of the history,
physical examination, electrocardiogram, and chest X-ray, the type of problem
can be diagnosed correctly in many patients, and the severity and hemodynamics
correctly estimated.
Even though a patient may ultimately require referral to a cardiac center, the
practitioner will appreciate and understand better the specific type of specialized
diagnostic studies performed, and the approach, timing, and results of operation
or management. This book helps select patients for referral and offers guidelines
for timing of referrals.
The book has 12 chapters:
Chapter 1 (Tools to diagnose cardiac conditions in children) includes sections
on history, physical examination, electrocardiography, and chest radiography, and
discusses functional murmurs. A brief overview of special procedures, such as
echocardiography and cardiac catheterization, is included.
Chapter 2 (Environmental and genetic conditions associated with heart disease
in children) presents syndromes, genetic disorders, and maternal conditions com-
monly associated with congenital heart disease.
Chapters 3 to 7 are “Classification and physiology of congenital heart disease in
children,” “Anomalies with a left-to-right shunt in children” (acyanotic and with
increased pulmonary blood flow), “Conditions obstructing blood flow in children”
(acyanotic and with normal blood flow), “Congenital heart disease with a right-
to-left shunt in children” (cyanosis with increased or decreased pulmonary blood
flow), and “Unusual forms of congenital heart disease in children.” This set of
chapters discusses specific congenital cardiac malformations. The hemodynam-
ics of the malformations are presented as a basis for understanding the physical
vii
viii Preface
findings, electrocardiogram, and chest radiographs. Emphasis is placed on features
that permit differential diagnosis.
Chapter 8 (Unique cardiac conditions in newborn infants) describes the cardiac
malformations leading to symptoms in the neonatal period and in the transition
from the fetal to the adult circulation.
Chapter 9 (The cardiac conditions acquired during childhood) includes cardiac
problems, such as Kawasaki disease, rheumatic fever, and the cardiac manifesta-
tions of systemic diseases which affect children.
Chapter 10 (Abnormalities of heart rate and conduction in children) presents
the practical basics of diagnosis and management of rhythm disorders in children.
Chapter 11 (Congestive heart failure in infants and children) considers the
pathophysiology and management of cardiac failure in children. Medical and
surgical (including transplantation) treatments are discussed.
Chapter 12 (A healthy lifestyle and preventing heart disease in children) dis-
cusses preventive issues for children with a normal heart (the vast majority), includ-
ing smoking, hypertension, lipids, exercise, and other risk factors for cardiovascular
disease that become manifest in adulthood. Prevention and health maintenance
issues particular to children with heart disease are also discussed.
This book is not a substitute for the many excellent and encyclopedic texts on
pediatric cardiology, or for the expanding number of electronic resources. The ref-
erences sections accompanying some chapters and the additional reading section
at the end of the book include both traditional and online resources chosen to be
of greatest value to readers.
Certain generalizations are made. In pediatric cardiology, as in all fields, excep-
tions occur. Therefore, not all instances of cardiac abnormality will be correctly
diagnosed on the basis of the criteria set forth here.