PRESENTATION OF CONGESTIVE CARDIAC FAILURE IN CHILDREN WITH VENTRICULAR SEPTAL DEFECT

Authors

  • Maqbool Hussain
  • Sajjad Hussain
  • Jai Krishin
  • Saleem Abbasi

Abstract

Background: While there is much data on cardiac problems of adults, there is a limited statistical dataavailable to evaluate the magnitude of the cardiac problems in children in Pakistan. Many of thesechildren present with recurrent chest infections and congestive cardiac failure (CCF), and are managedby general practitioners. A careful search for underlying cardiac problems and awareness about thepresentation of CCF and its magnitude will definitely decrease the morbidity and mortality of thesechildren. The objective of this study was to see the frequency and clinical presentation of CCF inchildren with Ventricular Septal Defect (VSD). Methods: Forty-nine patients met the preset criteriaduring the study period of 6 months. A detailed history and physical examination with special emphasison symptoms and signs was sought and the findings were noted in a questionnaire. Data was analysedusing SPSS-11. Frequencies and percentages were calculated for all categorical variables. Results:CCF in VSD was found more in males, with a male to female ratio of 1.45:1. Majority (63.1%) of thepatients presented in infancy. The common symptoms at presentation were dyspnoea (98%), cough(83.7%), and feeding difficulty (9.6%). Other important symptoms were fever, fatigue, failure to thrive,sweating and wheezing. The common physical signs in order of frequency were murmur 98%,tachypnoea 91.8%, tachycardia 89.8%, hepatomegally 89.9% and crackles in chest 85.7%. Otherpresenting signs were displaced apex beat 57%, oedema 28.6% and chest deformity 20.4%. Regardingthe type of VSD, perimembranous was the commonest 61.2% as confirmed by echocardiography.Conclusion: This study was done on a smaller scale in hospitalised children. The exact studiesregarding CCF in paediatric patients are scarce. There is a need to design more studies in children withCCF. Early recognition of signs and symptoms of CCF on paediatric patients with VSD and awarenessat primary health care level can prevent the delay in the diagnosis and early referrals by GPs to hospitalsetup will definitely reduce the morbidity and mortality.Keywords: Children, Congestive cardiac failure, Ventricular septal defect

References

Joseph DK, Steven DC. Congestive heart failure in pediatric

patients. Am Heart J 2001;142:923–8.

Ejaz MS, Ghaffar BA. Clinical pattern of heart diseases in

children. J Coll Physcian Surg Pak 2000;10:10–12.

Aziz KU (Ed). Incidence of congenital heart diseases in children

at NICVD. In: Heart disease in children, Karachi: Shakoor Sons,

:1–5.

O’Laughlin MP. Congestive heart failure in children. Pediatr Clin

North Am 1999;46:263–73.

Shah GS, Singh MK, Panday TR, Kalakheti BK, Bhandari GP.

Incidence of congenital heart disease in tertiary care hospital.

Kathmandu Univ Med J 2008;6:33–6.

Masood N, Sharif M, Asghar RM, Qamer M, Hussain I.

congenital heart diseases at Benazir Bhutto Hospital, Rawalpindi.

Ann Pak Inst Med Sci 2010;6:120–3.

Driscoll DJ. Left to right shunt lesion. Pediatr Clin North Am

;46:359–65.

Aziz KU. Ventricular septal defect. In: Heart disease in children,

Karachi, Shakoor Sons, 1991:239–54.

WHO. Concise guide to the management of heart failure (special

report). Pakistan Heart J 1996;29:17–29.

Bernstein D. The cardiovascular system. In: Behrman RE,

Klagman RM, Jenson HB, (eds). Nelson textbook of pediatrics.

th ed California. WB Sauders, 2008.

Satou GM, Lacro RV, Chang T, Gauvreau K, Jenkins KJ. Heart

size on chest x-ray as a predictor of cardiac enlargement by

echocardiography in children. Pediatr Cardiol 2001;22:218–22.

Aziz K, Kundi A, Memon NA, Lashari AH. Color flow and

Doppler assessment of ventricular septal defect. Pakistan Heart J

;30:2–7.

Park MK. Pediatric cardiology for practitioners. 2nd ed. Chicago

Year Book Medical Publishers, 1988:92.

Ramachandran U, Alukor V, Thaplia A. Pattern of cardiac

diseases in children in Pokhara, Nepal. Kathmandu Univ Med J

;4:222–7.

Abu-Harb M, Hey E, Wren C. Death in infancy from

unrecognized congenital heart disease. Arch Dis Child

;71:3–7.

Pelech AN. Evaluation of the pediatric patients with cardiac

murmur. Pediatr Clin North Am 1999;46:167–88.

Jaypee Gupte S. The short text book of pediatrics. 8th ed. New

Delhi: Jay Pee, 1998:239.

Park MK. Pediatric cardiology for practitioners. 2nd ed. New

Delhi: Jay pee brothers, 1989:13.

Balistreri WF. Manifestation of liver disease. In: Behrman RE,

Klagman RM, Jenson HB (eds). Nelson textbook of pediatrics.

th ed. Philadelphia: WB Saunders, 2000;1198.

Pihkala J, Naykamen D, Freedom RM, Benson LN. International

cardiac catheterization. Pediatr Clin North AM 1999;46:441–64.

Bernstein D. The cardiovascular system. In: Behrman RE,

Kleigman RM, Jenson HB (eds). Nelson textbook of pediatrics.

th ed. California: WB Saunders 2000:1266.

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Published

2010-12-01

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