Symptoms of congenital heart disease

In the diagnosis of congenital heart defects, everything is important: anamnesis, objective examination, data from functional and radiological studies.

Anamnesis

When interviewing parents, it is necessary to clarify the time of development of the child's static functions: when he began to sit in the crib independently, to walk. It is necessary to find out how the child gained weight in the first year of life, since heart failure and hypoxia, accompanying heart defects, are accompanied by increased fatigue, "lazy" sucking and poor weight gain. In case of defects with hypervolemia of the pulmonary circulation, pneumonia and bronchitis often develop. If a defect with cyanosis is suspected, it is necessary to clarify the time of occurrence (from birth or during the first six months of life), the circumstances of the appearance of cyanosis and its localization. Defects with cyanosis are always accompanied by polycythemia, which leads to disorders of the central nervous system - hyperthermia, hemiparesis, paralysis. In clinical practice, situations are possible when, observing signs of deterioration in health (shortness of breath, tachycardia), a suspicion of a congenital heart defect is first expressed by a doctor giving a massage to a young child.

Clinical examination

Build. Changes in build are observed only with some defects. Coarctation of the aorta is accompanied by the formation of an "athletic" build with predominant development of the shoulder girdle. In most cases, congenital heart defects are characterized by poor nutrition (often to the development of grade II-III hypotrophy and/or hypostature). If we include the shape of the nails in the features of build, we should pay attention to such symptoms as "drumsticks" and "watch glasses" that develop with blue-type congenital defects.

Skin. Pale defects are characterized by pale skin, defects with cyanosis are characterized by diffuse cyanosis of the skin and visible mucous membranes with a predominance of acrocyanosis. A rich "raspberry" color of the terminal phalanges of the fingers is also characteristic of high pulmonary hypertension. accompanying defects with left-to-right blood flow, in any case, such coloring indicates an increase in the content of reduced hemoglobin in the blood (more than 5 mmol/l).

Respiratory system: Changes in the respiratory system often reflect increased pulmonary blood flow and are manifested in the early stages by signs of dyspnea.

Cardiovascular system. Visually determine the presence of a "heart hump" and its location (bisternal or left-sided). Palpation - systolic or diastolic tremor, localization of the detected phenomenon, location and characteristics of the apical impulse, presence of a pathological cardiac impulse. Percussion determines the change in the boundaries of relative cardiac dullness. When listening to auscultatory noise phenomena, the following characteristics are determined:

• in what phase of the cardiac cycle does the noise appear;
• duration, i.e. what part of systole the noise occupies or what part of diastole it is heard in (protodiastolic, mesodiastolic, presystolic);
• variability of noise with changes in body position;
• noise conductivity.

Changes in blood pressure (both increase and decrease) are rarely observed in congenital heart defects. Coarctation of the aorta is characterized by an increase in blood pressure in the arms and a significant decrease in the legs. However, such changes can also occur in vascular pathology. For example, in nonspecific aortoarteritis, accompanied by significant asymmetry in blood pressure on the right and left arm, on the right and left leg. A decrease in blood pressure can occur in defects with severe hypovolemia (aortic stenosis).

Digestive system. In heart failure, the main clinical complication of congenital heart defects, the liver and sometimes the spleen enlarge due to venous congestion. Liver enlargement usually does not exceed 1.5-2 cm. Venous congestion of the mesentery and esophagus vessels may manifest itself in complaints of vomiting, which occurs more often during physical exertion and is accompanied by abdominal pain, possibly due to stretching of the liver capsule.

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