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Symptoms of congenital heart defects
Last reviewed: 23.04.2024
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In the diagnosis of congenital heart defects, everything matters: history, objective examination, data from functional and radiological studies.
Anamnesis
When interviewing parents, it is necessary to clarify the timing of the child's static functions: when he began to sit on his own in the crib, walk. It is necessary to find out how the child was gaining weight in the first year of life, because heart failure and hypoxia accompanying heart defects are accompanied by increased fatigue, "lazy" sucking and poor weight gain. When vices with hypervolemia of the small circle of circulation often develop pneumonia and bronchitis. If suspicion of vice with cyanosis should be clarified the time of occurrence (from birth or during the first half of life), the circumstances of the appearance of cyanosis and its localization. Defects with cyanosis always accompanies polycythemia, which leads to disorders of the central nervous system - hyperthermia, hemiparesis. Paralysis. In clinical practice, there are situations when, observing signs of deterioration of health (dyspnea, tachycardia), a doctor who does an early massage for a young child expresses a suspicion of congenital heart disease.
Clinical examination
Body type. Changes in the constitution are observed only with certain defects. Coarctation of the aorta is accompanied by the formation of an "athletic" build with the prevailing development of the shoulder girdle. In most cases, low birth weight is characteristic of congenital heart diseases (often before the development of grade II-III hypotrophy and / or hypostatism). If we take the shape of the nails to the peculiarities of the physique, we should pay attention to such symptoms as "drumsticks" and "watch glasses" that develop with congenital defects of the blue type.
Skin covers. For pale-type malformations, the paleness of the skin is characteristic, for vices with cyanosis - diffuse cyanosis of the skin and visible mucous membranes with a predominance of acrocyanosis. The saturated "crimson" color of the terminal phalanges of the fingers is also characteristic of high pulmonary hypertension. Accompanying vices with a discharge of blood from left to right, in any case, this color indicates an increase in the content in the blood of the restored hemoglobin (more than 5 mmol / l).
Respiratory system. Changes in the respiratory system often reflect an increase in pulmonary blood flow and manifest in the early stages of dyspnea.
The cardiovascular system. Visually determine the presence of the "heart hump" and its location (bisternal or left-sided). Palpation - systolic or diastolic tremor, localization of the revealed phenomenon, location and characteristics of apical impulse, presence of pathological heart beat. Percutaneously determine the change in the boundaries of relative cardiac dullness. When listening to auscultative phenomena of noise, determine its following characteristics:
- in what phase of the cardiac cycle does noise appear?
- duration, i. What part of the systole the noise occupies or in what part of the diastole is heard (proto-diastolic, mesodiastolic, presystolic);
- the changeability of noise when the position of the body changes;
- conductivity of noise.
Changes in blood pressure (both increase and decrease) with congenital heart defects are observed infrequently. Coarctation of the aorta is characterized by an increase in blood pressure on the hands and a significant lowering on the legs. However, such changes can also occur with vascular pathology. For example, with nonspecific aortoarteriitis, accompanied by a significant asymmetry of blood pressure on the right and left arm, on the right and left legs. Lowering blood pressure may be with vices with pronounced hypovolemia (aortic stenosis).
Digestive system. With heart failure - the main clinical complication of congenital heart disease - due to venous congestion, the liver increases, and sometimes the spleen. The enlargement of the liver usually does not exceed 1.5-2 cm. Venous pleiotomy of the mesentery and esophagus may be manifested by complaints of vomiting that occurs more often with physical exertion and accompanied by pains in the abdomen, possibly due to the dilatation of the liver capsule.
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