2011.07.05 1
2
3 2008/06/14 99 ~ 100
4 2008/06/14 300 91 93 2495 2219 578 1000 3
5 2011-03-24 43% 57% 208
6 99 ~ 100-1
99 ~ 100-2 7 - http://www.youtube.com/watch?v=bnsi4icp8oo - http://www.youtube.com/watch?v=ibbxfolqnyu - 2010/11/10 http://www.youtube.com/watch?v=xe83vm6nbae 2011-01-23 ( ) http://www.youtube.com/watch?v=6apaahyybf8
8
9
10 (Chief compliant) (Present illness) (System review) (Past history) (Family history) (Social history)
11 interview
12 ---
13
PQRST 14
Assessing a child with a CV disorder -History History Fatigue, cyanosis, frequency URI, feeding difficulty, poorly weight gain, growth failure Past medical history Infection during pregnancy, difficulty with resuscitation at birth Family history Other members with heart disorders 15
16 X 99%
17 EKG Holter EKG Chest X-ray Echocardiography Magnetic resonance imaging Ventilation-perfusion scan Pulse oximetry
18 Assessing a child with a CV disorder -Physical examination Decreasing height and weight Easily fatigue Frequency nose bleeds Cyanosis of mucous Membrane or polycythemia (redness) Tachypnea or tachycardia Displaced apex beat Heart murmur Enlarged liver Absent femoral pulses Faint peripheral pulses Clubbing of fingers Pain in legs
MS, TS, AR, PR S4 S3 O.S. MC/TC, AO/PO S1 S2 MO/TO, AC/PC E.C. MR, TR, VSD, AS, PS 19
20 Abnormal pulse patterns Water hammer Pulsus alternant Dicrotic Thready
21 Treatable causes of arrhythmias The H's and T's concept Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypo-/hyperkalemia Hyperglycemia Hypothermia Toxins Tamponade, cardiac Tension pneumothorax Thrombosis (coronary or pulmonary) Trauma (hypovolemia)
22 Cardiovascular disease in children multiple risk factors Obesity Increased insulin levels High blood pressure High cholesterol
23 CPR
(Wen 2004 arrhythmogenic right ventricular dysplasia atherosclerotic coronary artery disease others 51 5 16 7 6 5 2 hypertrophic cardiomyopathy coronary artery anomalies myocarditis aortic valve stenosis dilated cardiomyopathy aortic rupture total Van Cam (%) 1 3 4 100 Maron (%) 36 10 19 3 4 3 5 3 2 15 100 24
25 (Marfan syndrome, MFS) -1 ( ) ( )
26 (Marfan syndrome, MFS) -2 15 50% ( ) 10%
27
28
29
30
31
32
33
34
35
36 -
- 37
- (1/2) 38
- (2/2) 39
- (1/2) 40
- (2/2) 41
- 42
- 43
- 44
- 45
46
47