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TABLE OF CONTENTS
PART I
Basic Tools in Routine Evaluation of Cardiac Patients
1. History Taking 3
A. Gestational and Natal History 3
B. Postnatal History 4
C. Family History 6
2. Physical Examination 10
A. Inspection 10
B. Palpation 14
C. Blood Pressure Measurement 16
D. Auscultation 18
3. Electrocardiographyl 34
A. Normal Pediatric Electrocardiograms 34
B. Routine Interpretation 34
C. Atrial Hypertrophy 44
D. Ventricular Hypertrophy 44
E. Ventricular Conduction Disturbances 48
4. Chest Roentgenography 52
A. Heart Size and Silhouette 52
B. Evaluation of Cardiac Chambers and Great Arteries 54
C. Pulmonary Vascular Markings 57
D. Systematic Approach 57
5. Flow Diagram 60
PART II
Special Tools in Evaluation of Cardiac Patients
6. Noninvasive Techniques 67
A. Echocardiography 67
B. Exercise Test 78
C. Ambulatory Electrocardiography 81
7. Invasive Procedures 83
A. Cardiac Catheterization and Angiocardiography 83
B. Catheter Intervention Procedures 87
PART III
Pathophysiology
8. Fetal and Perinatal Circulation 93
A. Fetal Circulation 93
B. Changes in Circulation after Birth 95
C. Changes in Pulmonary Vascular Resistance and
Closure of Patent Ductus Arteriosus 96
D. Premature Newborns 98
9. Pathophysiology of Leff-to-Right Shunt Lesions 99
A. Atrial Septal Defect 99
B. Ventricular Septal Defect 101
C. Patent Ductus Arteriosus 103
D. Endocardial Cushion Defect 104
10. Pathophysiology of Obstructive and Valvular
Regurgitant Lesions 107
A. Obstruction to Ventricular Output 107
B. Stenosis of Atrioventricular Valves 110
C. Valvular Regurgitant Lesions 111
11. Pathophysiology of Cyanotic Congenital Heart
Defects 114
A. Pathophysiology of Cyanosis 114
B. Common Cyanotic Head Defects 117
PART IV
Specific Congenital Heart Detects
12. Left-to-Right Shunt Lesions 131
A. Atrial Septal Defect 131
B. Ventricular Septal Defect 135
C. Patent Ductus Arteriosus 142
D. Complete Endocardial Cushion Defect 145
E. Partial Endocardial Cushion Defect 152
F. Partial Anomalous Pulmonary Venous Return 154
13. Obstructive Lesions 157
A. Pulmonary Stenosis 157
B. Aortic Stenosis 160
C. Coarctation of the Aorta 168
D. Interrupted Aortic Arch 173
14. Cyanotic Congenital Heart Defects 176
A. Complete Transposition of the Great Arteries 176
B. Congenitally Corrected Transposition of the
Great Arteries (L-TGA) 188
C. Tetralogy of Fallot 191
D. Tetralogy of Fallot with Pulmonary Atresia 199
E. Tetralogy of Fallot with Absent Pulmonary Valve 203
F. Total Anomalous Pulmonary Venous Return 205
G. Tricuspid Atresia 210
H. Pulmonary Atresia with Intake Ventricular Septum 217
I. Ebstein's Anomaly 221
J. Persistent Truncus Arteriosus 227
K. Single Ventricle 231
L. Double-Outlet Right Ventricle 235
M. Splenic Syndromes 239
15. Vascular Ring 245
16. Chamber Localization and Cardiac Malposition 251
A. Chamber Localization 251
B. Dextrocardia and Mesocardia 254
17. Miscellaneous Congenital Cardiac Conditions 256
A. Aneurysm of the Sinus of Valsalva 256
B. Anomalous Origin of the Left Coronary Artery
from the Pulmonary Artery 256
C. Aortopulmonary Septal Defect 258
D. Arteriovenous Fistula, Coronary 258
E. Arteriovenous Fistula, Pulmonary 259
F. Arteriovenous Fistula, Systemic 260
G. Cervical Aortic Arch 260
H. Common Atrium 260
I. Cor Triatriatum 260
J. Double-Chamber Right Ventricle 261
K. Ectopia Cordis 261
L. Hemitruncus Arteriosus 262
M. Idiopathic Dilatation of the Pulmonary Artery 262
N. Kartagener's Syndrome 262
O. Mitral Regurgitation, Congenital 263
P. Mitral Stenosis, Congenital 263
Q. Patent Foramen Ovale 263
R. Pericardial Defect, Congenital 264
S. Pseudocoarctation of the Aorta 264
T. Pulmonary Artery Stenosis 264
U. Rubella Syndrome 265
V. Scimitar Syndrome 265
W. Systemic Venous Anomalies 265
X. Taussig-Bing Malformation 267
PART V
Acquired Heart Disease
18. Primary Myocardial Disease 271
A. Hypertrophic Cardiomyopathy 271
B. Dilated or Congestive Cardiomyopathy 277
C. Endocardial Fibroelastosis 279
D. Doxorubicin Cardiomyopathy 282
E. Restrictive Cardiomyopathy 283
F. Right Ventricular Dysplasia 284
19. Cardiovascular Infections 285
A. Infective Endocarditis 285
B. Myocarditis 290
C. Pericarditis 292
D. Constrictive Pericarditis 294
E. Kawasaki's Disease 294
F. Lyme Carditis 300
20. Acute Rheumatic Fever 302
A. Prevalence 302
B. Etiology 302
C. Pathology 302
D. Clinical Manifestations 302
E. Diagnosis 305
F. Differential Diagnosis 305
G. Clinical Course 306
H. Management 306
I. Prognosis 308
J. Prevention 308
21. Valvular Heart Disease 310
A. Mitral Stenosis 310
B. Mitral Regurgitation 312
C. Aortic Regurgitation 315
D. Mitral Valve Prolapse 317
22. Cardiac Tumors 320
A. Prevalence 320
B. Pathology 320
C. Clinical Manifestations 321
D. Treatment 324
23. Cardia Involvement in Systemic Diseases 325
A. Mucopolysaccharidoses 325
B. Periarteritis Nodosa 325
C. Systemic Lupus Erythematosus 325
D. Rheumatoid Arthritis 326
E. Friedreich's Ataxia 326
F. Muscular Dystrophy 326
G. Marfan Syndrome 326
H. Acute Glomerulonephritis 327
I. Hyperthyroidism, Congenital and Juvenile 327
J. Hypothyroidism, Congenital or Juvenile 328
K. Sickle Cell Anemia 329
PART VI
Electrocardiography II
24. Cardiac Arrhythmias 333
A. Rhythms Originating in the Sinus Node 333
B. Rhythms Originating in the Atrium 335
C. Rhythms Originating in the AV Node 341
D. Rhythms Originating in the Ventricle 343
25. Disturbances of Atrioventricular Conduction 350
A. First-Degree AV Block 350
B. Second-Degree AV Block 350
C. Third-Degree AV Block 351
26. Pacemakers in Children 353
A. ECGs of Artificial Cardiac Pacemakers 353
B. Pacemaker Therapy in Children 354
27. ST-Segment and T-Wave Changes 358
A. Nonpathologic ST-Segment Shift 358
B. Pathologic ST-Segment Shift 358
C. Electrolyte Disturbances 362
PART VII
Neonates with Cardiac Problems
28. Special Features in Cardiac Evaluation of the
Newborn 367
A. Physical Examination 367
B. Blood Pressure Measurements 368
C. Electrocardiography 369
D. Chest Roentgenography 371
29. Manifestations of Cardiac Problems in the Newborn 374
A. Heart Murmurs 374
B. Cyanosis in the Newborn 375
C. Heart Failure in the Newborn 385
D. Arrhythmias and Atrioventricular Conduction
Disturbances 394
PART VIII
Special Problems
30. Congestive Heart Failure 401
A. Definition 401
B. Etiology 401
C. Clinical Manifestations 402
D. Treatment 404
31. Systemic Hypertension 412
A. Definition 412
B. Etiology 413
C. Diagnosis and Work-Up 415
D. Management 417
E. Hypertensive Crisis 419
32. Pulmonary Hypertension 420
A. Definition 420
B. Etiology 420
C. Pathogenesis 421
D. Pathology 422
E. Pathophysiology 423
F. Clinical Manifestations 424
G. Natural History 427
H. Diagnosis 427
I. Management 428
33. Hyperlipidemia in Childhood 430
A. Lipids and Lipoproteins 431
B. Lipid and Lipoprotein Metabolism 432
C. Clinical Features of Hypercholesterolemia 434
D. Cholesterol Lowering Strategies 436
E. Treatment 440
34. Child with Chest Pain 443
35. Syncope 452
A. Prevalence 452
B. Definition 452
C. Etiology 452
D. Extracardiac Causes of Syncope 453
E. Cardiac Causes of Syncope 455
F. Long QT Syndrome 458
36. Postoperative Syndromes 462
A. Postcoarctectomy Hypertension 462
B. Postpericardiotomy Syndrome 463
C. Postperfusion Syndrome 463
D. Hemolytic Anemia Syndrome 464
37. Cardiac Transplantation 465
A. Prevalence and Indication 465
B. Selection of the Recipient 465
C. Evaluation and Management of the Cardiac Donor 466
D. Informed Consent from the Family and Patient 467
E. Operative Technique 467
F. Postoperative Management 469
G. Posttransplant Follow-Up 471
H. Prognosis 474
APPENDIX A Miscellaneous 475
APPENDIX B Echocardiographic Values 481
APPENDIX C Cholesterol and Lipoprotein Levels and
Recommended Foodstuff 486
APPENDIX D Pediatric Cardiovascular Drug Dosages 489
SUGGESTED READINGS 506
INDEX 516
