7 yr pt came with c/o SOB after slight exertion or running, symptoms from early childhood, that's why not going even to school, on auscultation systolic murmur heard with thrill in all areas, belong to low socioeconomic class and used to consult quacks or pharmacist only, discuss possible dx considering ECG, CXR etc attached below..




7 yr male Not going to school Breathlessness on exertion No bluish lips or squatting History suggestive of Acyanotic CHD Examination Clubbing Murmur X ray Cardiomegaly So it has to be ACHD probably VSD/PA moderate to large size with complications may be Infective endocarditis

Developed eissenmengers as well

Cardiomegaly Left ventricular enlargement Clubbing grade 4 Severe pallor Murmur may be haemic Rule out RHD Investigations advised Echocardiography Streptococcal throat swab ESR MT KOCH HB ELECTROPHORESIS

Appeared to be case of congenital heart disease likely vsd,pulmonary stenosis, ASD or PDA.May be acynotic initially but now gross clubbing shows that reversal of shunt has taken place otherwise clubbing won't be there,and central cynosis must be there. Echo cardiography will tell the exact type of disorder or its combination. However as per ECG and xray harm to the heart has not taken place as yet.So surgical correction to be planned as soon as possible with cardiothoracic surgeon in single or phase manner. The question is whether he can afford?

ECG - RAD, RVH with early transition X ray- no cardiomegaly, RV apical contour, decreased QP. Pedicle not prominent Clubbing of all 4 limbs but deep cyosis is not marked. From the above features I think this is case of TOF, or VSD with severe PS ( R- L shunt) - it is the PS murmur which is widely audible.

Absence of deep cyanosis could be due to less shunting, aorto- pulmonary collaterals or associated severe anaemia.

Symptom...breathlessness on exertion Sign.....widely separated nipples 4th grade clubbing of fingers and toes Xray.... straightning of lft heart border ECG ..... indicates ventricular hypertrophy and enlargement, ......tall t -waves , All indicates that child had Acynotic heart disease. Probably VSD with Aortic stenosis Treat before essermengrization develops

Seems to be Pt of acyanotic CHD ASD/VSD/PDA Has developed reversal shunt going for Eisenmenger syndrome Pediatric cardiologist opinion, echocardiography and color doppler study can reveal the exact structural pathology and prognosis

Face looks like a Copd pt Clubbing Ecg show RAD LPHB P.pulmonale RVH Need Echo Some congenital heart disease

Cyanotic heart dz

SOB/DOE since childhood Systolic murmur with thrill generally pathologic Left ventricular enlargement & hypertrophy Clubbing, severe pallor Acyanotic CHD VSD/ASD probable diagnosis Go for 2D-echo so as to confirm exact diagnosis

Looks like he has congenital heart disease.most probably tetrology of fallots aa evidenced by cyanosis. Get echo done.

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