Pustaka Ilmiah Universitas Padjadjaran

Abstrak

The role of non-invasive modalities in diagnosis of Congenital Heart Disease

The approach to the patient with known or suspected cardiovascular disease begins with a directed history and targeted physical examination, the scope of which depends on the clinical context at time of presentation. Elective, ambulatory encounters allow comparatively more time for the development of a comprehensive assessment, whereas emergency department visits and urgent bedside consultations require a more focused strategy. The history is an invaluable source of information and often will provide clues linking seemingly disparate aspects of the patient’s presentation. It affords a unique opportunity to assess the patient’s personal attitudes, his/her intelligence, comprehension, acceptance, denial, motivation, fear, and prejudices. The major symptoms associated with cardiac disease include chest discomfort, dyspnea, fatigue, edema, palpitations, and syncope. Cough, hemoptysis, and cyanosis are additional examples. Claudication, limb pain, edema, and skin discoloration usually indicate a vascular disorder. The chest radiograph was one of the first clinical studies to use the then-new technology of diagnostic x-ray. The major variables that determine the diagnostic value of the chest x-ray include the specific technical factors involved in producing the radiographs, patient-specific factors (e.g., body habitus, age, physiological status, ability to stand and to take and hold a deep breath), and training, experience, and focus of the interpreter. In the clinical diagnosis of congenital or acquired heart disease, the presence of electrocardiographic (ECG) abnormalities is often helpful. Hypertrophies (of ventricles and atria) and ventricular conduction disturbances are the two most common forms of ECG abnormalities. Other ECG abnormalities such as atrioventricular (AV) conduction disturbances, arrhythmias, and ST-segment and T-wave changes are also helpful in the clinical diagnosis of cardiac problems. Echocardiography (echo) is an extremely useful, safe, and noninvasive test used for the diagnosis and management of heart disease. Echo studies, which use ultrasound, provide anatomic diagnosis as well as functional information. This is especially true with the incorporation of Doppler echo and color flow mapping. The M-mode echo provides an “ice-pick” view of the heart. It has limited capability in demonstrating the spatial relationship of structures but remains an important tool in the evaluation of certain cardiac conditions and functions, particularly by measurements of dimensions and timing. It is usually performed as part of two-dimensional echo studies. The two-dimensional echo has an enhanced ability to demonstrate the spatial relationship of structures. This capability allows a more accurate anatomic diagnosis of abnormalities of the heart and great vessels. The Doppler and color mapping study has added the ability to detect easily valve regurgitation and cardiac shunts during the echo examination. It also provides some quantitative information such as pressure gradients across cardiac valves and estimation of pressures in the great arteries and ventricles. Echo examination can be applied in calculation of cardiac output and the magnitude of cardiac shunts. Discussion of instruments and techniques is beyond the scope of this book. Normal echo images and their role in the diagnosis of common cardiac problems in pediatric patients are briefly presented.