Rizky Adriansyah

Langsa, 19 Mei 1979 Pendidikan

S1 FK USU : lulus tahun 2001 Pendidikan Profesi Dokter FK USU: lulus tahun 2002 S2 Ilmu Kesehatan Anak FK USU: lulus tahun 2010 Pendidikan Dokter Spesialis Anak FK USU: lulus tahun 2011

Pekerjaan
Dokter PTTT / Kepala Puskesmas Nusajaya, Kabupaten Halmahera Timur, Provinsi Maluku Utara, 2003 - 2005 Staf Dinas Kesehatan Provinsi Sumatera Staf Divisi Kardiologi, Departemen Ilmu Kesehatan Anak

Heart Diseases in Children: An Introduction

Rizky Adriansyah

Approach to Heart Diseases in Children

Basic Tools in Routine Evaluation
History Taking and Physical Examination Cardiac Interpretation of Pediatric Chest X-Ray Pediatric Electrocardiography

Special Tools
Pediatric Echocardiography Pediatric Cardiac Catheterization

Pediatric Heart Diseases

Congenital Heart Diseases
Acyanotic CHDs (Left to Right Shunt)
Ventricular Septal Defect (VSD) Atrial Septal Defects (ASD) Patent Ductus Arteriosus (PDA) Atrioventricular Septal Defect (AVSD) Pulmonary Stenosis (PS) Aortic Stenosis (AS) Coarctation Aorta (CoA), etc

Cyanotic CHDs (Right to Left Shunt)

Tetralogy of Fallot (TOF) Transposition of the Great Arteries (TGA), etc

Pediatric Heart Diseases

Acquired Heart Diseases
Rheumatic Fever and Rheumatic Heart Disease (RHD) Kawasaki Disease Cardiovascular infections Cardiomyopathy Cardiac Arrhythmias Cardiac Involvement in Systemic Diseases, etc

Special Problems
Pediatric Heart Failure Pediatric Hypertension, etc

Selected Aspects of History Taking GESTATIONAL AND NATAL HISTORY Infections, medications, excessive smoking or alcohol intake during pregnancy; Birth weight POSTNATAL, PAST AND PRESENT HISTORY Weight gain, development, and feeding pattern Cyanosis, cyanotic spells, and squatting Tachypnea, dyspnea, puffy eyelids Frequency of respiratory infection Exercise intolerance; Heart murmur Chest pain; Syncope; Palpitations; Joint symptoms; Neurologic symptoms; Medications FAMILY HISTORY Hereditary disease; Congenital heart defect; Rheumatic fever; Sudden unexpected death; Diabetes mellitus, arteriosclerotic heart disease, hypertension, and so on

Major Syndromes Associated with Cardiovascular Abnormalities CV Abnormalities: Disorders Major Features Etiology Frequency and Types Hypotonic, flat facies, slanted palpebral Down syndrome Frequent (40%50%); fissure, small eyes, Trisomy 21 (trisomy 21) ECD, VSD mental deficiency, simian crease Prenatal growth retardation, Occasional (25% microcephaly, short Fetal alcohol Ethanol or its 30%); VSD, PDA, ASD, palpebral fissure, syndrome byproducts TOF mental deficiency, irritable infant or hyperactive child Macrosomia, hypoglycemia and CHDs (3%5%); TGA, hypocalcemia, Infant of diabetic VSD, COA; Fetal exposure to high polycythemia, mother cardiomyopathy glucose levels hyperbilirubinemia, (10%20%); PPHN other congenital anomalies

Major Syndromes Associated with Cardiovascular Abnormalities CV Abnormalities: Disorders Major Features Etiology Frequency and Types Congenital deafness (not in Romano-Ward syndrome), syncope Very common; long resulting from Long QT syndrome: QT interval on ventricular arrhythmias, family history of sudden death () Frequent; aortic Arachnodactyly with aneurysm, aortic Marfan syndrome hyperextensibility, AD and/or mitral subluxation of lens regurgitation Similar to Turner's Frequent; PS syndrome but may Noonan's syndrome (dystrophic occur in phenotypic (Turner-like pulmonary valve), Usually sporadic male and without syndrome) LVH (or anterior chromosomal septal hypertrophy) abnormality

Major Syndromes Associated with Cardiovascular Abnormalities CV Abnormalities: Disorders Major Features Etiology Frequency and Types Excessive bone Occasional; aortic fragility with Osteogenesis dilatation, aortic deformities of AD/AR imperfecta regurgitation, MVP skeleton, blue sclera, hyperlaxity of joints Triad of the syndrome: deafness, cataract, and CHDs. Others include intrauterine growth Maternal rubella Frequent (>95%); PDA Rubella syndrome retardation, infection during the and PA stenosis microcephaly, first trimester microphthalmia, hepatitis, neonatal thrombocytopenic purpura

Major Syndromes Associated with Cardiovascular Abnormalities CV Abnormalities: Disorders Major Features Etiology Frequency and Types Low birth weight, central facial Very common (80%); anomalies, Trisomy 13 syndrome VSD, PDA, polydactyly, chronic Trisomy 13 (Patau's syndrome) dextrocardia hemangiomas, lowset ears, visceral and genital anomalies Low birth weight, microcephaly, Trisomy 18 syndrome Very common (90%); micrognathia, rockerTrisomy 18 (Edwards' syndrome) VSD, PDA, PS bottom feet, closed fists with overlapping fingers

Major Syndromes Associated with Cardiovascular Abnormalities CV Abnormalities: Disorders Major Features Etiology Frequency and Types Vertebral anomalies, anal atresia, congenital heart VATER association defects, Common (>50%); (VATER/VACTERL tracheoesophageal Sporadic VSD, other defects syndrome) (TE) fistula, renal dysplasia, limb anomalies (e.g., radial dysplasia)

Etc

Prevalence of Associated Congenital Heart Defects in Patients with Other System Malformations
Organ System and Malformation Central Nervous System Hydrocephalus Dandy-Walker syndrome Agenesis of corpus callosum Meckel-Gruber syndrome Thoracic Cavity TE fistula and/or esophageal atresia Diaphragmatic hernia Gastrointestinal Duodenal atresia Jejunal atresia Anorectal anomalies Imperforate anus Ventral Wall Omphalocele Gastroschisis Genitourinary Renal agenesis Bilateral Unilateral Horseshoe kidney Renal dysplasia Frequency (Range) (%) 6 (4.514.9) 3 (2.54.3) 15 14 Specific Cardiac Defects VSD, ECD, TOF VSD No specific defects No specific defects

21 (1539) 11 (9.622.9)
17 5 22 12 21 (1932) 3 (07.7)

VSD, ASD, TOF No specific defects

No specific defects No specific defects No specific defects TOF, VSD No specific defects No specific defects

43 17 39 5

No specific defects No specific defects No specific defects No specific defects