PRESENTATION OF CONGESTIVE CARDIAC FAILURE IN CHILDREN WITH VENTRICULAR SEPTAL DEFECT

Abstract

Background: While there is much data on cardiac problems of adults, there is a limited statistical dataavailable to evaluate the magnitude of the cardiac problems in children in Pakistan. Many of thesechildren present with recurrent chest infections and congestive cardiac failure (CCF), and are managedby general practitioners. A careful search for underlying cardiac problems and awareness about thepresentation of CCF and its magnitude will definitely decrease the morbidity and mortality of thesechildren. The objective of this study was to see the frequency and clinical presentation of CCF inchildren with Ventricular Septal Defect (VSD). Methods: Forty-nine patients met the preset criteriaduring the study period of 6 months. A detailed history and physical examination with special emphasison symptoms and signs was sought and the findings were noted in a questionnaire. Data was analysedusing SPSS-11. Frequencies and percentages were calculated for all categorical variables. Results:CCF in VSD was found more in males, with a male to female ratio of 1.45:1. Majority (63.1%) of thepatients presented in infancy. The common symptoms at presentation were dyspnoea (98%), cough(83.7%), and feeding difficulty (9.6%). Other important symptoms were fever, fatigue, failure to thrive,sweating and wheezing. The common physical signs in order of frequency were murmur 98%,tachypnoea 91.8%, tachycardia 89.8%, hepatomegally 89.9% and crackles in chest 85.7%. Otherpresenting signs were displaced apex beat 57%, oedema 28.6% and chest deformity 20.4%. Regardingthe type of VSD, perimembranous was the commonest 61.2% as confirmed by echocardiography.Conclusion: This study was done on a smaller scale in hospitalised children. The exact studiesregarding CCF in paediatric patients are scarce. There is a need to design more studies in children withCCF. Early recognition of signs and symptoms of CCF on paediatric patients with VSD and awarenessat primary health care level can prevent the delay in the diagnosis and early referrals by GPs to hospitalsetup will definitely reduce the morbidity and mortality.Keywords: Children, Congestive cardiac failure, Ventricular septal defect