What is the purpose of screening examination of the heart?
- Detect neonates with congenital heart disease
- Early identification of major or critical CHD: to aviod neonatal collapse with the increased risk of death and long term neurological impairment
What are the incidence of congenital heart disease?
Incidence of congenital heart disease: 8:1000
(6.3:1000 in England)
Critical congenital heart disease
- Critical congenital heart disease accounts for 15% - 25% of these and is a leading cause of morbidity and mortality.
- Includes a potentially life-threatening duct-dependent conditions and those that require procedures within the first 28 days of life.
Major congenital heart disease
Major congenital heart disease includes defects not classified as critical but requiring invasive intervention in the first year of life.
Less major congenital heart disease
Less major congenital heart disease requiring intervention but not in the first year of life
Non-significant congenital heart disease
Non significant congenital heart disease which is unlikely to require intervention
What are the risk factors to developing congenital heart disease?
First degree relative with a history of CHD:
Mum 5-12% increased risk
Dad 1-3% increased risk
1 x sibling, increase of 2-4%
2 x siblings increase of 10%
What observations should take place for the heart?
Tone, colour (central and peripheral), size and shape of chest,symmetry of chest movements, RR, signage if respiratory distress. Link with feeding (observe neonatal reaction to high energy and oxygen demand)
What palpations should take place when examining the heart?
Femoral and brachial pulses (strength, rhythm, volume)
capillary refill time (returns 3s), position of cardiac apex
presence of thrills,
hepatomegaly; in particular the liver (associated with congenital cardiac failure).
What will you assess when auscultation?
Presence of a murmur - systolic or diastolic, loud or quiet (+/- pulse oximetry)
What are the site for palpitations of the heart?
- Brachial pulse located over the antecubital space
- Femoral pulse located at the groin
What are some characteristic of the femoral and brachial pulses?
- The brachial and femoral should be present and equal bilaterally
- Femoral pulses that are weaker than the brachial pulses may indicate impaired blood flow, as in coarctation of the aorta
How is congenital heart described?
CHD used to describe a problem with the structure and function of the heart that is present at birth
How many cases of congenital heart disease are detected by USS?
Only ~50% of CHD is detected by USS
What are the different ranges of congenital heart disease?
CHD range from non-significant to major and critical
What are the auscultation sites?
- 2nd intercostal space - right
- 2nd intercostal space - left
- 4th intercostal space - left
- 5th intercostal space - left midclavicular line
- 5th site: mid-scapulae (murmurs linked with coarctation)
What is each site of auscultation listening to?
-2nd (right) intercostal - Aortic
- 2nd (left) intercostal - pulmonic
- 4th (left) intercostal - Tricuspid
- 5th (left) midclavicular line - Mitral
What are the types of heart murmurs?
Three main types:
- Systolic murmur
- Diastolic murmur
- Continuous murmur
Define systolic murmur.
Systolic murmur - when the heart is pumping blood to the rest of the body
Define diastolic murmur.
Diastolic murmur - when the heart relaxes between beats to fill up with blood
Define continuous murmur.
Continuous murmur - through the heart beat
Next step for negative screening.
Baby referred to the healthy child programme. Repeat 6-8 weeks.
Next step for positive screening?
Refer for neonatal review - time sensitive (within 24 hours) depending on severity
What are the 8 signs of positive screening?
- A/n diagnosis or p/n suspicion of trisomy 21
- Tachypnoea at rest
- Episode of apnea
- Recession, nasal flaring, intercostal
- Central cyanosis
- Visible pulsation, heaves, thrills
- Absent/or weak femoral pulses
- Murmurs and/or extra heart sounds
