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 these
children present with recurrent chest infections and congestive cardiac failure (CCF), and are managed
by general practitioners. A careful search for underlying cardiac problems and awareness about the
presentation of CCF and its magnitude will definitely decrease the morbidity and mortality of these
children. The objective of this study was to see the frequency and clinical presentation of CCF in
children with Ventricular Septal Defect (VSD). Methods: Forty-nine patients met the preset criteria
during the study period of 6 months. A detailed history and physical examination with special emphasis
on symptoms and signs was sought and the findings were noted in a questionnaire. Data was analysed
using 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 the
patients 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%. Other
presenting signs were displaced apex beat 57%, oedema 28.6% and chest deformity 20.4%. Regarding
the 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 studies
regarding CCF in paediatric patients are scarce. There is a need to design more studies in children with
CCF. Early recognition of signs and symptoms of CCF on paediatric patients with VSD and awareness
at primary health care level can prevent the delay in the diagnosis and early referrals by GPs to hospital
setup will definitely reduce the morbidity and mortality.
Keywords: Children, Congestive cardiac failure, Ventricular septal defect
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