Problem based learning
(Session I)
Cyanosis
Moderator,Dr,Gui yonghao
Cyanosis---Hints
? Central cyanosis,implies
decreased arterial oxygen
saturation
? Peripheral cyanosis,caused by a
decreased rate of peripheral blood
flow
Differential diagnosis
? Cardiovascular disease
-Congenital heart disease
-Eisenmenger syndrome
-Pulmonary arteriovenous fistulae
-Systemic arteriovenous fistulae
-Primary pulmonary hypertension
Differential diagnosis
-Congestive heart failure/ low output state
? Respiratory diseases
-Nasal obstruction
-Foreign body aspiration
-Tracheal compression
-Bronchiolitis
-Reactive airway disease
Differential diagnosis
-RDS
-Meconium aspiration
-Pneumonia
-Plural effusion
-Diaphragmatic hernia
-Lung hypoplasia
Differential diagnosis
? Metabolic disease
-Hypoglycemia
? Neurologic diseases
-Seizures
-Edema
-Hemorrhage
Differential diagnosis
? Miscellaneous
-Crying
-Sepsis
-Breath holding
-Drug,respiratory depressants
Differential diagnosis Discussion
? Cardiovascular
-Neonates with cyanosis by CHD
1,Poor mixing of the systemic and pulmonary
circulations
Differential diagnosis Discussion
? Decreased pulmonary blood flow and
normal peripheral perfusion
Differential diagnosis Discussion
? Increased pulmonary venous pressure leading to
pulmonary edema and poor gas exchange
Differential diagnosis Discussion
? Decreased systemic perfusion
? Congestive heart failure
Differential diagnosis Discussion
? Cyanosis in older children
-Tetralogy of Fallot
Cyanotic spells,early
morning feedings,
prolonged crying,defecation
Heart Murmurs
Session II
Presented by Dr,Yonghao Gui
The Heart Sound
? First heart sound is produced by closure
of the MV and TV
? The second sound is produced by
closure of the aortic valve immediately
followed by closure of the pulmonic
valve
The Heart Sound
? Splitting of S2
Atrial septal defect
Mild pulmonic stenosis
Complete right bundle branch block
Left ventricular paced beats
Massive pulmonary embolus
The Heart Sound
? Conditions causing prominent S2
Physiology (infants and children)
Congestive heart failure
Ventricular septal defects (large QP/QS)
Mitral insufficiency
Hyperdynamic ventricular with high
output
Differential Diagnosis
? Functional/innocent murmurs (normal)
? Physiologic murmurs (due to an
abnormality of flow not of primary
cardiac origin
? Pathology murmurs (due to an
abnormality of primary cardiac origin)
Differential Diagnosis
? Functional/innocent murmurs (normal)
Still murmur
Aged 2 to early adolescence
May related to turbulent flow across th
left ventricular outflow tract
Best heard at left lower sternal border
Never associated with a thrill
Differential Diagnosis
? Physiologic murmurs (due to an
abnormality of flow not of primary
cardiac origin
High cardiac output states
Arteriovenous fistula
Periferal pulmonic stenosis
Differential Diagnosis
? Pathology murmurs (due to an
abnormality of primary cardiac origin)
Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus
Tetralogy of fallot
房间隔缺损 室间隔缺
损
动脉导管
未闭
肺动脉瓣
狭窄
法洛四联症
分类 左向右分流 无分流 右向左分流
症状 一般发育落后,乏力, 活动后
心悸, 咳嗽,
气短, 晚期出
现肺动脉高压
时有青紫
同左 同左 轻者可 无症
状, 重 者活
动后心 悸,
气短, 青紫
发育落后, 乏
力, 青紫 （ 吃
奶, 哭叫时加
重 ）, 蹲踞,
可有阵发性昏
厥
心
脏
体
症
杂音
部位
第 2,3肋间 第 3,4肋
间
第 2肋间 第 2肋间 第 2,3肋
间
杂音性
质和响
度
II ～ III 级
收缩期吹风
样杂音, 传
导范围较小
II～ V级粗
糙全收缩
期杂音,
传导范围
广
II ～ IV 级
连续性机
器样杂音,
向颈部传
导
III ～ V 级
喷射性收
缩期杂音,
向颈部传
导
II～ IV级喷
射性收缩期
杂音, 传导
范围较广