When congenital heart disease should be suspected in the newborn

Review article about the main clinical features of congenital heart disease presenting in the newborn period. Based on clinical data such as heart murmur, cyanosis, breathlessness and arrhythmia, the most frequently associated clinical findings are discussed as well as the entities most likely to be related to them. Informations on diagnosis and therapy are also briefly provided.Artigo de revisão sobre as principais manifestações clínicas das cardiopatias congênitas, que se manifestam no período neonatal. A partir da presença de dados clínicos, como sopro cardíaco, cianose, taquipnéia e arritmia, são discutidos os principais elementos clínicos associados, assim como as entidades mais provavelmente a eles relacionadas. Informações sobre diagnóstico e terapêutica são também sumariamente apresentadas

Cardiologic evaluation of children with suspected heart disease: experience of a public outpatient clinic in Brazil

CONTEXT: During initial evaluation of children on an outpatient basis, the index of suspected heart disease may be high, particularly if we consider that innocent murmur occurs in about 50% of the pediatric population. This is the most common cause of referral to the pediatric cardiologist. OBJECTIVE: To report on the experience of a public outpatient clinic in the southeastern region of Brazil. DESIGN: Retrospective analysis of all patients submitted to cardiologic evaluation within a 39 month period. SETTING: public pediatric cardiology outpatient clinic. PARTICIPANTS: 2675 consecutive children aged<FONT FACE="Symbol"> £</font>15 years referred from the local and regional basic health units due to suspected heart disease. MAIN MEASUREMENTS: Reason for referral, diagnostic investigation, final diagnostis based on the reason for referral, therapeutic procedures. RESULTS: The main reasons for referral were: murmur (70%), precordial pain (9%), suspicion of arrhythmia (9%) and breathlessness (5%). Of the total number, 695 cases (26%) did not complete the investigation and were not included in the analysis. A final diagnosis was obtained based on the reason for referral and the main conclusions were: l) a high incidence of normality was found: murmur (83%), pain (98%), arrhythmia (97%) and breathless (94%); 2) heart disease was unlikely, based on other referral reasons; 3) 14% of the children were considered abnormal and 1% needed therapeutical procedures. CONCLUSIONS: The establishment of a pediatric cardiology outpatient clinic within the public health service in the region seems to be justifiable, due to the high current demand. The low global incidence of heart disease, with a high prevalence of children with innocent murmur, discloses the need for a specific training program in cardiology for pediatricians

Cardiopatia chagásica em crianças: relato de dois casos

Os Autores apresentam dois casos de cardiopatia chagásica crônica na infância, procedentes da região limítrofe entre os Estados de São Paulo e Minas Gerais. O objetivo é mostrar a possibilidade de contaminação natural da doença na área rural da região da qual as crianças são provenientes, assim como contribuir no entendimento fisiopatológico da Doença de Chagas. Ambos os casos apresentaram insuficiência cardíaca refratária aos recursos terapêuticos atuais, evoluindo para o óbito. São feitos comentários gerais sobre a fisiopatologia da doença, com base na literatura pertinente