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      Casos clínicos en Cardiología (N.º 11): lactante de tres meses que se fatiga con las tomas Translated title: Clinical cases in Cardiology (nº 11): three months old infant showing shortness of breath when feeding

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          Abstract

          Continuamos con la serie de casos clínicos en Cardiología pediátrica, revisando los motivos de consulta y datos exploratorios frecuentes en las consultas de Pediatría de Atención Primaria, y presentados de forma breve y práctica. En este número se presenta el caso de un lactante de tres meses que acude por fatiga y sudoración con las tomas. Se discute cómo la exploración y los hallazgos electrocardiográficos orientan el manejo diagnóstico de este paciente.

          Translated abstract

          We continue the series of clinical cases in Pediatric Cardiology checking frequent reasons for consultation in the pediatric offices of Primary Care as well as exploratory signs, and presenting them in a brief and practical way. In this paper, we present the case of a 3 month-old infant who is taken because of shortness of breath and sweating with feeding. The way the physical exploration and the electrocardiographic findings guide the diagnosis of this patient is discussed.

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          Most cited references4

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          Evaluation and management of heart murmurs in children.

          Heart murmurs are common in healthy infants, children, and adolescents. Although most are not pathologic, a murmur may be the sole manifestation of serious heart disease. Historical elements that suggest pathology include family history of sudden cardiac death or congenital heart disease, in utero exposure to certain medications or alcohol, maternal diabetes mellitus, history of rheumatic fever or Kawasaki disease, and certain genetic disorders. Physical examination should focus on vital signs; age-appropriate exercise capacity; respiratory or gastrointestinal manifestations of congestive heart failure; and a thorough cardiovascular examination, including features of the murmur, assessment of peripheral perfusion, and auscultation over the heart valves. Red flags that increase the likelihood of a pathologic murmur include a holosystolic or diastolic murmur, grade 3 or higher murmur, harsh quality, an abnormal S2, maximal murmur intensity at the upper left sternal border, a systolic click, or increased intensity when the patient stands. Electrocardiography and chest radiography rarely assist in the diagnosis. Referral to a pediatric cardiologist is recommended for patients with any other abnormal physical examination findings, a history of conditions that increase the likelihood of structural heart disease, symptoms suggesting underlying cardiac disease, or when a specific innocent murmur cannot be identified by the family physician. Echocardiography provides a definitive diagnosis and is recommended for evaluation of any potentially pathologic murmur, and for evaluation of neonatal heart murmurs because these are more likely to be manifestations of structural heart disease.
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            Guía rápida para la lectura sistemática del ECG pediátrico

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              Nadas' pediatric cardiology

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                pap
                Pediatría Atención Primaria
                Rev Pediatr Aten Primaria
                Asociación Española de Pediatría de Atención Primaria (Madrid )
                1139-7632
                June 2013
                : 15
                : 58
                : 157-160
                Affiliations
                [1 ] Hospital Universitario Fundación Alcorcón Spain
                Article
                S1139-76322013000200010
                10.4321/s1139-76322013000200010
                1c322894-f215-4b89-a814-481962ef0351

                http://creativecommons.org/licenses/by/4.0/

                History
                Categories
                PEDIATRICS

                Pediatrics
                Systolic murmur,Left ventricular hypertrophy,Congenital heart disease,Ventricular septal defect,Soplo sistólico,Hipertrofia ventricular izquierda,Cardiopatía congénita,Comunicación interventricular

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