Clinical pearls in pediatric cardiology

In this section, the authors present four interesting clinical cases that presented with common symptoms, but required careful clinical examination and investigations to arrive at a correct diagnosis and institute appropriate management. The first case is a 3-month-old infant who presented with hypertonia, bulging anterior fontanelle and tachycardia. ECG revealed supraventricular tachycardia which was managed appropriately. The clinical suspicion of meningitis was not borne out by the CSF findings. The second is a pre-school girl who presented with recurrent, episodic wheezing that did not respond to standard asthma therapy. The authors discuss the management approach in such cases; careful examination of radiographs and clinical course led to the correct diagnosis of dilated cardiomyopathy. The next two cases are older children; one of them presented with massive bilateral pleural effusion; this was found to be caused by congestive cardiac failure. The last case is a 10-year-old child presenting with features of right sided heart failure without obvious cardiac abnormality on clinical examination. Advanced investigations confirmed a rare diagnosis of arrhythmogenic right ventricular dysplasia; retrospective ECG examination showed the characteristic findings of this condition.