Soplos en pediatría ambulatoria / Heart murmurs in ambulatory pediatrics

La auscultación de un soplo cardíaco es un hallazgo frecuente en pediatría y la mayoría de las veces es un soplo fisiológico y no refleja cardiopatía, sin embargo, los médicos deben realizar un acertado análisis para derivar a especialista a los niños que sí requieren evaluación y estudio.

Jones criteria and underdiagnosis of rheumatic fever.

OBJECTIVE: The authors attempt to determine whether typical clinical and laboratory manifestations of acute rheumatic fever (ARF) are in accordance to what has been traditionally described and how useful the Jones criteria are for diagnosis. METHODS: Data from 81 cases of ARF were retrospectively collected. Inclusion criteria: 5 to 15 years of age and diagnosis of ARF confirmed by 2 or more rheumatologists, sustained for at least 6 months and two or more visits. RESULTS: Girls had more chorea (23/50.0% vs. 5/14.3%)(p< 0.0001). Cardiovascular (65/80.2%) and joint involvements (63 / 77.8%) were the most frequent manifestations. Fever was noted in roughly half of the patients. Arthritis was more frequent than arthralgia (47/58.0% vs. 16/19.8%, respectively) (p< 0.0001); however, no specific pattern of joint involvement was found to be more prevalent. Mitral insufficiency was the most frequently detected echocardiographic sign (53 / 93.0%) and its association with aortic insufficiency was noted in 27 / 47.4% patients. Only 24 / 29.6% patients fulfilled Jones criteria for ARF requiring an evidence of previous group-A streptococcal infection (GASI). When compulsory GASI was disregarded, this number rose to 71/87.7% patients (p< 0.0001). CONCLUSION: Girls were more affected by chorea; heart valves and joints were equally affected and represented the major clinical features; no specific pattern of joint involvement (eg.: migratory arthritis) could be labeled as typical; and strict adherence to Jones criteria, with compulsory documentation of a previous GASI, may lead to underdiagnosis of ARF.

Confronto anátomo-propedêutico: sopro de Austin Flint em um caso de endocardite bacteriana / Anatomopropaedeutical confrontation: Austin Flint's murmur in a case of bacterial endocarditis

Trata da correlaçäo anátomo-clínica e ecocardiográfica de um trombo séptico em valva aórtica, que na ausculta cardíaca revelou sopro diastólico com reforço pré-sistólico em foco mitral (sopro de Austin Flint) e, cujo ecocardiograma näo demonstrou a vegetaçäo. Foi discutido a correlaçäo anátomo-radiológica das embolias pulmonares decorrentes da endocardite bacteriana da valva tricúspide.

Avaliaçäo prática dos sopros cardíacos / Practic evaluation of heart murmurs

Säo descritos esquematicamente as características da ausculta dos principais sopros cardíacos como orientaçäo inicial ao exame clínico.

Electrocardiographic demostration of dual atrioventricular nodal pathways in children

Dual atrioventricular nodal, pathaways, as evaluated by electrocardiography, were found in two children without arrhythmias over a six year period. Although none have developed tachycardia, they have the substrate to develop atrioventricular reentrant tachycardia