Diagnosis of congenital heart disease in acyanotic infant

Abstract

Customarily, differential diagnosis of congenital heart defects consists of correlating symptoms and signs with radiographic and electrocardiographic findings which belong to one isolated defect more than another. This approach, while academically interesting to the physician infrequently involved in cardiac problems, has proved to be unhelpful either in early detection of heart disease in the infant or in better management, once recognized. The approach presented in this review has intentionally avoided reference to specific anomalies in order to place emphasis where it is obviously needed— on functional assessment of the cardiovascular system rather than on clinical diagnosis of the anatomical defect. The plan of evaluation, if effective, would reduce prompt referral to a cardiac center of the healthy infant with a benign heart defect just as much as it would promote early referral of the infant with a morbid form of heart disease. The infant with heart disease has been featured since his problems are greater in number and complexity and because his nonverbalized complaints of cardiorespiratory distress are so frequently misinterpreted. The roles and competence of the several physicians who will be responsible for the infant with heart disease have been candidly discussed, since each has his function and his limitations in the total cardiovascular assessment. The first physician who sees the infant and is accountable for his overall care, has the most exacting assignment. It is for him that this plan is proposed, and it is to him that this article is very respectfully dedicated.