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Child has dyspnea, tachypnea, hypoxemia, done echo, clicking noise.Doctors say asthma. Is it heart?

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Pediatrician, Infectious Diseases
Practicing since : 2005
Answered : 1528 Questions
daughter has had chronic admissions for dyspnea, tachypnea, hypoxemia. After much insistence on my part (Nurse/mother) the docs agreed to an echo. Results showed "trivial" tricuspid regurgitation and small PFO with right to left shunting. Pulmonary veins were difficult to visualize, and ventricular function ok with shortening fraction of 35%.
Chronic Dyspnea unrelieved by medications and requires supplemental O2 for mil relief
Chronic Nighttime O2 desaturations, retractions, cyanosis, in increase work of breathing
Often becomes SOB with activity
Laryngomalacia, RUL Bronchomalacia, RAD, Status asthmaticus, respiratory distress, chronic bronchiolitits.

PLEASE.....Having my nursing degree gives me inside knowledge. While I listen to hear lung sounds I often ;ately have heard a clicking noise which seems to originate from her heart. Also, her heartrate no longer increases with respiratory effort and in fact has now shown decline while having respiratory difficulty. I feel its the are saying....ASTHMA???? She is 23 months old and has only been having these problems since about her 1st Birthday. Almost 1 full year. Just doesnt add up.
Posted Wed, 18 Apr 2012 in Hypertension and Heart Disease
Answered by Dr. Hema Yadav 3 hours later

Thanks for the query.

Chronic dyspnoea not relieved by medications associated with cyanosis and structural lesion in heart does warrant a thorough cardiac workup by a pediatric cardiologist.

Controller medication like steroids and bronchodilator inhalers is usually started to treat asthma / bronchiolitis and response to treatment is monitored. You have not specified if any such treatment was given to your daughter. If treatment was inadequate, it again points to cardiac condition and entails evaluation.

A small 'patent foramen ovale' or trivial tricuspid regurgitation may be asymptomatic in toddlers but when associated with change in heart rate and clicks then further monitoring is needed.

I understand your dilemma and difference of opinion with your doctors. But please don't panic. I understand you are looking for the best and have every right to clear any doubts, but the best way is through mutual discussion with your pediatrician.

As per my suggestion , first of all you need to consult a pediatric cardiologist who can manage both cardiac and respiratory problems of your child . Such a doctor will need a detailed history of your daughters exacerbation, onset duration, progress of symptoms, factors aggravating and relieving it, any history of allergy, birth history, etc. He can thoroughly check her respiratory and heart
sounds and based on all the findings may order few tests to differentiate between respiratory and cardiac pathology like high resolution computed tomography (HRCT scan) of chest, Magnetic resonance Angiography of heart vessels, arterial blood gas analysis, ECG, blood counts, ESR, doppler study of heart, and pulmonary function tests. The above tests may or may not be needed depending on the doctors examination findings.

I am sure with these tests, it is possible to clearly diagnose your daughters condition and a proper treatment can be planned.

Hope I have answered your query. I will be available for any follow up queries.

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