Si le diagnostic n’a pas été fait avant la naissance plusieurs signes peuvent orienter votre médecin vers un diagnostic de malformation ou maladie cardiaque après la naissance:
– Un souffle cardiaque entendu lors de l’auscultation au stéthoscope.
– Une cyanose (couleur bleu de la peau), reflétant un manque d’oxygène qui est mesuré grace à un saturomètre.
– Des difficultés respiratoire ou des sueurs lors des tétées, de la prise du biberon.
– Une mauvaise prise de poids.
– Des symptômes chez le grand enfants comme des douleurs thoraciques des palpitations, un malaise, un éssouflement à l’effort.
– La découverte d’une hypertension artérielle.
– La découverte d’un ‘gros’ coeur à la radio.
– La découvert d’une maladie génétique qui est souvent associée à une malformation cardiaque.
En cas de suspicion de malformation ou de maladie cardiaque, votre enfants sera amené à réaliser certains examens pour identifier le problème et poser un diagnostic le plus complet possible
L'échographie cardiaque
L’échographie cardiaque pédiatrique est un examen non invasif qui permet de visualiser le coeur grâce à un faisceau d’ultrason. Les images sont dynamiques, en temps réel, et permettent d’étudier l’architecture du coeur, sa contractilité, les flux sanguins et ainsi faire le diagnostique de malformations cardiaques.
Le contact avec le gel d’échographie (conducteur) est un peu froid mais cet examen est non douloureux et peut être réalisé dès la naissance. Il n’est pas nécessaire d’être à jeun pour réaliser l’examen.
L'électrocardiogramme (ECG)
C’est un examen qui permet d’étudier l’activité électrique du cœur. Des électrodes sont placés selon un schéma bien précis sur le thorax et permettent d’imprimer un tracé électrique. Ces lignes permettent d’étudier le rythme cardiaque, sa régularité et ainsi faire le diagnostic de trouble du rythme, de conduction etc…
C’est un examen sans danger, rapide et non douloureux. Seul le retrait des patchs chez le nourrisson peut être désagréable mais des moyens de retraits existent pour éviter la douleur.
Le holter ECG
C’est est un examen qui permet d’enregistrer sur une longue période (24h ou plus) le rythme électrique du coeur, contrairement à l’électrocardiogramme (ECG) qui enregistre l’instant ‘T’.
Tout comme l’électrocardiogramme, des électrodes sont placées sur le thorax et sont reliées à un petit appareil qui enregistre en continu. Votre enfant rentre chez lui avec l’appareil et peut poursuivre une activité normale (sauf la douche). L’examen est également adapté aux tout petit. On vous remettra un feuille ou vous pourrez noter les activités et les symptômes de votre enfant pendant la période d’enregistrement.
Une fois l’enregistrement terminé, nous analysons les données du boitier ce qui permet parfois de faire le diagnostic de troubles du rythmes paroxystiques qui peuvent survenir à tout moment et qui passeraient inaperçues lors d’un examen limité au cabinet.
L'épreuve d'effort
C’est un examen qui permet d’examiner l’activité électrique du coeur (comme l’ECG) pendant un effort.
Il permet surtout chez l’enfant de dépister des trouble du rythme survenant dans un contexte d’effort.
Il peut être couplé à une mesure de la capacité respiratoire à l’effort qui permettra d’objectiver les répercussions fonctionnelles de certaines opérations cardiaques.
Le scanner ou l'IRM cardiaque
Dans certains cas, l’échographie cardiaque ne suffit pas pour visualiser l’anatomie cardiaque.
Il est util dans ce cas de réaliser des imagerie de coupe comme le scanner ou l’IRM qui permettent de visualiser les structures, reconstruire des plans en 3D, mesurer des volumes etc…
Il est parfois nécessaire de sédater (endormir) un peu les enfants pour éviter les mouvements pendant l’examen.
Le cathétérisme cardiaque
Le cathétérisme cardiaque est une technique invasive qui peut être utilisée à des fins diagnostiques ou thérapeutiques.
Un cathéter est introduit dans une veine ou une artère et dirigé vers le coeur. Le médecin est guidé par des images radiologiques (grâce à l’injection de produit de contraste) qui lui sont transmises par un écran.
Dans le cas du cathétérisme diagnostic, l’examen a pour objectif de visualiser la circulation à travers les différentes structures cardiaque mais également mesurer les pressions, saturations et débits dans l’objectif de prendre des décisions opératoires.
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