Clinical characteristics of children with small heart syndrome

doi:10.3877/cma.j.issn.1673-5250.2019.05.013

Objective

To investigate the clinical characteristics of small heart syndrome (SHS) in children.

Methods

A total of 8 children with SHS who were treated in the Cardiovascular department of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from March 2016 to December 2017 were selected as research objects and included in SHS group. By using the method of simple random sampling, 8 healthy children who underwent physical examination in the outpatient department of the same hospital in the same period were selected and included in control group. The clinical data or physical examination records of 16 children were analyzed retrospectively. The general clinical data, heart rate fluctuation range, blood pressure and sum of the distance between both hilus pulmonis and the middle line between two groups were statistically compared by independent-samples t test. This study was in line with World Medical Association Declaration of Helsinki revised in 2013, with the informed consent of the guardians of all testees.

Results

①There were no significant differences between two groups in proportion of males, age, weight, height, body surface area, body mass index (BMI), systolic blood pressure and diastolic blood pressure (P>0.05). The range of heart rate fluctuation in SHS group was (117.9±20.1) beats/min, which was higher than that of (94.8±3.9) beats/min in control group; the sum of the distance between both hilus pulmonis and the middle line of SHS group was (88.3±10.5) mm, which was shorter than that of (99.3±5.7) mm in control group, and the differences were statistically significant (t=3.191, P=0.007; t=2.587, P=0.021). ②Among 8 SHS children in SHS group, 5 cases (62.5%, 5/8) were diagnosed as ematiation. Six cases (75.0%, 6/8) presented clinical symptoms, such as chest blockage, chest pain, palpitation, fatigue or dizziness. When chest blockage, chest pain and other possible symptoms attacked in 8 SHS children, their heart rate significantly increased, heart rate fluctuated in a wide range and blood pressure decreased. Four SHS children (50.0%, 4/8) were complicated with sinus arrhythmia. No specific abnormal changes were found of 8 SHS children in myocardial zymogram, 24 h dynamic electrocardiogram (Holter) and color Doppler echocardiography (CDE). ③After taken sufficient rest of children in SHS group, the clinical symptoms as mentioned above could be relieved. The SHS pregnant women were followed up for 18 to 36 months after discharged, and no SHS related clinical symptoms were found in them again.

Conclusions

The clinical manifestations of children with SHS were diversified. For the thin and small children with chest blockage and dizziness, chest X-ray examination should be carried out and the cardiothoracic ratio (CTR) should be measured in order to avoid missed diagnosis and misdiagnosis of SHS.

Key words: X-rays, Radiography, Small heart syndrome, Pathological conditions, signs and symptoms, Cardiothoracic ratio, Child

表1 2组受试儿临床资料比较

组别	例数	男性[例数(%)]	年龄(岁，±s)	体重(kg，±s)	身高(cm，±s)	体表面积(m²，±s)
SHS组	8	4(50.0)	11.0±2.0	36.6±11.9	143.5±13.8	1.18±0.25
对照组	8	4(50.0)	10.9±2.2	40.0±8.4	142.3±10.7	1.16±0.16
检验值	?	χ²＝0	t＝0.125	t＝0.651	t＝0.193	t＝0.191
P值	?	1.000	0.903	0.523	0.850	0.851
组别	例数	BMI(kg/m²，±s)	心率波动范围^b(次/min，±s)	收缩压(mmHg，±s)	舒张压(mmHg，±s)	两侧肺门距中线距离之和(mm，±s)
SHS组	8	17.3±3.3	117.9±20.1	104.4±3.0	69.1±6.6	88.3±10.5
对照组	8	20.5±2.6	94.8±3.9	106.0±9.9	71.0±7.3	99.3±5.7
检验值	?	t＝2.142	t＝3.191	t＝0.445	t＝0.541	t＝2.587
P值	?	0.050^a	0.007	0.663	0.597	0.021

表1 2组受试儿临床资料比较

组别	例数	男性[例数(%)]	年龄(岁，±s)	体重(kg，±s)	身高(cm，±s)	体表面积(m²，±s)
SHS组	8	4(50.0)	11.0±2.0	36.6±11.9	143.5±13.8	1.18±0.25
对照组	8	4(50.0)	10.9±2.2	40.0±8.4	142.3±10.7	1.16±0.16
检验值	?	χ²＝0	t＝0.125	t＝0.651	t＝0.193	t＝0.191
P值	?	1.000	0.903	0.523	0.850	0.851
组别	例数	BMI(kg/m²，±s)	心率波动范围^b(次/min，±s)	收缩压(mmHg，±s)	舒张压(mmHg，±s)	两侧肺门距中线距离之和(mm，±s)
SHS组	8	17.3±3.3	117.9±20.1	104.4±3.0	69.1±6.6	88.3±10.5
对照组	8	20.5±2.6	94.8±3.9	106.0±9.9	71.0±7.3	99.3±5.7
检验值	?	t＝2.142	t＝3.191	t＝0.445	t＝0.541	t＝2.587
P值	?	0.050^a	0.007	0.663	0.597	0.021

表2 8例小心脏综合征患儿的临床资料

编号	性别	就诊年龄(岁)	症状	体征	BMI(kg/m²)
患儿1	女	13	心悸、乏力、胸闷、胸痛、头晕	心率为45～151次/min，血压为102 mmHg/62 mmHg；听诊心律不齐，胸骨左缘2～3肋间吹风样杂音	24.04
患儿2	男	7	心悸、乏力	心率为70～95次/min，血压为102 mmHg/70 mmHg；听诊正常	15.94
患儿3	女	9	因体检发现心律失常就诊，无明显心悸、胸闷等症状	心率为47～131次/min，血压为102 mmHg/73 mmHg；听诊心律不齐，可闻及早搏	13.44
患儿4	男	11	心悸、胸闷	心率为45～117次/min，血压为103 mmHg/57 mmHg；听诊心律不齐	14.49
患儿5	男	11	头晕、胸闷	心率为73～91次/min，血压为108 mmHg/78 mmHg；听诊正常	19.03
患儿6	女	13	头晕、心悸	心率为65～128次/min，血压为108 mmHg/70 mmHg；听诊正常	18.42
患儿7	男	12	因肺炎就诊，无明显心悸、胸闷等症状	心率为45～151次/min，血压为102 mmHg/62 mmHg；听诊肺部湿啰音，心律不齐	15.66
患儿8	女	12	因支气管炎就诊，无明显心悸、胸闷等症状	心率为69～125次/min，血压为102 mmHg/73 mmHg；听诊正常	17.57
编号	CTR(%)	两侧肺门距中线距离之和(mm)	24 h动态心电图检查结果	CDE检查结果
患儿1	38.0	112.07	①窦性心律不齐；②单个房性早搏；③MV5偶见ST段下移0.05～0.10 mV，MV3偶见ST段下移0.05 mV	二尖瓣、肺动脉瓣、三尖瓣轻度反流，EF为65%，Ea>Aa
患儿2	39.8	80.42	因家属拒绝，故未进行该项检查	因家属拒绝，故未进行该项检查
患儿3	37.8	82.47	①偶见窦性心律不齐；②单个房性早搏；③单个室性早搏共10 695次，偶成二联律，形态一致；④MV3、MV5见q波，MV1偶见q波	未见异常
患儿4	33.6	77.83	窦性心律不齐	三尖瓣、肺动脉瓣轻度反流，Ea>Aa
患儿5	37.3	88.47	因家属拒绝，故未进行该项检查	因家属拒绝，故未进行该项检查
患儿6	37.0	88.91	因家属拒绝，故未进行该项检查	因家属拒绝，故未进行该项检查
患儿7	37.5	89.88	偶见窦性心律不齐	未见异常
患儿8	35.0	86.43	因家属拒绝，故未进行该项检查	因家属拒绝，故未进行该项检查

表2 8例小心脏综合征患儿的临床资料

编号	性别	就诊年龄(岁)	症状	体征	BMI(kg/m²)
患儿1	女	13	心悸、乏力、胸闷、胸痛、头晕	心率为45～151次/min，血压为102 mmHg/62 mmHg；听诊心律不齐，胸骨左缘2～3肋间吹风样杂音	24.04
患儿2	男	7	心悸、乏力	心率为70～95次/min，血压为102 mmHg/70 mmHg；听诊正常	15.94
患儿3	女	9	因体检发现心律失常就诊，无明显心悸、胸闷等症状	心率为47～131次/min，血压为102 mmHg/73 mmHg；听诊心律不齐，可闻及早搏	13.44
患儿4	男	11	心悸、胸闷	心率为45～117次/min，血压为103 mmHg/57 mmHg；听诊心律不齐	14.49
患儿5	男	11	头晕、胸闷	心率为73～91次/min，血压为108 mmHg/78 mmHg；听诊正常	19.03
患儿6	女	13	头晕、心悸	心率为65～128次/min，血压为108 mmHg/70 mmHg；听诊正常	18.42
患儿7	男	12	因肺炎就诊，无明显心悸、胸闷等症状	心率为45～151次/min，血压为102 mmHg/62 mmHg；听诊肺部湿啰音，心律不齐	15.66
患儿8	女	12	因支气管炎就诊，无明显心悸、胸闷等症状	心率为69～125次/min，血压为102 mmHg/73 mmHg；听诊正常	17.57
编号	CTR(%)	两侧肺门距中线距离之和(mm)	24 h动态心电图检查结果	CDE检查结果
患儿1	38.0	112.07	①窦性心律不齐；②单个房性早搏；③MV5偶见ST段下移0.05～0.10 mV，MV3偶见ST段下移0.05 mV	二尖瓣、肺动脉瓣、三尖瓣轻度反流，EF为65%，Ea>Aa
患儿2	39.8	80.42	因家属拒绝，故未进行该项检查	因家属拒绝，故未进行该项检查
患儿3	37.8	82.47	①偶见窦性心律不齐；②单个房性早搏；③单个室性早搏共10 695次，偶成二联律，形态一致；④MV3、MV5见q波，MV1偶见q波	未见异常
患儿4	33.6	77.83	窦性心律不齐	三尖瓣、肺动脉瓣轻度反流，Ea>Aa
患儿5	37.3	88.47	因家属拒绝，故未进行该项检查	因家属拒绝，故未进行该项检查
患儿6	37.0	88.91	因家属拒绝，故未进行该项检查	因家属拒绝，故未进行该项检查
患儿7	37.5	89.88	偶见窦性心律不齐	未见异常
患儿8	35.0	86.43	因家属拒绝，故未进行该项检查	因家属拒绝，故未进行该项检查

图1 小心脏综合征患儿(患儿4，男性，11岁)的胸部X射线摄片检查结果(心胸比率为33.6%)

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