Pediyatrik Kalp Hastaliklarında Tanı Yöntemleri
Özet
Pediyatrik kardiyolojide tanı süreci; ayrıntılı hasta öyküsü, fizik muayene, göğüs radyografisi, nabız oksimetresi ve kan basıncı ölçümleri ile başlar. Öyküde gebelik, doğum, ilaç ve aile hikayesi detaylıca sorgulanırken; fizik muayenede siyanoz, üfürüm, periferik nabızlar, prekordiyum, organomegali ve döküntüler değerlendirilir. Göğüs röntgeni kardiyotorasik oran, kardiyak kontur ve pulmoner vaskülarite hakkında temel bilgiler sağlarken; nabız oksimetresi kritik siyanotik doğuştan kalp hastalıklarının erken yenidoğan döneminde taranmasında zorunlu bir kriterdir. Ekstremiteler arası kan basıncı ölçümü aort koarktasyonunu, 24 saatlik tansiyon Holter izlemi ise beyaz önlük hipertansiyonunu ve gece tansiyon yükünü tespit etmede kullanılır. Ritim ve iletim bozukluklarının tanısında elektrokardiyografi (EKG), 24 saatlik Holter EKG, anlık olay kaydediciler ve invaziv elektrofizyolojik çalışmalar kritik rol oynar. Ekokardiyografi (TTE, TÖE, Fetal ve Stres EKO); kalp odacıkları, kapaklar, kardiyak şantlar ve fonksiyonların değerlendirilmesinde ana noninvaziv görüntüleme yöntemidir. Egzersiz testi iskemi ve egzersiz kapasitesini, tilt table testi ise vazovagal senkopu değerlendirmede tercih edilir. Bilgisayarlı tomografi ve manyetik rezonans görüntüleme karmaşık anatomik ve vasküler anomalileri radyasyonsuz veya yüksek çözünürlüklü olarak sunarken, kardiyak kateterizasyon ve anjiyografi ayrıntılı hemodinamik veriler ve girişimsel tedavi imkanı sağlar. Ayrıca troponin, NT-proBNP ve CRP gibi spesifik biyokimyasal markerlar da tanı ve takip süreçlerini tamamlamaktadır.
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