CHD

Question 1

What is the MC CHD?

Answer 1

VSD

Question 2

Describe the murmur of a VSD

What kind of shunt?

Tx

Answer 2

Murmur:

• Holosystolic murmur at LLSB +/- RV heave
• If large: harsh pansystolic murmur at LLSB

Shunt: L>R (acyanotic)

Tx:

• small: serial monitoring
• large: patch @ 3-6 months

Question 3

Describe the murmur of an ASD

What kind of shunt?

Tx

Answer 3

Murmur:

• Fixed, widely split S2, RV heave
• Systolic ejection murmur at RVOT
• Large shunt: mid-diastolic murmur at LLSB

Shunt: L>R (acyanotic)

Tx:
- surgical closure via cath

Question 4

Which CHD is common in Down Syndrome

Answer 4

AVSD

Question 5

Describe the murmur of an AVSD

What kind of shunt?

Tx

Answer 5

Murmur: non specific systolic murmur

Shunt: L>R (acyanotic)

Tx: Control CHF and manage growth until surgery can be performed 4-6 YO

Question 6

Describe the murmur of a PDA

What kind of shunt?

Tx

Answer 6

Murmur: Continuous, machine-like murmur at L infraclavicular space + widened pulse pressure + bounding pulses

Shunt: L>R (acyanotic)

Tx:

• If pt is a preemie: give NSAIDs
• If not, NSAIDs won’t work: cardiac cath closure

Question 7

Which CHD is common in Turners?

Answer 7

Coarctation of the aorta

Question 8

Describe the murmur in CoA

What kind of shunt?

Tx

Answer 8

Murmur: Systolic murmur - left back or axilla
+ decreased femoral pulses and large BP gradient

Shunt: L>R (acyanotic)

Tx: Prostaglandins

PDA needed for survival (Transposition of the Great Arteries also needs PDA for survival)

Question 9

Which acyanotic CHD is the most critical?

Answer 9

CoA

Question 10

What must be done for all cyanotic CHD?

Answer 10

Within the first year:

• In nursery: give O2, IV/umb cath, supportive care while waiting for surgery
• PROSTAGLANDINS!!!

Question 11

Which cyanotic CHD is the MC?

Answer 11

Tetralogy of Fallot

Question 12

Describe the murmur in Tetralogy of Fallot

What kind of shunt?

Tx

Answer 12

Murmur:

• Single S2 from aorta
• Systolic ejection murmur / LSB at 3rd rib

Shunt: R>L (cyanotic)

Tx:

• O2, Morphine, Propanolol
• Surgery before 2 yo. Often need revision ~10-15 YO

Question 13

Describe the murmur in Transposition of the Great Arteries

What kind of shunt?

Tx

Answer 13

Murmur: none-zo

Shunt: R>L (cyanotic)

Tx:

• Prostaglandins
• Switch vessels w/in 4-7 days

PDA needed for survival (Coarctation of the Aorta also needs PDA for survival)

PROFOUND CYANOSIS

Question 14

Describe the murmur in tricuspid atresia

What kind of shunt?

Tx

Answer 14

Murmur:

• Single S2
• No murmur

Shunt: R>L (cyanotic)

Tx: Prostaglandins, baby

Patent Foramen Ovale or ASD critical for life

Question 15

Describe the murmur in total anomalous pulmonary venous return (TAPVR)

What kind of shunt?

Tx

Answer 15

Murmur:

• Widely split S2
• Systolic ejection murmur at LUSB

Shunt: R>L (cyanotic)

Tx: Prostaglandins, surgery

Question 16

Describe the murmur in truncus arteriosus

What kind of shunt?

Tx

Answer 16

Murmur:

• Single accentuated S2
• Loud, holosystolic @ LLSB
• Loud systolic ejection click

Shunt: R>L (cyanotic)

Tx: Anticongestive measures

VSD always present!

Question 17

Describe the murmur in hypoplastic left heart

What kind of shunt?

Tx

Answer 17

Murmur: ?

Shunt: R>L (cyanotic)

Tx: PGs and for the love of all that is good AVOID O2

PDA is critical