Congenital heart disease Flashcards
What in infants shunts about 2/3 of blood from right atrium to the left atrium?
foramen ovale
What in infants shunts blood from the pulmonary artery directly into systemic circulation?
ductus arteriosis
Syndrome when left to right shunt becomes right to left
eisenmenger syndrome
What defect could this be:
Asymptomatic and often resolves on own – larger defect causes symptoms of HF (respiratory distress, poor weight gain, fatigue) - 4-6 weeks
VSD
VSD is acyanotic or cyanotic
acyanotic (MC)
ASD is acyanotic or cyanotic
acyanotic
PDA is acyanotic or cyanotic
acyanotic
coarcation of the aorta is acyanotic or cyanotic
acyanotic
teratology of fallot is acyanotic or cyanotic
cyanotic
transposition of the great vessels is acyanotic or cyanotic
cyanotic
What does this indicate:
High pitched harsh holosystolic murmur at lower left sternal border
Handgrip increases intensity
VSD
How do you manage VSD?
⅓ will close spontaneously
Severe w/ HF signs: diuretics + digoxin
Surgery if no response to decongestion
ASD is mostly
asymptomatic
ASD is commonly associated with
anomalies of AV valves
What does this indicate:
RV heave at lower left sternal border, systolic crescendo- decrescendo ejection murmur over pulmonic area, wide, fixed split S2
TTE is initial test w/ Doppler - RA and RV dilation
ASD
How do you manage ASD?
Symptomatic - surgical or catheterization closure
Asymptomatic - elective closure at 3 years of age
What does this indicate:
Widened pulse pressure – “bounding pulses”, cyanosis
Most asymptomatic
PDA
What are these risk factors for:
Higher altitudes, females>males
Prematurity and maternal rubella infection
PDA
What does this indicate:
Machine-like continuous murmur at pulmonic area, crescendo-decrescendo at 2nd IC space
Echo - increased LAE and LVE
PDA
How do you manage PDA?
Asymptomatic = watchful waiting
Symptomatic = IV indomethacin – promoting closure
surgical closure
What does this indicate:
Poor feeding, respiratory distress, shock
Older kids = asymptomatic but may have leg discomfort with exercise, nose bleeds, HTN (headache)
Cyanosis
Bilateral claudication
coarctation of the aorta
What is coarctation of the aorta associated with?
turner syndrome and bicuspid aortic valve
What does this indicate:
Absent or diminished femoral pulses
BP: LE < UE
Blowing, harsh systolic murmur in left interscapular area of back
CXR: marked cardiomegaly + pulmonary edema, rib notching “3 sign”
EKG: normal in infants, LVH in older children
Dx: ECHO to confirm, angiography is gold standard
coarcation of the aorta
How do you manage coarctation of the aorta?
Prostaglandin E1 (alprostadil) to keep ductus arteriosus open in preoperatively
Neonates = anastomosis
Balloon angioplasty for older kids
What does this indicate:
Hypoxic “spells” during infancy - “TET SPELLS”
- restlessness, agitation, crying spells, toddlers may squat
- cyanosis by 4 months, easy fatigability and DOE
Hyperpnea and increasing cyanosis
tetralogy of fallot
What are the 4 findings of tetralogy of fallot?
Large VSD
Pulmonary stenosis - murmur
Overriding aorta
RVH (heave)
What does this indicate:
Large VSD
Pulmonary stenosis - murmur
Overriding aorta
RVH (heave)
Loud single S2
Lab: hemoglobin, hematocrit, RBC elevated
CXR: normal heart, RV hypertrophy (boot shape)
EKG: RVH, RAD
ECHO: anomaly
tetralogy of fallot
How do you manage tetralogy of fallot?
Treat spells with oxygen + knee-chest position
IV Morphine to relax pulmonary infundibulum + sedation
Consider phenylephrine to increase vascular resistance
Prostaglandin therapy to maintain ductal patency
Beta blockers to decrease risk of Tet spells until surgery
Surgical repair
Birth - 2 years
Close VSD + repair stenosis
Bacterial endocarditis prophylaxis indicated until 6 months or until VSD repaired
Tetralogy of fallot patients usually need later in life a
pulmonary valve replacement
What does this indicate:
Profoundly cyanotic w/o respiratory distress + significant murmur
Infants with a large VSD = less cyanotic + more noticable murmur
Severe cyanosis and tachypnea w/n 30 days of life, diaphoresis and poor feeding
transposition of the great vessels
Transposition of the great vessels is most common
newborn period
Patients with transposition of the great vessels also have
ASD, VSD, PDA
What does this indicate:
EKG: RAD + RVH
CXR: increased pulm vascularity + “egg on a string” - cardiomegaly + narrowed mediastinum
Get ECHO
Loud and single S2
transposition of the great vessels
How do you treat transposition of the great vessels?
Prostaglandin E1 (alprostadil)
Balloon atrial septoplasty
Arterial switch operation performed w/n 2 weeks of life
