VSD and CHF Flashcards
Failure to thrive
failure to gain weight appropriately (
Feeding patterns in young infants
Breastfed - 10-30 minutes a time every 2 hours
Bottle fed - every 3-4 hours
DDx for respiratory distress and feeding difficulty
CHF - congenital defects
Respiratory infection - anything causing resp distress can cause poor feeding
Sepsis - signs can be nonspecific
Metabolic Disorder - almost all of them can cause poor feeding
Cardiac Exam
Complete exam includes looking at patient color, palpate precordial, assess pulses, auscultate
Precordial - if overactive, heart has increased workload
Grading murmur intensity
I - faint
II - obvious
III - loud
IV - associated with thrill
Holosystolic murmur
The murmur starts with S1 and encompasses all of systole
- VSDs, mitral insufficiency, tricuspid insufficiency
Ejection murmur
occurs during systole but not until after S1
- aortic and pulmonic valve stenosis
Hepatomegaly in infants
normal liver edge = 1-2 cm below ribs
- hepatomegaly consistent with CHF
- decreased renal blood flow –> activates renin-angiotensin system –> fluid retention –> venous congestion –> hepatomegaly
Signs of CHF in infant
Poor feeding, diaphoresis, poor growth, active precordium, hepatomegaly
- inefficient circulation leads to adrenergic activation –> increased metabolic demands –> poor weight gain
Innocent murmurs
common (70-80% at one time have murmur) –> cause no distress or symptoms
- make sure no other alarming signs before brushing off
Murmurs discovered around 3-5 years old
ASD - wide, fixed split of S2
Coarctation of Aorta - progressive, HTN in upper extremities
VSD murmur
Ventricular septal defect - very common
- vary in clinical importance, size
- holosystolic mumur starting with S1
Tetralogy of Fallot
VSD, Overriding aorta, pulmonary stenosis, RVH
- cyanosis through obstruction of pulmonary artery
- R –> L shunt
Transposition of great vessels
vessels switched, severe cyanosis and urgent, early intervention is required
Aortic Stenosis
systolic ejection murmur followed by early diastole murmur
Pulmonic stenosis
prominent systolic click just after S1, harsh systolic ejection murmur
PDA
continuous machine like murmur
Heart defects that cause CHF
VSD
Aortic Stenosis
Coarctation of Aorta
Large PDA
Evaluating a congenital heart defect
EKG
Chest Xray
Echo
Hallmark of CXR in L–>R shunts
cardiomegaly, increased pulmonary vascular markings, pulmonary edema
EKG findings in VSD
prominent biventricular forces (high QRS in V1 and V2) –> LV volume overload and RV pressure overload
- large VSD –> RVH
- moderate VSD –> LVH
Admission criteria for congenital heart disease
not everyone needs admission for management
- present with cyanosis or CHF = admit
- shock = admits
VSD
persistent communication between ventricles
- either membranous or muscular septum
Phys: L–>R shunt –> increased pulmonary blood flow –> increased pulmonary return –> LVH –>
Clinical picture of VSD
murmur and signs not present in nursery (high pulmonary vascular resistance –> no shunting)
- large defecst = CHF as pulmonary resistance falls
Treatment of CHF
Furosemide - lasix to get extra fluid off accumulated by renal system
Digoxin - not clear but has shown to improve symptoms of CHF from VSD
Enalapril - afterload reduction promotes forward flow rather than thru VSD
Eisenmenger’s Syndrome
HORRIBLE OUTCOME FOR VSD
- pulmonary vasculature constricts in response to high flow and high pressure –> permanent changes and pulmonary vasculature unable to relax –> shifts to R->L shunt -> death
