Congenital heart disease - Revision history

Danbot: Add MedicationDose entries for PGE1, propranolol, phenylephrine

2026-03-20T21:16:25Z

Add MedicationDose entries for PGE1, propranolol, phenylephrine

← Older revision		Revision as of 21:16, 20 March 2026
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	==Disposition==		==Disposition==

			==Medication Dosing==
			{{MedicationDose
			\| drug = Prostaglandin E1
			\| dose = 0.1mcg/kg/min IV/IO
			\| route = IV/IO
			\| context = Duct-dependent lesions, maintain PDA patency
			\| indication = Congenital heart disease
			\| population = Pediatric
			}}
			{{MedicationDose
			\| drug = Propranolol
			\| dose = 0.2mg/kg IV
			\| route = IV
			\| context = Tet spell (TOF), relieves infundibular spasm
			\| indication = Congenital heart disease
			\| population = Pediatric
			}}
			{{MedicationDose
			\| drug = Phenylephrine
			\| dose = 2-10mcg/kg/min IV infusion
			\| route = IV
			\| context = Tet spell (TOF), increase SVR
			\| indication = Congenital heart disease
			\| population = Pediatric
			}}

	==See Also==		==See Also==

Elcatracho: /* Shock (duct-dependent lesion) */

2020-12-10T18:45:23Z

Shock (duct-dependent lesion)

← Older revision		Revision as of 18:45, 10 December 2020
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	***Apnea ([[intubation\|intubate]])		***Apnea ([[intubation\|intubate]])
	****[[Hypotension]]		****[[Hypotension]]
	****Bradycardia		****[[Bradycardia]]
	****Flushing		****Flushing
	*[[NS]] 10cc/kg		*[[NS]] 10cc/kg

Elcatracho: /* Shock (duct-dependent lesion) */

2020-12-10T18:44:41Z

Shock (duct-dependent lesion)

← Older revision		Revision as of 18:44, 10 December 2020
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	*[[PGE1]] 0.1mcg/kg/min IV/IO		*[[PGE1]] 0.1mcg/kg/min IV/IO
	**Side Effects:		**Side Effects:
	***Apnea (intubate)		***Apnea ([[intubation\|intubate]])
	****[[Hypotension]]		****[[Hypotension]]
	****Bradycardia		****Bradycardia

Elcatracho: /* Cyanotic */

2020-12-10T18:42:14Z

Cyanotic

← Older revision		Revision as of 18:42, 10 December 2020
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	\| [[Truncus arteriosus]]\|\|Cardiomegaly, increased pulmonary vascular markings\|\|Biventricular hypertrophy		\| [[Truncus arteriosus]]\|\|Cardiomegaly, increased pulmonary vascular markings\|\|Biventricular hypertrophy
	\|}		\|}

			*Can use the "5 T's' mnemonic:<ref>Waldman JD, Wernly JA. Cyanotic congenital heart disease with decreased pulmonary blood flow in children. Pediatr Clin North Am. 1999;46(2):385-404. doi:10.1016/s0031-3955(05)70125-5</ref>
			**1 vessel: Truncus arteriosus
			**2 vessels switched: Transposition of the great vessels
			**3=TRIcuspid: Tricuspid atresia
			**4 defects: Tetralogy of Fallot
			**5 letters: Total anomalous pulmonary vascular return (TAPVR)

	===Acyanotic (duct-dependent)===		===Acyanotic (duct-dependent)===

ClaireLewis: /* Management */

2019-08-25T21:37:01Z

Management

← Older revision		Revision as of 21:37, 25 August 2019
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	==Management==		==Management==
	===Shock (duct-dependent lesion)===		===[[Pediatric shock\|Shock]] (duct-dependent lesion)===
	*[[PGE1]] 0.1mcg/kg/min IV/IO		*[[PGE1]] 0.1mcg/kg/min IV/IO
	**Side Effects:		**Side Effects:

Josgood: /* Acyanotic non-duct dependent (i.e. CHF) */

2019-06-25T23:11:19Z

Acyanotic non-duct dependent (i.e. CHF)

← Older revision		Revision as of 23:11, 25 June 2019
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	\| align="center" style="background:#f0f0f0;"\|'''Right axis deviation, [[RVH]], [[RBBB]]'''		\| align="center" style="background:#f0f0f0;"\|'''Right axis deviation, [[RVH]], [[RBBB]]'''
	\|-		\|-
	\| [[VSD]]\|\|Cardiomegaly with increased vascular markings\|\|[[LAH]], [[LVH]], ([[RVH]] with larger VSDs)		\| [[VSD]]\|\|Cardiomegaly with increased vascular markings\|\|[[Left atrial enlargement\|LAH]], [[LVH]], ([[RVH]] with larger VSDs)
	\|-		\|-
	\| [[PDA]]\|\|Cardiomegaly with increased vascular markings\|\|[[LVH]], [[RVH]] with larger PDAs		\| [[PDA]]\|\|Cardiomegaly with increased vascular markings\|\|[[LVH]], [[RVH]] with larger PDAs

Tomfadial: /* Evaluation */

2018-09-08T17:49:01Z

Evaluation

← Older revision		Revision as of 17:49, 8 September 2018
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	==Evaluation==		==Evaluation==
			[[File:CHD.png\|thumb\|Algorithm for the Evaluation and Management of Suspected Congenital Heart Disease in Neonates]]
	===Cyanotic===		===Cyanotic===
	{\| class="wikitable"		{\| class="wikitable"

Kxl328: /* Thrombolysis for Surgical Shunt Obstruction */

2018-03-18T15:38:24Z

Thrombolysis for Surgical Shunt Obstruction

← Older revision		Revision as of 15:38, 18 March 2018
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	===Thrombolysis for Surgical Shunt Obstruction===		===Thrombolysis for Surgical Shunt Obstruction===
	*Blalock-Taussig shunt should maintain flow murmur		*Blalock-Taussig shunt should maintain flow murmur
	*Loss of flow murmur alongside ~~hypotension and~~ hypoxia relative to baseline saturations should prompt consideration for shunt obstruction		*Loss of flow murmur alongside profound hypoxia relative to baseline saturations should prompt consideration for shunt obstruction
	*Definitive treatment is surgical, but systemic recombinant tPA may be considered as salvage intervention when other options are not readily available<ref>Diaz F et al. Systemic thrombolysis with recombinant tissue plasminogen activator for acute life-threatening Blalock-Taussig shunt obstruction. Indian J Crit Care Med. 2016 Jul; 20(7): 425–427.</ref>		*Definitive treatment is surgical, but systemic recombinant tPA may be considered as salvage intervention when other options are not readily available<ref>Diaz F et al. Systemic thrombolysis with recombinant tissue plasminogen activator for acute life-threatening Blalock-Taussig shunt obstruction. Indian J Crit Care Med. 2016 Jul; 20(7): 425–427.</ref>
	**Heparin bolus 50-100 u/kg		**Heparin bolus 50-100 u/kg

Kxl328: /* Management */

2018-03-18T15:37:46Z

Management

← Older revision		Revision as of 15:37, 18 March 2018
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	*[[Dopamine]] 5-10mcg/kg/min		*[[Dopamine]] 5-10mcg/kg/min
	*[[Dobutamine]] 5-10mcg/kg/min		*[[Dobutamine]] 5-10mcg/kg/min

			===Thrombolysis for Surgical Shunt Obstruction===
			*Blalock-Taussig shunt should maintain flow murmur
			*Loss of flow murmur alongside hypotension and hypoxia relative to baseline saturations should prompt consideration for shunt obstruction
			*Definitive treatment is surgical, but systemic recombinant tPA may be considered as salvage intervention when other options are not readily available<ref>Diaz F et al. Systemic thrombolysis with recombinant tissue plasminogen activator for acute life-threatening Blalock-Taussig shunt obstruction. Indian J Crit Care Med. 2016 Jul; 20(7): 425–427.</ref>
			**Heparin bolus 50-100 u/kg
			**Notify cardiology, CT surgeon, ECMO
			**0.01 mg/kg bolus r-tPA, then 0.03 - 0.06 mg/kg/hr

	==Disposition==		==Disposition==

ClaireLewis at 21:34, 31 August 2017

2017-08-31T21:34:22Z

← Older revision		Revision as of 21:34, 31 August 2017
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	\| [[Cardiovascular shock]] \|\|Critical [[aortic stenosis]], [[coarctation of the aorta]], [[Hypoplastic left heart syndrome\|HLHS]] \|\|Coarctation of the aorta (infants)		\| [[Cardiovascular shock]] \|\|Critical [[aortic stenosis]], [[coarctation of the aorta]], [[Hypoplastic left heart syndrome\|HLHS]] \|\|Coarctation of the aorta (infants)
	\|-		\|-
	\| [[Congestive heart failure]] \|\|Rare: PDA, HLHS \|\|PDA, VSD, [[ASD]], atrioventricular canal		\| [[Congestive heart failure]] \|\|Rare: PDA, HLHS \|\|[[PDA]], [[VSD]], [[ASD]], atrioventricular canal
	\|-		\|-
	\| [[Murmur]] \|\|PDA, valvular defects (AS, PS) \|\|VSD, [[ASD]], PDA, outflow obstructions, valvular defects (AS, PS)		\| [[Murmur]] \|\|[[PDA]], valvular defects (AS, PS) \|\|[[VSD]], [[ASD]], [[PDA]], outflow obstructions, valvular defects (AS, PS)
	\|-		\|-
	\| [[Syncope]] \|\|— \|\|AS, PS, Eisenmenger complex		\| [[Syncope]] \|\|— \|\|AS, PS, Eisenmenger complex
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	\| align="center" style="background:#f0f0f0;"\|'''Right axis deviation, [[RVH]], [[RBBB]]'''		\| align="center" style="background:#f0f0f0;"\|'''Right axis deviation, [[RVH]], [[RBBB]]'''
	\|-		\|-
	\| VSD\|\|Cardiomegaly with increased vascular markings\|\|[[LAH]], [[LVH]], ([[RVH]] with larger VSDs)		\| [[VSD]]\|\|Cardiomegaly with increased vascular markings\|\|[[LAH]], [[LVH]], ([[RVH]] with larger VSDs)
	\|-		\|-
	\| PDA\|\|Cardiomegaly with increased vascular markings\|\|[[LVH]], [[RVH]] with larger PDAs		\| [[PDA]]\|\|Cardiomegaly with increased vascular markings\|\|[[LVH]], [[RVH]] with larger PDAs
	\|-		\|-
	\| Endocardial cushion defect\|\|Cardiomegaly with increased vascular markings\|\|Superior QRS axis with [[RVH]], [[RBBB]], [[LVH]], prolonged PR interval		\| Endocardial cushion defect\|\|Cardiomegaly with increased vascular markings\|\|Superior QRS axis with [[RVH]], [[RBBB]], [[LVH]], prolonged PR interval
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	*O2		*O2
	*[[Morphine]] or [[NS]] to increase preload		*[[Morphine]] or [[NS]] to increase preload
	*~~Na bicarb~~ 2mEq/kg IV bolus (promotes vasodilation)		*[[Sodium bicarbonate]] 2mEq/kg IV bolus (promotes vasodilation)
	*[[Propranolol]] 0.2mg/kg IV (relieves infundibular spasm)		*[[Propranolol]] 0.2mg/kg IV (relieves infundibular spasm)
	*[[Phenylephrine]] 2-10mcg/kg/min to increased SVR		*[[Phenylephrine]] 2-10mcg/kg/min to increased SVR