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| == Background == | | ==Background== |
| | {{Congenital heart disease DDX}} |
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| *Cyanotic
| | ==Clinical Features== |
| **Tetralogy
| | {| class="wikitable" |
| **Tricuspid anomalies
| | | align="center" style="background:#f0f0f0;"|'''Clinical Presentation''' |
| **Truncus arteriosus
| | | align="center" style="background:#f0f0f0;"|'''Causative Conditions in Neonates''' |
| **Total anomalous pulmonary venous return
| | | align="center" style="background:#f0f0f0;"|'''Causative Conditions in Infants and Children''' |
| **Transposition
| | |- |
| *Acyanotic
| | | Cyanosis ||[[Transposition]] of the great arteries, [[TOF]], tricuspid atresia, [[truncus arteriosus]], total anomalous pulmonary venous return||TOF, Eisenmenger complex |
| **VSD
| | |- |
| **ASD
| | | [[Cardiovascular shock]] ||Critical [[aortic stenosis]], [[coarctation of the aorta]], [[Hypoplastic left heart syndrome|HLHS]] ||Coarctation of the aorta (infants) |
| **PDA
| | |- |
| **AV canal
| | | [[Congestive heart failure]] ||Rare: PDA, HLHS ||[[PDA]], [[VSD]], [[ASD]], atrioventricular canal |
| **Pulmonary/aortic stenosis
| | |- |
| | | [[Murmur]] ||[[PDA]], valvular defects (AS, PS) ||[[VSD]], [[ASD]], [[PDA]], outflow obstructions, valvular defects (AS, PS) |
| | |- |
| | | [[Syncope]] ||— ||AS, PS, Eisenmenger complex |
| | |- |
| | | [[Hypertension]] ||— ||[[Coarctation of the aorta ]] |
| | |- |
| | | [[Arrhythmias]] ||— ||[[ASD]], Ebstein anomaly, postsurgical complication after repair of congenital heart defect |
| | |} |
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| == Diagnosis == | | ==Differential Diagnosis== |
| | {{Sick neonate DDX}} |
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| {| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" width="100%"
| | ==Evaluation== |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
| | [[File:CHD.png|thumb|Algorithm for the Evaluation and Management of Suspected Congenital Heart Disease in Neonates]] |
| ! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Clinical Presentation
| | ===Cyanotic=== |
| ! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Causative Conditions in Neonates
| | {| class="wikitable" |
| ! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Causative Conditions in Infants and Children
| | | align="center" style="background:#f0f0f0;"|'''Cardiac Lesion''' |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | | | align="center" style="background:#f0f0f0;"|'''Chest Radiograph''' |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Cyanosis | | | align="center" style="background:#f0f0f0;"|'''ECG''' |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Transposition of the great arteries, TOF, tricuspid atresia, truncus arteriosus, total anomalous pulmonary venous return | | |- |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | TOF, Eisenmenger complex | | | [[Tetralogy of Fallot]]||Boot-shaped heart, normal-sized heart, decreased pulmonary vascular markings||Right axis deviation, right ventricular hypertrophy |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | | |- |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Cardiovascular shock | | | [[Transposition of the great arteries]]||Egg-shaped heart, narrow mediastinum, increased pulmonary vascular marking||Right axis deviation, right ventricular hypertrophy |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Critical AS, coarctation of the aorta, HLHS | | |- |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Coarctation of the aorta (infants) | | | [[Total anomalous pulmonary venous return]]||Snowman sign, significant cardiomegaly, increased pulmonary vascular markings||Right axis deviation, right ventricular hypertrophy, right atrial enlargement |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | | |- |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Congestive heart failure | | | [[Tricuspid atresia]]||Heart of normal to slightly increased size, decreased pulmonary vascular markings||Superior QRS axis with right atrial hypertrophy, left atrial hypertrophy, left ventricular hypertrophy |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Rare: PDA, HLHS
| | |- |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | PDA, VSD, ASD, atrioventricular canal | | | [[Truncus arteriosus]]||Cardiomegaly, increased pulmonary vascular markings||Biventricular hypertrophy |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Murmur | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | PDA, valvular defects (AS, PS) | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | VSD, ASD, PDA, outflow obstructions, valvular defects (AS, PS) | |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
| |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Syncope | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | — | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | AS, PS, Eisenmenger complex | |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Hypertension | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | —
| |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Coarctation of the aorta
| |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Arrhythmias | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | — | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ASD, Ebstein anomaly, postsurgical complication after repair of congenital heart defect | |
| |} | | |} |
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| == Work-Up == | | ===Acyanotic (duct-dependent)=== |
| | | {| class="wikitable" |
| === Cyanotic ===
| | | align="center" style="background:#f0f0f0;"|'''Coarctation of the aorta''' |
| | | | align="center" style="background:#f0f0f0;"|'''Cardiomegaly with pulmonary edema (neonate)''' |
| {| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" width="100%" style="color: rgb(51, 51, 51); font-family: Verdana, Arial, Helvetica, sans-serif;" | | | align="center" style="background:#f0f0f0;"|'''RVH, right bundle-branch block (neonate)''' |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
| | |- |
| ! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Cardiac Lesion
| | | ||Rib notching and collateral vascularity (child)||LVH (child) |
| ! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Chest Radiograph
| | |- |
| ! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | ECG
| | | [[Hypoplastic left heart syndrome]]||Cardiomegaly||Right atrial enlargement, RVH, peaked P waves |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
| | |- |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Tetralogy of Fallot
| | | Aortic stenosis||Cardiomegaly||LVH in severe cases |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Boot-shaped heart, normal-sized heart, decreased pulmonary vascular markings | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Right axis deviation, right ventricular hypertrophy
| |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Transposition of the great arteries
| |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Egg-shaped heart, narrow mediastinum, increased pulmonary vascular marking
| |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Right axis deviation, right ventricular hypertrophy
| |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Total anomalous pulmonary venous return | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Snowman sign, significant cardiomegaly, increased pulmonary vascular markings | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Right axis deviation, right ventricular hypertrophy, right atrial enlargement | |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Tricuspid atresia | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Heart of normal to slightly increased size, decreased pulmonary vascular markings | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Superior QRS axis with right atrial hypertrophy, left atrial hypertrophy, left ventricular hypertrophy | |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Truncus arteriosus | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Cardiomegaly, increased pulmonary vascular markings | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Biventricular hypertrophy | |
| |} | | |} |
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| === Acyanotic (duct-dependent) === | | ===Acyanotic non-duct dependent (i.e. CHF)=== |
| | | {| class="wikitable" |
| {| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" width="100%" | | | align="center" style="background:#f0f0f0;"|'''[[Atrial septal defect]]''' |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
| | | align="center" style="background:#f0f0f0;"|'''Cardiomegaly with increased vascular markings''' |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Coarctation of the aorta | | | align="center" style="background:#f0f0f0;"|'''Right axis deviation, [[RVH]], [[RBBB]]''' |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Cardiomegaly with pulmonary edema (neonate) | | |- |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | RVH, right bundle-branch block (neonate) | | | [[VSD]]||Cardiomegaly with increased vascular markings||[[Left atrial enlargement|LAH]], [[LVH]], ([[RVH]] with larger VSDs) |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | | |- |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Rib notching and collateral vascularity (child) | | | [[PDA]]||Cardiomegaly with increased vascular markings||[[LVH]], [[RVH]] with larger PDAs |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | LVH (child) | | |- |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | | | Endocardial cushion defect||Cardiomegaly with increased vascular markings||Superior QRS axis with [[RVH]], [[RBBB]], [[LVH]], prolonged PR interval |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Hypoplastic left heart syndrome | | |- |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Cardiomegaly
| | | Anomalous origin of the left coronary artery||Cardiomegaly||Abnormally deep and wide Q waves with precordial ST segment changes |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Right atrial enlargement, RVH, peaked P waves | |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Aortic stenosis | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Cardiomegaly | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | LVH in severe cases | |
| |} | | |} |
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| === Acyanotic (CHF) === | | ==Management== |
| | ===[[Pediatric shock|Shock]] (duct-dependent lesion)=== |
| | *[[PGE1]] 0.1mcg/kg/min IV/IO |
| | **Side Effects: |
| | ***Apnea (intubate) |
| | ****[[Hypotension]] |
| | ****Bradycardia |
| | ****Flushing |
| | *[[NS]] 10cc/kg |
| | *[[Dobutamine]] |
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| | ===[[Tet Spell]]=== |
| | *Knee chest position |
| | **Increased venous return to heart, increased SVR (decreased R>L shunting) |
| | *O2 |
| | *[[Morphine]] or [[NS]] to increase preload |
| | *[[Sodium bicarbonate]] 2mEq/kg IV bolus (promotes vasodilation) |
| | *[[Propranolol]] 0.2mg/kg IV (relieves infundibular spasm) |
| | *[[Phenylephrine]] 2-10mcg/kg/min to increased SVR |
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| {| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" width="100%"
| | ===[[CHF]]=== |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| | *[[O2]] (give only if SpO2 <95%) |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Atrial septal defect
| | *[[Furosemide]] 1-2mg/kg IV |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Cardiomegaly with increased vascular markings
| | *[[Dopamine]] 5-10mcg/kg/min |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Right axis deviation, RVH, RBBB
| | *[[Dobutamine]] 5-10mcg/kg/min |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | VSD
| |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Cardiomegaly with increased vascular markings
| |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | LAH, LVH, (RVH with larger VSDs)
| |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | PDA
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Cardiomegaly with increased vascular markings
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | LVH, RVH with larger PDAs
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Endocardial cushion defect
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Cardiomegaly with increased vascular markings
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Superior QRS axis with RVH, RBBB, LVH, prolonged PR interval
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| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Anomalous origin of the left coronary artery
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Cardiomegaly
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Abnormally deep and wide Q waves with precordial ST segment changes
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| | ===Thrombolysis for Surgical Shunt Obstruction=== |
| | *Blalock-Taussig shunt should maintain flow murmur |
| | *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> |
| | **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 |
|
| |
|
| == Treatment (by presentation) == | | ==Disposition== |
|
| |
|
| #Shock (duct-dependent lesion)
| | ==See Also== |
| ##PGE1 0.1mcg/kg/min IV/IO
| | *[[Innocent Murmurs (Peds)]] |
| ###Side Effects:
| | *[[Congenital Heart Defects - Surgical Procedures]] |
| ####Apnea (intubate)
| | *[http://pted.org/?id=list www.pted.org - list of congenital heart diseases, overviews, management strategies] |
| #####Hypotension
| |
| #####Bradycardia
| |
| #####Flushing
| |
| ##NS 10cc/kg
| |
| ##Dobutamine
| |
| #Tet spells
| |
| ##Knee chest position
| |
| ###Incr venous return to heart, incr SVR (decr R>L shunting)
| |
| ##O2
| |
| ##Morphine or NS to increase preload
| |
| ##Nabicarb 2mEq/kg IV bolus (promotes vasodilation)
| |
| ##Propranolol 0.2mg/kg IV (relieves infundibular spasm)
| |
| ##Phenylephrine 2-10mcg/kg/min to incr SVR
| |
| #CHF
| |
| ##O2 (give only if SpO2 <95%)
| |
| ##Furosemide 1-2mg/kg IV
| |
| ##Dopamine 5-10mcg/kg/min
| |
| ##Dobutamine 5-10mcg/kg/min
| |
|
| |
|
| ==Source== | | ==References== |
| Tintinalli
| | <references/> |
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| [[Category:Peds]] | | [[Category:Pediatrics]] |
| [[Category:Cards]] | | [[Category:Cardiology]] |