Congenital heart disease: Difference between revisions
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*Cyanotic | *Cyanotic | ||
**Tetralogy | **[[Tetralogy of Fallot]] | ||
**Tricuspid anomalies | **Tricuspid anomalies | ||
**Truncus arteriosus | **Truncus arteriosus |
Revision as of 02:15, 13 January 2015
Background
- Cyanotic
- Tetralogy of Fallot
- Tricuspid anomalies
- Truncus arteriosus
- Total anomalous pulmonary venous return
- Transposition
- Acyanotic
- VSD
- ASD
- PDA
- AV canal
- Pulmonary/aortic stenosis
Diagnosis
Clinical Presentation | Causative Conditions in Neonates | Causative Conditions in Infants and Children |
---|---|---|
Cyanosis | Transposition of the great arteries, TOF, tricuspid atresia, truncus arteriosus, total anomalous pulmonary venous return | TOF, Eisenmenger complex |
Cardiovascular shock | Critical AS, coarctation of the aorta, HLHS | Coarctation of the aorta (infants) |
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) |
Syncope | — | AS, PS, Eisenmenger complex |
Hypertension | — | Coarctation of the aorta |
Arrhythmias | — | ASD, Ebstein anomaly, postsurgical complication after repair of congenital heart defect |
Work-Up
Cyanotic
Cardiac Lesion | Chest Radiograph | ECG |
---|---|---|
Tetralogy of Fallot | Boot-shaped heart, normal-sized heart, decreased pulmonary vascular markings | Right axis deviation, right ventricular hypertrophy |
Transposition of the great arteries | Egg-shaped heart, narrow mediastinum, increased pulmonary vascular marking | Right axis deviation, right ventricular hypertrophy |
Total anomalous pulmonary venous return | Snowman sign, significant cardiomegaly, increased pulmonary vascular markings | Right axis deviation, right ventricular hypertrophy, right atrial enlargement |
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 |
Truncus arteriosus | Cardiomegaly, increased pulmonary vascular markings | Biventricular hypertrophy |
Acyanotic (duct-dependent)
Coarctation of the aorta | Cardiomegaly with pulmonary edema (neonate) | RVH, right bundle-branch block (neonate) |
Rib notching and collateral vascularity (child) | LVH (child) | |
Hypoplastic left heart syndrome | Cardiomegaly | Right atrial enlargement, RVH, peaked P waves |
Aortic stenosis | Cardiomegaly | LVH in severe cases |
Acyanotic (CHF)
Atrial septal defect | Cardiomegaly with increased vascular markings | Right axis deviation, RVH, RBBB |
VSD | Cardiomegaly with increased vascular markings | LAH, LVH, (RVH with larger VSDs) |
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 |
Anomalous origin of the left coronary artery | Cardiomegaly | Abnormally deep and wide Q waves with precordial ST segment changes |
Treatment (by presentation)
- Shock (duct-dependent lesion)
- PGE1 0.1mcg/kg/min IV/IO
- Side Effects:
- Apnea (intubate)
- Hypotension
- Bradycardia
- Flushing
- Apnea (intubate)
- Side Effects:
- NS 10cc/kg
- Dobutamine
- PGE1 0.1mcg/kg/min IV/IO
- Tet Spell
- Knee chest position
- Incr venous return to heart, incr SVR (decr R>L shunting)
- O2
- Morphine or NS to increase preload
- Na bicarb 2mEq/kg IV bolus (promotes vasodilation)
- Propranolol 0.2mg/kg IV (relieves infundibular spasm)
- Phenylephrine 2-10mcg/kg/min to incr SVR
- Knee chest position
- CHF
- O2 (give only if SpO2 <95%)
- Furosemide 1-2mg/kg IV
- Dopamine 5-10mcg/kg/min
- Dobutamine 5-10mcg/kg/min
See Also
Source
Tintinalli