Cyanotic and Acyanotic heart defects
Acyanotic has what kind of shunt
Left to right
Acyanotic congenital heart diseases include what kind of defects?
Ventricular septal, Atrial septal, PDA, Endocardial cushion, pulmonic stenosis, aortic stenosis, and coartation of the Aorta
Cyanotic congenital heart diseases have what kind of a shunt?
Right to Left
C yanotic congenital heart diseases include what kind of defects?
All the Ts..Tetralogy of Fallot, Transposition of the Great Artery, Tricuspid Atresia, Truncus Arteriosus, Total anomalous pulmonary venous Return, and Hypoplastic Left heart Syndrome
Where is a ventricular septal defect most common?
Perimembranous - Just below the aortic valve
What type of murmur would a VSD have?
Loud, pansystolic murmur at LLSB and/or could have mid diastolic murmur due to increased mitral flow
Is there splitting associated with VSD?
Yes, S2 splitting due to increased flow thru lungs
What types of defects can be present in an Atrial Septal Defect?
Primum defect - more inferior
Secundum defect - more superior
Sinus venosus defect - on the side
Heart sound abnormalities associated with ASD
Soft systolic ejection murmur (SEM)
Fixed S2 split
What would an EKG show in a person with ASD?
R axis deviation - RVH
It's rarely symptomatic and may resolve on it's own.
-At 3, if still significant surgery is indicated (primum, sinus venosus) or catheter-implanted closure device (secundum)
Why would someone have a corrigan pulse (wide pulse pressure)?
They have a PDA
Continuous, machine like murmur is most closely associated with -
What is the treatment for a Patent Ductus Arteriosus?
Closure induced by Indomethacin (NSAID). If unsuccessful, may need coil embolization or PDA closure devise.
-Diuretics and digoxin as needed for symptoms
How do we keep a PDA open?
Exogenous prostaglandins (PGE2)
What is an endocardial cushion defect?
Combination of ASD, VSD, and A-V valve malformation.
Does and endocardial cushion defect get better or worse as pulmonary resistance increases?
How do we treat an Endocardial Cushion defect?
Diuretics and Digoxin, but ultimately surgery
Pulmonary and Aortic stenosis will have what kind of murmur
Systolic ejection murmur
Tx for pulmonary and aortic stenosis
-If severe/significant balloon valvuloplasty
-Surgery (prosthetic valve/pulmonic valve autograph) if valvuloplasty unsuccessful
What can help to reduce symptoms with coarctation of the Aorta?
A PDA (IV prostaglandins) and Ionotropes (digoxin)
What type of murmur is common with coarctation of the Aorta
Systolic ejection murmur
4 defects associated with tetrology of fallot
-Pulmonary stenosis => systolic murmur common
"Tet" spell is associated with what and does it look like?
Tetrology of Fallot
-Toddlers may Squat to compensate
-Tachypnea with increasing cyanosis
-Loss of consciousness, seizures, hemiparesis, or death if sever
Treatment of Tetralogy of Fallot
Tuck knees to chest, Morphine, alpha agonist, and endocarditis prophylaxis
Surgery usually done in infancy
If a patient has _____, but does not have any of the following: ASD, VSD, PFO, or PDA; death occurs rapidly without intervention
Transposition of the Great Arteries
What is transposition of the Great Arteries
pulmonary artery and aorta reversed with abnormal deptation of the truncus arteriosus.
Desaturated blood returns to right heart
CXR shows an "egg on a string"
Transposition of the great artery
What would your exam findings be for a patient with transposition of the great arteries?
May have palpable impulses due to heart being hyperdynamic
-No murmur unless VSD or other defect
Transposition of the Great Arteries tx
Surgical correction w/in 1st 2 weeks of life
What is the most common cause of death from heart defects in the first year of life
Hypoplastic Left heart syndrome
Truncus does not septate into aorta and pulmonary arteries => pulmonary arteries off of arterial trunk
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