Congenital Heart Disease

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PEPTIC ULCER

af SHAMIM IQBAL

Aortic Stenosis

af Tommy Kovitwanichkanont

Stroke

af Kadin Aucoin

BIPOLAR DISORDERS

af camila martinez

Congenital Heart Disease

Cyanotic

Others

Truncus Arteriosus

Hypoplastic Left Ventricle

Totally Anomalous Pulmonary Venous Return

Tricuspid Atresia

Transposition of the Great Arteries

Mx:

Surgery within 2 weeks

Prostaglandin

CXR: "egg on a string" (narrow mediastinum)

Progressive cyanosis unresponsive to oxygen ==> less dramatic if VSD present

R-L Shunt

Ebstein´s anomaly

massively enlarged RA, patent foramen ovale ==> R-L shunt

Lithium / benzodiazepine use in 1st trimester

defect of the tricuspid valve ("atrialization of RV")

TOF

Mx: surgery

CXR: "boot-shaped" heart; decreased pulmonary flow

ECG: RAD, RVH

hypoxic spells caused by exertion

Mx: O2, knee-chest, morphine, propranolol

peak 2-4 months

may have L-R shunt initially; progressive RVOTO causes R-L shunt

VSD, RVOTO, overriding aorta, RVH

Murmurs

Pathologic

Unchanged with position

>3/6 +

Dyatolic ,pansystolic or continuous

Symptomatic

Innocent

varies with position

no extra sounds/clicks

systolic ejection

asymptomatic

do not warrant investigation!!!

General aspects

Risk Factors

Medications ==> Phenytoin, retinoic acid, valproate

Sibling with CHD

Alcohol ==> ASD, VSD

TORCH (Rubella)

SLE ==> complete heart block

DM ==> TGA

Turner ==> Aortic Coarctation, bicuspid aortic valve

Marfan / Ehler-Danlos ==> Mitral prolapse, aortic abnormalities

Down's Syndrome ==> AVSD

Prematurity ==> PDA

0,8% of births

Acyanotic

Obstructive

Pulmonic Stenosis

Mx: surgical repair

ECG: RVH

asymptomatic to CHF

usually part of other lesions

Aortic Stenosis

Mx: surgical correction; exercise restriction

Dyspnea + Syncope + Chest pain; ejection click

CoAo

Mx:

surgical/balloon correction

prostaglandin (keep ductus arteriosus open) for stabilization;

Complication: HTN

ECG: RVH in early infance; LVH later in childhood

often asymptomatic; higher SBP and stronger pulses in upper limbs

50% with bicuspid aortic valve; 35% Turner syndrome

pallor, decreased UO, cool extremities, poor pulses

Shunt L-R

AVSD

Mx: surgery by 6 months to prevent PAH

Spectrum from VSD and ASD to complete AV canal with common AV valve

common in Down´s syndrome

PDA

Mx: surgical/catheter closure if persistent after 3 months

ECG: LAH, LVH, BVH

tachycardia, bounding pulses, machinery murmur, hyperactive precordium

asymptomatic; may have apneic/bradycardic spells; poor feeding

VSD

Mod-Large

Mx: CHF management; surgical closure by 1 year

CXR: CHF features

ECG: LAD, LVH, RVH

2ary PAH; CHF by 2 months

small

most common CHD; asymptomatic ==> spontaneous closure

ASD

Mx: surgery/catether closure between 2-5 yrs

CXR: increased pulmonary vasculature

ECG: RAD, RVH, RBBB

CHF, PAH in adult life

Often asymptomatic; spontaneous closure if <8mm