Congenital Heart Disease

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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