pedscard.txt

Persistence of fetal pathways definition

life saving

Life stressing/threatening

meds for persistence of fetal path

CHD Incidence

CHD Etiology

Identifiable single gene defect

chromosal abn

Environmental/maternal

CHD Defects

opening btwn 2 atria=shunting

often asymptomatic or mild ftt/exs intolerance=present as CHF

r/ventricular lift, S2 widely split, systolic ejection murmur in left mid-upper sternal border, short rumbling mid-diastolic murmur, child may suck & pant when eating do to exs intolerance

opening between the 2 ventricles, results in shunting. Presentation varies according to size & severity of left to right shunting.

Loud harsh blowing holosystolic murmur LLSB,thrill & in the neonate the murmur greatest at apex

Clinical presentation in large VSD

Apical thrust w/systolic thrill that inc S2, blowing systolic murmur or low pitched diastolic rumble

most common cardiac malformation=25% of CHD

when blood leaves the LV either through aorta or VSD, the direction is dependant upon resistance

In the first days of life, pulmonary vascular resistance is high and there is little flow across the VSD

At 3 days of life, PVR falls & shunting begins

persists in extrauterine life. Often asymptomatic but with large shunting � cardiac failure or growth retardation are possible

continuous machinery systolic murmur 2nd left intercostal space and or radiate left sterna border or left clavicle

deformed valve cusps which do not fully open which results in right ventricular outflow obstruction

Most often asymptomatic but in severe cases right ventricular failure � hepatomegaly, peripheral edema, exercise intolerance

In neonate cyanosis is possible if shunting occurs though the foramen ovale. If heart failure occurs it is typically during the 1st month of life

Ejection click after S1, split S2, systolic ejection murmur pulmonic region radiating to the lungs

single or multiple constrictions along the branches of the pulmonary arteries. Often associated with other malformations

Presentation varies with severity and other defects. In neonatal period, there is a mild transient form

Increase in right ventricular pressure and in the pulmonary artery proximal to the obstruction, systolic ejection murmur

leaflet thickening and commissures are fused to variable degrees which results in left ventricular outflow obstruction and hypertrophy

Presentation varies with severity. In severe cases � cardiomegaly, failure, pulmonary edema, decreased pulses and pallor

ejection click at apex & LSB, split s2, systolic ejection murmur RUSB radiating neck & LMSB;soft D mur=present maybe

constriction of the aorta, typically at the ductus arteriosus

Most are symptomatic, may complain of weakness/pain in legs after exercise. Can go onto cardiac failure but rare. Often diagnosed when found to be hypertension on routine PE

pulse disparity (pulses unequal), short systolic murmur and left sternal 3rd-4th intercostals space

right ventricular outflow obstruction (pulmonary stenosis/atresia), VSD (right to left shunting), overriding aorta (or rather hypoplasia of pulmonary trunk) and right ventricular hypertrophy

most common type of cyanotic HD & 10-15% CHD

Presentation varies depending on degree of obstruction. Acyanotic � CHF. Cyanosis is typically present by 4 months and progressive

It is a major concern in neonates if dependent on a patent ductus arteriosus

Other � growth retardation, fatigue, exertion, dyspnea, clubbing. Hypoxemic or cyanotic spells can occur, especially under 2 years

50% will have a systolic thrill at the left sternal border, single S2, loud harsh systolic murmur left sternal border and may radiate,CXR:boot shaped heart

the aorta arises from the right ventricle and the pulmonary artery from the left ventricle

common cyanotic heart lesion that is often associated w/other cardiac defect

presents as cyanosis, resp distress that depends on associated lesions; growth retardation & card fail

single, loud S2, a soft systolic murmur left middle sternal border may be heard

In the neonate, the defect can be fatal. If suspected, begin prostaglandin E

presentation varies w/severity, cyanosi, tachypnea, systolic murmur LSB, gallob rhythm=S3 or S4

a group of anomalies � underdeveloped left side of heart (aortic atresia, mitral stenosis) and hypoplasia of the ascending aorta

dependent on PDA & may be associated w/other anomalies=kidney/CNS

cyanosis, cardiomegaly, CHF, dyspnea, hepatomegaly, low cardiac output, weak or absent pulses, systolic murmur, fata in most cases

surgical intervention has a variable prognosis=normwood operation

only one great vessel arises from heart and supplies both the systemic, pulmonary and coronary arteries, VSD present & relative rare cyanotic lesion

presentation of CHD

distinguish between general (all) or circumoral cyanosis (around mouth) and acryocyanosis (hands and feet)

lasts >3hrs in newborn, warning sign-pulmonary etiology is absent, think cardiac & half will need surgery

CHD cyanosis DDx for dec pulm blood flow

cHD cyanosis DDx for inc pulm blood flow

presents with tachypnea, tachycardia, dyspnea with feeds, poor weight gain, hepatosplenomegaly

CHF DDx

abnormal heart sounds

Evaluation suspected congenital HD

giving O2 & watching symptoms=not helping probably not resp issue rather a card issue

Found in more than 30% of children and increases in the presence of fever, infection, and anxiety (due to increased demand on the heart)

short systolic murmur at left mid-lower sternal border that changes with respiration or position. Usually does not radiate. Typically seen in 3-7 year olds

higher pitched, blowing, early systolic murmur at 2nd left parasystolic space. Easier to hear when patient is supine

soft humming sound during systole and diastole in neck and upper anterior chest (turbulence in the jugular venous system). Can vary by changing position or light compression of jugular vein

It is a very unusual manifestation of cardiac disease w/inc in teens having MI's, HPT, hypercholesterolemia, obesity, cocaine

what is important with chest pain

Chest pain DDx

Preventative Cardiology

hypercholesterolemia & hyperlipidemia screen in children & teens with