Congenital heart disease: Difference between revisions
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*CXR & ECG | *CXR & ECG | ||
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{| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" width="100%" style="color: rgb(51, 51, 51); font-family: Verdana, Arial, Helvetica, sans-serif; " | |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ||
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | |||
! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Cardiac Lesion | ! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Cardiac Lesion | ||
! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Chest Radiograph | ! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Chest Radiograph | ||
! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | ECG | ! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | ECG | ||
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ||
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Tetralogy of Fallot | | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Tetralogy of Fallot | ||
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Boot-shaped heart, normal-sized heart, decreased pulmonary vascular markings | | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Boot-shaped heart, normal-sized heart, decreased pulmonary vascular markings | ||
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Right axis deviation, right ventricular hypertrophy | | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Right axis deviation, right ventricular hypertrophy | ||
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ||
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Transposition of the great arteries | | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Transposition of the great arteries | ||
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Egg-shaped heart, narrow mediastinum, increased pulmonary vascular marking | | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Egg-shaped heart, narrow mediastinum, increased pulmonary vascular marking | ||
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Right axis deviation, right ventricular hypertrophy | | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Right axis deviation, right ventricular hypertrophy | ||
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ||
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Total anomalous pulmonary venous return | | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Total anomalous pulmonary venous return | ||
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Snowman sign, significant cardiomegaly, increased pulmonary vascular markings | | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Snowman sign, significant cardiomegaly, increased pulmonary vascular markings | ||
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Right axis deviation, right ventricular hypertrophy, right atrial enlargement | | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Right axis deviation, right ventricular hypertrophy, right atrial enlargement | ||
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ||
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Tricuspid atresia | | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Tricuspid atresia | ||
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Heart of normal to slightly increased size, decreased pulmonary vascular markings | | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Heart of normal to slightly increased size, decreased pulmonary vascular markings | ||
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Superior QRS axis with right atrial hypertrophy, left atrial hypertrophy, left ventricular hypertrophy | | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Superior QRS axis with right atrial hypertrophy, left atrial hypertrophy, left ventricular hypertrophy | ||
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ||
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Truncus arteriosus | | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Truncus arteriosus | ||
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Cardiomegaly, increased pulmonary vascular markings | | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Cardiomegaly, increased pulmonary vascular markings | ||
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Biventricular hypertrophy | | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Biventricular hypertrophy | ||
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== Treatment (by presentation) == | == Treatment (by presentation) == | ||
Revision as of 18:03, 22 June 2011
Background
- Cyanotic
- Tetralogy
- 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
- CXR & ECG
| 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 |
Treatment (by presentation)
- Cyanosis (shunt)
- PGE1* (0.01mg/kg; may repeat at double dose x 3)
- pressors
- Tet spells
- knee chest position
- O2
- CHF
- diuretis, NTG, inotrops
- Shock (resrictive lesion)
- Dobutamine
PGE1 Side Effects
- Apnea (intubate)
- Hypotension
- Bradycardia
- Hyperexia
- Flushing