Congenital heart disease

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

Treatment (by presentation)

1. Cyanosis (shunt)
   1. PGE1* (0.01mg/kg; may repeat at double dose x 3)
   2. pressors
2. Tet spells
   1. knee chest position
   2. O2
3. CHF
   1. diuretis, NTG, inotrops
4. Shock (resrictive lesion)
   1. Dobutamine

PGE1 Side Effects

1. Apnea (intubate)
2. Hypotension
3. Bradycardia
4. Hyperexia
5. Flushing