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Common way to determine heart diseasee in children
History and PE
About ___ of every 1000 babies have congenital heart disease
8
____ - _____ % of children have innocent heart murmurs
50-80%
Innocent murmurs usually present at ___ - ___ years old
3;7
Innocent murmurs become accentuated in ______________________.
High Cardiac output states
High cardiac output states (4)
fever, anemia, anxiety, exercise
T/F Innocent murmurs have normal ECG and CXR.
TRUE
Types of innocent murmurms (5)
Vibratory, pulmonary flow, peripheral pulmonic stenosis, venous hum, mammary souffle
Pathologic murmurs usually present with (4)
Symptoms, abnormal cardiac size, abnormal CXR, abnormal ECG
Type of murmur that transmits to other parts of body
Systolic
____-_____% of cardiac lesions diagnosed by week 1
40-50%
___-___% of cardiac lesions diagnosed by month 1
50-60%
Childre with congenital heart disease usually presents with
Hx of difficulty feeding, sweating, FTT, exericse intolerance, syncope, chest pain, hx of other anomalies
PE findings of child with heart disease
Hyperdynamic precordium, cyanosis, bounding/dec. pulses, BP abnormalities, gallops/clicks, abnormal second heart sound, murmurs, hepatomeg, rales, tachypnea
Common Acyanotic CHDs (4 in order of most to least)
VSD>ASD>PDA>COA
Genetic abnormalities associated with CHD
Trisomy 18, Downs, Turners, Marfan
Risk Factor for VSD, TGA, COA
Maternal diabetes
Risk Factor for congenital heart block
SLE
Risk Factor for PDA and PPS
Congenital Rubella
% risk of CHD in general population
1%
% risk of next pregnancy if first pregnancy resulted in CHD
2-6%
% risk of next pregnancy if first and second pregnancy resulted in CHD
20-30%
% VSD that close spontaneously in first 6 mo
30-40%
Murmur: Loud, harsh, blowing, pansystolic, w/w/o thrill
VSD (small defect)
General S/Sx of large VSD
Volume overload
S/Sx of volume overload related to VSD
dyspnea, feeding difficulties, poor growth, recurrent pulm. Infxns, left precordial prominence, parasternal lift, apical thrust, systolic thrill
CXR: Cardiomegaly, RVH + LVH, enlarged left atrium, enlarged pulm. Artery
VSD
ECG: CVH, notched (peaked p waves)
VSD
Tx: VSD
Surgery w/in 1yr (6-12 mo if sxs)
T/F Prophylaxis of Subacute Bacterial Endocarditis (SBE) is recommended prior to VSD surgery
FALSE
Murmur: Ejection, medium pitch, LMSB, 2nd Heart sound WIDELY SPLIT
ASD
CXR: Increased size RA, RV; increased PA with increased pulmonary vasculature markings
ASD
EKG: Right Axis Deviation, RV conduction delay rSR\\\'
ASD
Congenital heart defect that allows blood flow btw left and right atria via interatrial septum
ASD
When do sxs of ASD present?
3rd decade of life
Complications of ASD
Pulm HTN, Tricuspid/mitral regurg, atrial arrythmias, CVA, embolization via ASD
Tx: ASD
Surgery (prior to school entry), Closure devices (Amplatz, cardioseal, helix)
MC site of coarctation of aorta
below origin of left subclavian artery (98%)
30% of these have COA
Turners
70% of those with COA will also have
bicuspid aortic valve
COA: increased BP _________________ to coarc
proximal
COA: decreased BP___________________ to coarc
distal
S/Sx: Weak peripheral pulses with poor perfusion, poor urine output, lethargy, poor feeding, or No sxs
COA (infants)
General S/Sx of COA
Cardiovascular collapse
Murmur: none in 50%, S2 single + loud, systolic ejection murmur, gallop rhythm
COA (infants)
Blood pressure differential (Upper Vs Lower extremities)
COA (infants)
EKG: Right Axis Deviation, RVH
COA (infants)
CXR: Cardiomegaly, Pulmonary Edema
COA (infants)
Pharm Tx: COA (infants)
Prostaglandin E1 until surgery, Inotropic agents (dopamine, dobutamine)
Surgical Tx: COA (infants)
Balloon angioplasty, Subclavian flap, end to end anastomosis
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