Ver el código de «Congenital heart disease»

== Background  ==

*Cyanotic 
**[[Tetralogy of Fallot]]
**Tricuspid anomalies 
**Truncus arteriosus 
**Total anomalous pulmonary venous return 
**Transposition 
*Acyanotic 
**VSD 
**ASD 
**PDA 
**AV canal 
**Pulmonary/aortic stenosis

== Diagnosis  ==

{| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" style="width: 559px; height: 262px;"
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
! bgcolor="#ffffff" align="left" valign="top" rowspan="1" | Clinical Presentation 
! bgcolor="#ffffff" align="left" valign="top" rowspan="1" | Causative Conditions in Neonates 
! bgcolor="#ffffff" align="left" valign="top" rowspan="1" | Causative Conditions in Infants and Children
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Cyanosis 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Transposition of the great arteries, TOF, tricuspid atresia, truncus arteriosus, total anomalous pulmonary venous return 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | TOF, Eisenmenger complex
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Cardiovascular shock 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Critical AS, coarctation of the aorta, HLHS 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Coarctation of the aorta (infants)
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Congestive heart failure 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Rare: PDA, HLHS 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | PDA, VSD, ASD, atrioventricular canal
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Murmur 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | PDA, valvular defects (AS, PS) 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | VSD, ASD, PDA, outflow obstructions, valvular defects (AS, PS)
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Syncope 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | — 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | AS, PS, Eisenmenger complex
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Hypertension 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | — 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Coarctation of the aorta
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Arrhythmias 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | — 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | ASD, Ebstein anomaly, postsurgical complication after repair of congenital heart defect
|}

== Work-Up  ==

=== Cyanotic  ===

{| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" style="color: rgb(51, 51, 51); font-family: Verdana,Arial,Helvetica,sans-serif; width: 567px; height: 227px;"
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
! bgcolor="#ffffff" align="left" valign="top" rowspan="1" | Cardiac Lesion 
! bgcolor="#ffffff" align="left" valign="top" rowspan="1" | Chest Radiograph 
! bgcolor="#ffffff" align="left" valign="top" rowspan="1" | ECG
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Tetralogy of Fallot 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Boot-shaped heart, normal-sized heart, decreased pulmonary vascular markings 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Right axis deviation, right ventricular hypertrophy
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Transposition of the great arteries 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Egg-shaped heart, narrow mediastinum, increased pulmonary vascular marking 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Right axis deviation, right ventricular hypertrophy
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Total anomalous pulmonary venous return 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Snowman sign, significant cardiomegaly, increased pulmonary vascular markings 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Right axis deviation, right ventricular hypertrophy, right atrial enlargement
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Tricuspid atresia 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Heart of normal to slightly increased size, decreased pulmonary vascular markings 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Superior QRS axis with right atrial hypertrophy, left atrial hypertrophy, left ventricular hypertrophy
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Truncus arteriosus 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Cardiomegaly, increased pulmonary vascular markings 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Biventricular hypertrophy
|}

=== Acyanotic (duct-dependent)  ===

{| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" style="width: 573px; height: 107px;"
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" | Coarctation of the aorta 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Cardiomegaly with pulmonary edema (neonate) 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | RVH, right bundle-branch block (neonate)
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Rib notching and collateral vascularity (child) 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | LVH (child)
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Hypoplastic left heart syndrome 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Cardiomegaly 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Right atrial enlargement, RVH, peaked P waves
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Aortic stenosis 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Cardiomegaly 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | LVH in severe cases
|}

=== Acyanotic (CHF)  ===

{| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" style="width: 579px; height: 133px;"
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Atrial septal defect 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Cardiomegaly with increased vascular markings 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Right axis deviation, RVH, RBBB
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | VSD 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Cardiomegaly with increased vascular markings 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | LAH, LVH, (RVH with larger VSDs)
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | PDA 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Cardiomegaly with increased vascular markings 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | LVH, RVH with larger PDAs
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Endocardial cushion defect 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Cardiomegaly with increased vascular markings 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Superior QRS axis with RVH, RBBB, LVH, prolonged PR interval
|- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Anomalous origin of the left coronary artery 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Cardiomegaly 
| bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Abnormally deep and wide Q waves with precordial ST segment changes
|}

<br> 

== Treatment (by presentation)  ==

#Shock (duct-dependent lesion) 
##PGE1 0.1mcg/kg/min IV/IO 
###Side Effects: 
####Apnea (intubate) 
#####Hypotension 
#####Bradycardia 
#####Flushing 
##NS 10cc/kg 
##Dobutamine 
#[[Tet Spell]] 
##Knee chest position 
###Incr venous return to heart, incr SVR (decr R&gt;L shunting) 
##O2 
##Morphine or NS to increase preload 
##Na bicarb 2mEq/kg IV bolus (promotes vasodilation) 
##Propranolol 0.2mg/kg IV (relieves infundibular spasm) 
##Phenylephrine 2-10mcg/kg/min to incr SVR 
#[[CHF]] 
##O2 (give only if SpO2 &lt;95%) 
##Furosemide 1-2mg/kg IV 
##Dopamine 5-10mcg/kg/min 
##Dobutamine 5-10mcg/kg/min

== See Also ==
*[[Innocent Murmurs (Peds)]]
*[[Congenital Heart Defects - Surgical Procedures]]

== Source ==

Tintinalli 

[[Category:Peds]] [[Category:Cards]]