Diferencia entre revisiones de «Coarctation of the aorta»
(Add MedicationDose entries for PGE1, furosemide, dopamine, dobutamine) |
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==Disposition== | ==Disposition== | ||
*Admit | *Admit | ||
==Medication Dosing== | |||
{{MedicationDose | |||
| drug = Prostaglandin E1 | |||
| dose = 0.1mcg/kg/min IV/IO | |||
| route = IV/IO | |||
| context = Duct-dependent lesion, maintain PDA patency | |||
| indication = Coarctation of the aorta | |||
| population = Pediatric | |||
}} | |||
{{MedicationDose | |||
| drug = Furosemide | |||
| dose = 1-2mg/kg IV | |||
| route = IV | |||
| context = CHF management | |||
| indication = Coarctation of the aorta | |||
| population = Pediatric | |||
}} | |||
{{MedicationDose | |||
| drug = Dopamine | |||
| dose = 5-10mcg/kg/min IV | |||
| route = IV | |||
| context = Inotropic support for CHF | |||
| indication = Coarctation of the aorta | |||
| population = Pediatric | |||
}} | |||
{{MedicationDose | |||
| drug = Dobutamine | |||
| dose = 5-10mcg/kg/min IV | |||
| route = IV | |||
| context = Inotropic support for CHF | |||
| indication = Coarctation of the aorta | |||
| population = Pediatric | |||
}} | |||
==See Also== | ==See Also== | ||
Revisión actual - 21:10 20 mar 2026
Background
- Narrowing of aorta, most commonly at ductus arteriosus insertion site just distal to left subclavian artery
- Less common: diffuse arch hypoplasia with long segment of narrowing proximal to left subclavian[1]
- ~7% of live births with congenital heart disease [2]
- Associated with bicuspid aortic valve (50%), VSD, PDA
Clinical Features
- Systolic murmur, often conducted to back
- Weak or absent femoral pulses, leg claudication, exercise intolerance
- Upper limb hypertension
- Usually diagnosed within first year of life, when presentation typically dramatic, particularly after closure of PDA in ductal-dependant critical coarctations.
- Consider in all critically ill neonates, particularly with poor perfusion to lower extremities
- Heart failure, shock
- Less severe coarctations may go undiagnosed for years, but can still lead to complications long-term[3]:
Differential Diagnosis
Sick Neonate
THE MISFITS [4]
- Trauma
- Heart
- Congenital heart disease
- Hypovolemia
- Endocrine
- Metabolic
- Sodium
- Calcium
- Glucose
- Inborn errors of metabolism
- Seizure
- Formula / feeding problems
- Intestinal Disasters
- Toxin
- Sepsis
Evaluation
- CXR
- Rib notching due to collateral blood vessels
- "Figure 3" sign seen in 50% of patients
- Abnormal aortic knob shadow due to coarct and dilation of left subclavian
- EKG: LVH +/- LA enlargement
- Echocardiography
- Cardiac MRI
Management
Neonate in Shock (duct-dependent lesion)
- PGE1 0.1mcg/kg/min IV/IO
- Side Effects:
- Apnea (intubate)
- Hypotension
- Bradycardia
- Flushing
- Apnea (intubate)
- Side Effects:
- NS 10cc/kg
- Dobutamine
CHF
- O2 (give only if SpO2 <95%)
- Furosemide 1-2mg/kg IV
- Dopamine 5-10mcg/kg/min
- Dobutamine 5-10mcg/kg/min
Disposition
- Admit
Medication Dosing
Prostaglandin E1 0.1mcg/kg/min IV/IO IV/IO Furosemide 1-2mg/kg IV IV Dopamine 5-10mcg/kg/min IV IV Dobutamine 5-10mcg/kg/min IV IV
See Also
External Links
References
- ↑ https://newbp.bmj.com/topics/en-gb/698
- ↑ Rosenthal E. Coarctation of the aorta form fetus to adult: curable condition or life long disease process? Heart Nov 2005; 91(11): 1495-1502
- ↑ https://pedemmorsels.com/coarctation-of-the-aorta-in-older-children/
- ↑ Brousseau T, Sharieff GQ. Newborn emergencies: the first 30 days of life. Pediatr Clin North Am. 2006 Feb;53(1):69-84, vi.