What is the MC CHD?
VSD
Describe the murmur of a VSD
What kind of shunt?
Tx
Murmur:
- Holosystolic murmur at LLSB +/- RV heave
- If large: harsh pansystolic murmur at LLSB
Shunt: L>R (acyanotic)
Tx:
- small: serial monitoring
- large: patch @ 3-6 months
Describe the murmur of an ASD
What kind of shunt?
Tx
Murmur:
- Fixed, widely split S2, RV heave
- Systolic ejection murmur at RVOT
- Large shunt: mid-diastolic murmur at LLSB
Shunt: L>R (acyanotic)
Tx:
- surgical closure via cath
Which CHD is common in Down Syndrome
AVSD
Describe the murmur of an AVSD
What kind of shunt?
Tx
Murmur: non specific systolic murmur
Shunt: L>R (acyanotic)
Tx: Control CHF and manage growth until surgery can be performed 4-6 YO
Describe the murmur of a PDA
What kind of shunt?
Tx
Murmur: Continuous, machine-like murmur at L infraclavicular space + widened pulse pressure + bounding pulses
Shunt: L>R (acyanotic)
Tx:
- If pt is a preemie: give NSAIDs
- If not, NSAIDs won’t work: cardiac cath closure
Which CHD is common in Turners?
Coarctation of the aorta
Describe the murmur in CoA
What kind of shunt?
Tx
Murmur: Systolic murmur - left back or axilla
+ decreased femoral pulses and large BP gradient
Shunt: L>R (acyanotic)
Tx: Prostaglandins
PDA needed for survival (Transposition of the Great Arteries also needs PDA for survival)
Which acyanotic CHD is the most critical?
CoA
What must be done for all cyanotic CHD?
Within the first year:
- In nursery: give O2, IV/umb cath, supportive care while waiting for surgery
- PROSTAGLANDINS!!!
Which cyanotic CHD is the MC?
Tetralogy of Fallot
Describe the murmur in Tetralogy of Fallot
What kind of shunt?
Tx
Murmur:
- Single S2 from aorta
- Systolic ejection murmur / LSB at 3rd rib
Shunt: R>L (cyanotic)
Tx:
- O2, Morphine, Propanolol
- Surgery before 2 yo. Often need revision ~10-15 YO
Describe the murmur in Transposition of the Great Arteries
What kind of shunt?
Tx
Murmur: none-zo
Shunt: R>L (cyanotic)
Tx:
- Prostaglandins
- Switch vessels w/in 4-7 days
PDA needed for survival (Coarctation of the Aorta also needs PDA for survival)
PROFOUND CYANOSIS
Describe the murmur in tricuspid atresia
What kind of shunt?
Tx
Murmur:
- Single S2
- No murmur
Shunt: R>L (cyanotic)
Tx: Prostaglandins, baby
Patent Foramen Ovale or ASD critical for life
Describe the murmur in total anomalous pulmonary venous return (TAPVR)
What kind of shunt?
Tx
Murmur:
- Widely split S2
- Systolic ejection murmur at LUSB
Shunt: R>L (cyanotic)
Tx: Prostaglandins, surgery
Describe the murmur in truncus arteriosus
What kind of shunt?
Tx
Murmur:
- Single accentuated S2
- Loud, holosystolic @ LLSB
- Loud systolic ejection click
Shunt: R>L (cyanotic)
Tx: Anticongestive measures
VSD always present!
Describe the murmur in hypoplastic left heart
What kind of shunt?
Tx
Murmur: ?
Shunt: R>L (cyanotic)
Tx: PGs and for the love of all that is good AVOID O2
PDA is critical
