Congenital heart defects
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Congenital Heart Defects. Incidence. Congenital heart disease affects 8 in 1,000 births Varies in severity Can be associated with genetic syndromes (Down, DiGeorge , velocardiofacial ). Ventricular Septal Defect. Hole between the two ventricles Left to right shunt( acyanotic )

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Congenital Heart Defects

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Congenital heart defects

Congenital Heart Defects



  • Congenital heart disease affects 8 in 1,000 births

  • Varies in severity

  • Can be associated with genetic syndromes (Down, DiGeorge, velocardiofacial)

Ventricular septal defect

Ventricular Septal Defect

  • Hole between the two ventricles

  • Left to right shunt(acyanotic)

  • Usually requires surgical repair-causes LVH

Vsd continued

VSD, continued

  • Most common heart lesion (30%)

  • Usually manifests in first weeks of birth

  • Most resolve spontaneously in 1st years of life

  • Findings: holosystolic murmur best heard at LLSB, may have palpable thrill

Atrial septal defect

Atrial Septal Defect

  • Hole between the atria

  • Usually asymptomatic

  • Starts as left to right shunt (acyanotic)

Asd findings

ASD findings

  • Grade II-IV systolic ejection murmur at LUSB

  • Louder with a smaller defect (turbulence)

  • Fixed splitting of S2

  • ECG/echo: RVH if uncorrected

  • If uncorrected:

    • RAH, pulmonary hypertension increases pressure on right side of heart

    • Shunts right to left(cyanotic)

Patent ductus arteriosus

Patent DuctusArteriosus

  • Ductusarteriosus does not close

  • Oxygenated blood back to lungs

  • Common in preemies

  • May have no early symptoms

Pda continued

PDA, continued

  • Grade II-IV holosystolic machinery murmur @ LUSB

  • ECG/echo: LVH or BiVH

  • If severe, CHF

  • Increased pulmonary vascular markings

  • Treatment: indomethacin or surgical closure

Transposition of the great arteries

Transposition of the Great Arteries

Aorta comes out of right ventricle (cyanotic)

Tga exam findings

TGA exam findings

  • Usually “blue baby”

  • If large VSD, may turn blue when crying/agitated and CHF symptoms

  • Murmurs vary depending on defect(s)

  • “Egg on a string”

Tga treatment

TGA treatment

  • Initially, medical management (prostaglandins)to keep intracardiac shunts open (if available)

  • Surgical correction definitive treatment

Tetralogy of fallot

Tetralogy of Fallot

  • Large VSD

  • Pulmonary stenosis

  • Overriding aorta

    • Positioned directly over VSD—unoxegenated blood to circulation

  • RVH

Tetralogy of fallot findings

Tetralogy of Fallot findings

  • Loud systolic ejection click @ M-LUSB

  • ECG: right axis deviation and RVH

  • X-ray: boot-shaped heart, no pulmonary vascular markings

  • Tet spells (cyanosis, crouching)

Aortic stenosis

Aortic Stenosis

  • Stenotic aortic valve

  • Findings

    • Grade II-IV systolic ejection click, does not vary with respirations

    • Thrill at RUSB

    • LVH if untreated

    • CHF if severe

Pulmonic stenosis

Pulmonic stenosis

  • Grade II-V systolic ejection click best heard at LUSB

  • Increases with expiration, decreases with inspiration

  • Thrill at LUSB radiating to back and sides

Coarctation of the aorta

Coarctation of the Aorta

  • II-IV systolic ejection murmur radiating to left interscapular

  • BP in lower extremities lower than upper

  • X-ray: rib notching

Questions or comments

Questions or comments?

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