Pediatric Cardiology

.' Patent ductus arteriosus •'.. Constant, niachihe-like murmur.-in -'upper left sternal.dyspnea •aiid' possible CHF; close with .

■'in'dpmethacnt (or .surgery if indorrtethacur^ ■■congenitalrubelkVaiKfhigl) alfitutfe's; ;.:

. Ventricular septal -defect ... Holo'systojic iriiirmur next to stcrnuni; niosi.cascs resolve;'on: their own; mwuoffinwft cpngcnitrti heart defect.: .

Atrial; septal .defect. • . . - Asymptomatic uritii-adulthood; fixed! split S2"-a»d"p^j»titiohs; most'defects;do'n0t need correction . . .

• Tetralogy of Fallot' '..'■'. (f^^tttticvilar^ept^-'ddfectj. .0) pulmonAty stenosis, and (4),over-.

/. Hdiftjg-a6rta;-i^.£M^^ -loo^ jfbr "tet"'«^«^? -(¡s^uattWg'^^

. Coarctation of aorta ■ ■.. Upper extremity^^ b)^eite»sionvonly; radtofemoral delay-; systolienruhntir heard over rttid-upper. back;: .

. .rib notching on;x-ray; associated;w^

Note: Endocarditis prophylaxis is required for all of these cardiac delects except asymptomatic atrial septal defect.

Important points:

1. A heart rate over 100 beats/min may be normal in children.

2. In the presence of a ventricular septal defect, think about the possibility of fetal alcohol syndrome, TORCH syndrome, or Down syndrome.

3. Hypertrophic obstructive cardiomyopathy classically presents in a young male who passes out on exertion (watch for collapse or sudden death in an athlete) and often is associated with a family history of sudden death. This disorder is considered a diastolic dysfunction and thus is treated with beta blockers to give the heart more time to fill. Positive inotropic agents (e.g., digoxin), diuretics, and vasodilators are contramdieatcil, because they make the condition worse.

4. Oxygen content in the fetal circulation is highest in the umbilical vein and lowest in the umbilical arteries; oxygen content is higher in blood going to upper extremities than in blood going to lower extremities.

5. Understand the changes in the circulation from intra - to extrauterine life. First breaths inflate the lungs and cause decreased pulmonary vascular resistance, which increases blood flow to the pulmonary arteries. This and the. clamping of The cord increase, left-sided heart pressures, which functionally close the foramen ovale, increased, oxygen concentration shuts off prostaglandin production in the ductus arteriosus, causing gradual closure.

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