Tuesday, June 12, 2012

Doctorese Babble: Acyanotic Heart Lesions

Acynanotic Heart Disease

- ASD most common in adults

o mostly asymptomatic due to minimal pressure difference

o Normal vitals

o Fixed split S2

o Ejection systolic murmur

o X-ray usually unremarkable

o Septum primum – sidenote

 Endocardial cushion defect

 Down’s syndrome – 30%

 30% of Trisomy 21 patients have ECD, 30% of ECD patients have Trisomy 21

 Cyanotic lesion

- VSD most common in children

o Becomes volume overload in lungs

o Full and red and wet

o Pressure difference isn’t large at birth

o As PVR decreases, L-R gradient increases

o Symptoms

 Increased respiratory rate

 Poor feeding *** -- only energy babies expend

• Will sweat around the forehead

• Poor weight gain

 Tachycardia

 Normal sats – unless severe pulmonary edema

 Biventricular hypertrophy

 Murmur

 Edema – sacral

 Crackles

o X-ray

 Cardiomegaly – cardiothoracic occupation is normally 60% in babies

 Edema

 White lungs

o Echo

 Size of lesion

 Location of lesion

• Muscular

• Membranous – will not close

 Many will close on their own – consider surgical repair if not resolved by 1-1.5 years

o Treatment

 Diuretics

 ACE inhibitors

 Surgical repair

 **Swiss cheese heart disease

- Bicuspid aortic MC congenital heart defect

- Coractation of the Aorta

o Critical if preductal – when PDA closes shock ensues

o Normal 10-20 point difference between upper and lower extremity BP – gap widens with coarct

No comments:

Post a Comment