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Congenital Heart Disease


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Statistics of Congenital Heart Disease
Approx 1% of all live births (very conservative)
Majority follow non-mendelian genetics (not always predictable)
Causes of Congenital Heart Dis
Multifactorial genetics (genetic & environ)
Chromosomal abnormalities - 10% (Downs - septal defects/AV canal, Turner Syn.-coarctation)
Maternal conditions -2-4% (DM, SLE, Fetal Alcohol Syn & drug addictions)
Which are Acyanotic Congenital Heart Diseases
Ventricular Septal Defect (1 in 3)
Patent Ductus Arteriosus- 8% (50% will close on their own)
Atrial Septal Defect -7%
Coarctation -6%
Aortic Stenosis -5%
Which is Cyanotic Congenital Heart Dis?
Tetralogy Fallot -5% (very dangerous - blue baby)
What's involved in a Cardiac Assessment?
Heart rate
Respiratory rate - most important vital sign
BP - also very important vital sign
Pericardial friction rub
Heart sounds
What are types of Skin Assessments?
Central cyanosis (arterial)
Peripheral cyanosis (venous
What is Acrocyanosis?
Peripheral cyanosis - venous desaturation - blue around mouth & tips of extremities
What is mottling?
Lacy, fish-net appearance of skin - can be due to cold stress or sepsis
What are signs of Peripheral Cyanosis?
Blue hands/feet/perioral
Can be normal for weeks
Normal reduced Hb levels
Normal O2 saturations
Venous desaturation - not a worry
What are signs of Central Cyanosis?
Blue inner lips & tongue
Abnormal after first few hours
Increased levels of reduced Hb
Decreased O2 sats
Arterial desaturation - great concern
What is the normal color of mucous membranes?
Strawberry sherbert color
What is the color of cyanotic membranes?
Resembles rasberry sherbert (deeper color of pink)
What can it mean if an infant is pale or washed out?
May be hypoxic or anemic
Mild degrees of cyanosis can be easily missed!
What percentage of pediatric pts will have a heart murmur?
50 - 90% at one time or another
Majority are functional or innocent murmurs
S1 Heart Sound
Ausc with diaphragm
Located at LLSB
Due to M/T closure
S2 Heart Sound
Ausc with diaphragm
Located LUSB
Due to A/P closure
S3 Heart Sound
Ausc with bell
Located at LSB
Vibration - normal
Tensing - pathological -stiff heart
S4 Heart Sound
Ausc with bell
Located at LSB
Vibration - normal
Tensing - pathological - stiff heart
Normal S1 & S2 Sounds
High frequency sounds
Consists of 2 sounds:
1)Aortic and pulmonic components
Determined by amount of splitting during inspiration and expiration
Physiological split - normal
Fixed split - bad - when it remains thru expiration & inspiration
Grade I Systolic Murmur
Very faint
Requires concentration to hear
Grade II Systolic Murmur
Can be heard without difficulty
Grade III Systolic Murmur
Heard immediately when placing the stethoscope on the chest
Grade IV Systolic Murmur
Can be associated with a thrill - can be felt
Grade V Systolic Murmur
Heard with the stethoscope partially off the chest wall
Thrill present
Grade VI Systolic Murmur
Heard with stethoscope off the chest
Thrill present
How are Diastolic murmurs graded?
Always pathological until proven otherwise (in kids)
What are innocent murmurs?
No structural or hemodynamic problem
Due to turbulence of blood flow
Characteristics of Innocent Murmurs
Normal history and physical
Soft intensity (GII, occasionally GIII)
Intensity varies with position
Short Duration (not holosystolic)
Musical quality - not harsh
Normal S1 & S2 (not a fixed split)
If evidence of cardiac disease is present - murmur should not be labeled "innocent"
What is a Functional Murmur?
aka nonorganic or innocent
Diagnosis by exclusion in the neonate
What is a Functional Murmur with Venous Hum?
Continuous humming murmur
Usually ages 2-5
Heart best under (R) clavicle
Movement of head or supine position changes murmur intensity
Differentiate from PDA (no change in PDA with head movement)

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