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Flashcards in VSD and CHF Deck (26):
1

Failure to thrive

failure to gain weight appropriately (

2

Feeding patterns in young infants

Breastfed - 10-30 minutes a time every 2 hours
Bottle fed - every 3-4 hours

3

DDx for respiratory distress and feeding difficulty

CHF - congenital defects
Respiratory infection - anything causing resp distress can cause poor feeding
Sepsis - signs can be nonspecific
Metabolic Disorder - almost all of them can cause poor feeding

4

Cardiac Exam

Complete exam includes looking at patient color, palpate precordial, assess pulses, auscultate
Precordial - if overactive, heart has increased workload

5

Grading murmur intensity

I - faint
II - obvious
III - loud
IV - associated with thrill

6

Holosystolic murmur

The murmur starts with S1 and encompasses all of systole
- VSDs, mitral insufficiency, tricuspid insufficiency

7

Ejection murmur

occurs during systole but not until after S1
- aortic and pulmonic valve stenosis

8

Hepatomegaly in infants

normal liver edge = 1-2 cm below ribs
- hepatomegaly consistent with CHF
- decreased renal blood flow --> activates renin-angiotensin system --> fluid retention --> venous congestion --> hepatomegaly

9

Signs of CHF in infant

Poor feeding, diaphoresis, poor growth, active precordium, hepatomegaly
- inefficient circulation leads to adrenergic activation --> increased metabolic demands --> poor weight gain

10

Innocent murmurs

common (70-80% at one time have murmur) --> cause no distress or symptoms
- make sure no other alarming signs before brushing off

11

Murmurs discovered around 3-5 years old

ASD - wide, fixed split of S2
Coarctation of Aorta - progressive, HTN in upper extremities

12

VSD murmur

Ventricular septal defect - very common
- vary in clinical importance, size
- holosystolic mumur starting with S1

13

Tetralogy of Fallot

VSD, Overriding aorta, pulmonary stenosis, RVH
- cyanosis through obstruction of pulmonary artery
- R --> L shunt

14

Transposition of great vessels

vessels switched, severe cyanosis and urgent, early intervention is required

15

Aortic Stenosis

systolic ejection murmur followed by early diastole murmur

16

Pulmonic stenosis

prominent systolic click just after S1, harsh systolic ejection murmur

17

PDA

continuous machine like murmur

18

Heart defects that cause CHF

VSD
Aortic Stenosis
Coarctation of Aorta
Large PDA

19

Evaluating a congenital heart defect

EKG
Chest Xray
Echo

20

Hallmark of CXR in L-->R shunts

cardiomegaly, increased pulmonary vascular markings, pulmonary edema

21

EKG findings in VSD

prominent biventricular forces (high QRS in V1 and V2) --> LV volume overload and RV pressure overload
- large VSD --> RVH
- moderate VSD --> LVH

22

Admission criteria for congenital heart disease

not everyone needs admission for management
- present with cyanosis or CHF = admit
- shock = admits

23

VSD

persistent communication between ventricles
- either membranous or muscular septum
Phys: L-->R shunt --> increased pulmonary blood flow --> increased pulmonary return --> LVH -->

24

Clinical picture of VSD

murmur and signs not present in nursery (high pulmonary vascular resistance --> no shunting)
- large defecst = CHF as pulmonary resistance falls

25

Treatment of CHF

Furosemide - lasix to get extra fluid off accumulated by renal system
Digoxin - not clear but has shown to improve symptoms of CHF from VSD
Enalapril - afterload reduction promotes forward flow rather than thru VSD

26

Eisenmenger's Syndrome

HORRIBLE OUTCOME FOR VSD
- pulmonary vasculature constricts in response to high flow and high pressure --> permanent changes and pulmonary vasculature unable to relax --> shifts to R->L shunt -> death