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heart disease



pulmonary blood

pulmonary blood


reumatic heart



L-RT shunt











aortic stenosis


coarctation of


cushion defect

kawasaki disease


*CXR> normal or mild enlargement of the heart. * according the severity of pulmonary stenosis it could appear either in infancy or at first or second year of life .cyanosis ( degree of it depends on pulmonary stenosis) -right ventricle impulse -single S2 *ECG > RT. *there is 4 abnormalities : VSD . VSD can occur as a part of the disease -Hypoxic (tet) spells . stages of surgery : 1-blalock taussing procedure 2-bidirectional glenn 3-fontan procedure . pulmonary stenosis . sup QRS axis . if it is small or absent give prostaglandin E1 . –rapid and deep breathing . Atrial hypertrophy. Rt.A) Cyanotic congenital heart disease ( the common complication of them that they are increase the risk of cerebral thromboembolism and cerebral abscess) Decrease pulmonary blood flow Tetralogy of fallot Tricuspid Atresia Definition characteristic Clinical picture Investigation Treatment *Due to abnormal septation of truncus arteriosus into the aorta and pulmonary artery .ventricular hypertrophy *CXR> Boot shaped heart sign *Echo .axis deviation and RT. *Echo Presence of VSD is important for the baby . Treatment of hypoxic spells : -O2 -knee chest position -morphine-sulphate -a-adrenergic agonist (phenylephrine ) *palliative shunt surgery *complete surgical repair . PDA and VSD is important for pulmonary blood flow and survival . overriding aorta and hypertrophy of right ventricle . *Severe cyanosis *single S2 *VSD murmur if VSD present . to keep ductus arteriosus open . *ECG > L.ventricle hyprertrophy . *most common cyanotic congenital heart disease . Absence of tricuspid valve lead to hypoplastic of right ventricle .

ventricle and pulmonary artery . -pallon atrial septostomy .cyanosis ( degree of it depends on the amount of mixing. *usually VSD. . placement of conduit between the RT.cyanosis ( degree of it depends on the amount of pulmonary blood flow ) -tachypnea -cough -peripheral pulses are usually pounding .prostaglandin E1 to maintain ductul patency .PDA occur as part of the disease . -queit tachypnea -single S2 -VSD murmur may present -may present with HF . *if there is no mixing death occur early in life . single arterial trunk arises from the heart with a large VSD immediately below the trunk valve .Cyanotic congenital heart disease increase pulmonary blood flow Transposition of great artery Truncus arteriosus Definition Transposition of great artery secondary to abnormality of septation of the truncus arteriosus Result from failure of septation of the truncus arteriosus during first 3-4 week of gastation . *CXR> displased pulmonary artery . If not diagnosed at birth . ASD . -single S2 -may be cystolic ejection click -systolic murmur -signs of HF .ventricular hypertrophy *CXR> egg on a string sign *Echo . characteristic *most common cyanotic losion that present in the newborn period . the infant may develop signs of heart failure . Clinical Investigation picture .axis deviation and RT. . *Echo -anticongistive drugs -surgical repair : VSD closure . Treatment *ECG > RT. -atrial switch usually done at the first 2 weeks of life *ECG > combined ventricular hypertrophy and cardiomegaly .


-hyperactive RT .Cyanotic congenital heart disease Mixed Definition Total anomalies pulmonary venous return Disruption of the development of normal pulmonary venous drainage during 3ed week of gastation . -widely split S2 . all of pulmonary viens fail to connect to the ledt atrium and return abnormally via RT side of the heart . and dyspnea . ( snow man sign on CXR ) Surgery repair : common pulmonary vie nary opend into the left atrium . they may have supracardiac . Infant wighout obstruction : *ECG > cinsistant with RT ventricular volume overload *CXR> cardiomrgaly *Echo Infants with obstruction : *ECG> RT. -systolic ejection murmur at the left sternal border . cardiac . ventricular impulse . infracardiac . . infant without obstruction have minimal cyanosis and nay be asymptomatic . and sighn of RT. Side heart failure including hepatomegaly .axis deviation and RT. and varieng degree of pulmonary edema that appear as pneumonia . mixed drainage . results one of 4 abnormalities .ventricular hypertrophy *CXR: normal or mild enleargment of the heart . marked tachypnea .mid-diastolic murmurs at the lower left sternal border -poor of growth infants with obstruction present with cyanosis . . characteristic Clinical picture Investigation Treatment The most important determinant of presentation is the presence or absence of obstruction to the pulmonary venous drainage .

-correction acidosis -surgical repair : norwood procedure .Hypoplastic left heart syndrome Failure of development of mitral or aortic valve or the aortic arch . *Echo . *ECG > RT. *CXR> cardiomegaly with pulmonary vonous congestion or pulmonary edema .prostaglandin E1 . mottled skin . decreased left ventricular forces . Ventricular hypertrophy . -sign of HF -pulses are weak or absent -S2 single and load -no murmur -cyanosis may be minimal but low cardiac output gives a grayish color to the cool . bidirectional glenn and fontan procedure ) . Most common cause of death from cardiac defects in the first month of life .


*peri-membranous VSD are the most common of all VSD. 2. large VSD: *ECG > left atrial and ventricular hypertrophy . the amount of shunt increase . Had 2 important sign : (important in OSCE) 1. most of it close surgically All children with VSD must be given antibiotic prophylaxis to prevent bacterial endocarditis . Small : no need for treatment . at first 6 to 8 weeks of life it decrease .thrill at left lower sternal border . up to 90% it will close spontaneously . Small VSD : little shunt so it may asymptomatic but have a loud murmur .Failure to thrive .Tachypnoea .Tachycardia Hepatomegaly -Recurrent chest infection one of the presentation *large shunt increase flow Small VSD normal in ECG and CXR .loud pan systolic murmur ar left lower sternal border . increase in pulmonary blood flow and increase in pulmonary artery silhouette. *CXR> cardiomegaly .B) ACyanotic congenital heart disease Left to right shunt Ventricul ar septal defect Definition characteristic Clinical picture Investigati on Treatment Ventricular septum contain 4 component : -muscular septum. Presentation is usually early and can present at 1 week of age with sign and symptoms of Heart failure : Breathlessness during feeding Poor feeding Sweating during feeding . and symptoms may develop . -endocardial cushion septum. diuretics . -supracristal septum. *large VSD are not symptomatic at birth . -membranous septum . initial treatment of moderate to large VSD include . VSD occur when any of these component fails to develop normally. *most common congenital heart disease . digoxin and afterload reduction . enlargement of L. moderate to large VSD : results in pulmonary over circulation and HF .Ventricle .

-prominent RT. Soft murmur at upper left sternal edge . if a shunt is still present at around 3 years . -large shunt may result in a middiastolic murmur at left lower sternal border . -even with large ASD infants are rarly symptomatic . while premium and sinus venous defect require surgical closure . which is important to keep open in fetal There is 3 types : *septum secundom defect with the hole in the region of the foramen ovale . Medical management rarely recommended . closure usually recommended. * the least common ASD is the sinus venous defect . * Parasternal Thrill *there may found splitting of S2 and intensity of P2. many secondum ASD closed by surgical device . *septum premium ( partial arterioventricular defect ) common in down syndrome . large VSD: *ECG > vary from normal to evidence of left In Preterm Baby: I/V indomethacin or Oral Brufen if no contraindication to these medications If Failed Medical :Treatment . *CXR> cardiomegaly and prominent pulmonary artery .ventricular impulse ( at the left lower sternal border) 2 most important sign : (important in OSCE) 1-systolic ejection murmur . Small PDA asymptomatic moderate to large PDA : shunts can produce the symptoms of heart failure . Finding : 2 most important sign : (important in OSCE) *ECG > RT.axis deviation and RT. Small VSD normal in ECG and CXR . or excessive reabsorption of tissue lead to ASD . exam. across mitral valve so middiastolic murmur at the apex may be heard ( Soft or no systolic murmur ). 2-fixed split S2 . is the most common type . Patent ductus arteriosus Failure of normal closure of ductus arteriosus .ventricular hypertrophy .Atrial septal defect Failure of septum growth .

may br complete or partial. it allows blood to flow from pulmonary artery to the aorta . axis deviation and combined ventricular hypertrophy. single S2 may be found . -symptoms may be earliar and more severe with significant arterio-ventricular valve insufficiency.poor growth of child. the complete defect defect results in * complete endocardial cushion defect are most commonly in a child with down syndrome . -FTT -symptom of HF usually develop. -large shunts can cause middiastolic murmur over mitral area ( at the apex ) and hyper dynamic pericardium . . or collapsing pulse ) 2-continuous . machine like murmur ( can be heard over mid-clavicular area . ventricular hypertrophy *CXR>full pulmonary artery silhouette . Endocard ial cushion defect Also called arterioventricular canal defect . 1-widened pulse pressure (Bounding pulse . digoxin . and increase pulmonary vasculature . -if there is large VSD . *Echo ( diagnostic test ) Initial management includes diuretics . -thrill may be palpable –splitting S2 and intensity of P2. Small PDA can be closed in Cardiac Cath Lab with COIL at 1 year If Large and S/S of Failure to thrive or Pulmonary HTN Surgical Ligation at 3-5 month *ECG > L. Failure of the septum to fuse with the endocardial results in abnormal arterioventricualr valves as well . . surgical repair is required . *CXR> cardiomegaly with increased vascularity .life . afterload reduction for treatment for treatment of HF . -presence of murmur varies depending on the amount of shunting .

premium ASD .there may be arterioventricular valve insufficiency . amd cleft in the anterior leaflet of the mitral and septal leaflet of the tricuspid valve . posterior or inlet VSD .

supvavular and supravalvular . surgical repair require if balloon unsuccessful . moderate to severe stenosis : exertional dyspnea .ACyanotic congenital heart disease Obstructi ve stenosis Definition Pulmona ry stenosis Failure of development in early gestation of the three leaflet of the valve . insufficient reapportion of infundibular or insufficient canalization of the peripheral pulmonary arteries. characte ristic Clinical picture Investigation Treatment Mild pulmonary stenosis : asymptomatic .in severe stenosis there may be RT.systolic ejection murmur at the second left intercostal space with radiates to the back . newborn with severe stenosis may be cyanotic because right to left shunt at the atrial level . axis deviation and Rt. moderate to severe : *ECG > Rt. easy fatigability . -S2 may be widely split . *CXR> heart size may be normal . dilatation of the main pulmonary artery . -thrill may be present . . .ventricular impulse . Balloon vavoplasty . *Echo Usually Nothing do with mild stenosis . ventricular hypertrophy . -valvular stenosis may result click that varies with respiration . . Can be valvular . Mild stenosis: normal in ECG and CXR .

. Mild to moderate stenosis : asymptomatic . dilatation of ascending aorta or aortic knop . -systolic ejection click often is heard . *Echo The degree of aortic stenosis frequently progresses with growth and age. serial follow up with Echo is indicated . is the most common ASD . exertional chest pain and syncope. * secundom defect with the hole in the region of the foramen ovale . Balloon vavoplasty . newborn with critical stenosis may present with symptoms of HF . -the aortic component of S2 may be decreased in intensity Mild stenosis: normal in ECG and CXR . moderate to severe : *ECG > L. Aortic insufficiency usually develop . severe stenosis : exertional dyspnea . ventricular hypertrophy . -thrill may be present at the .Aortic stenosis Failure of development of the three leaflet of the valve . *CXR> L. insufficient reapportion of tissue around the valve . supvavular and supravalvular . . surgical repair require if balloon unsuccessful . Can be valvular . ventricular hypertrophy .systolic ejection murmur at the right second intercostal space with radiates to the neck . * the least common ASD is the sinus venous defect .

In infantile coarctation symptoms : poor feeding . balloon angioplasty surgical repair most commonly perform . Rt ventriculat hypertrophy and pulmonary edema in older children : l. reviewed by shada albogami and Arwa Alahmadi (1436 H ) In infantile coarctation marked cardiomegaly . inotropic agent . hypertrophy Rib-notching may also be seen in older children ( > 8 years ) *echo *IV infusion of prostaglandin E1 . there is systolic ejection murmur and systolic ejection click . resulting in narrowing of the aortic lumen . respiratory distress .ventricular hypertrophy and midly enlarged heart . diuretics and other supportive care .Coarcta tion of the aorta During development of aortic arch area near the insertion of the ductus arteriosus fails to develop correctly . if there is abnormal aortic valve . Arterial hypertension in the arms with low blood pressure in the lower extremities is classic and weeker pulse in femoral artery ( radio-femoral delay ) the murmur is typically best heard in the left inter-scapular area of the back . headache . . classicaly the femoral pulses are weeeker and delayed compared with the right radial pulse ( radiofemoral delay ) . Done by Arwa Al-ahmadi . older children may be asymptomatic of have leg discomfort during exercise . or epistaxis . shock may develop before 2 weeks of life .there may be no murmur but S3 is often present . *Usually juxta-ductal in position Symptoms develop when aortic ampula of the ductus closes .