Pediatric Cardiology

a. PAC is most common arrhythmia of newborns b. Dextrocardia normal cardiac development, except on right side of chest c. History: i. Cyanosis with feeds (around mouth and toes) ii. Sweat, dyspnea, fatigue with feeds iii. JVD only seen in older children, newborns dont have necks d. Congenital heart Defects: e. Patent Ductus Arteriosum i. Connection shunting blood from the pulmonary artery to aorta, bypassing the lungs. Usually closes immediately after birth, at least by 3-4 days of age ii. Machine like murmur at LUSB, radiates to subclavicular area iii. Indomethacin helps to close iv. Tx: surgery for ligation via thoracotomy f. Patent Fossa Ovalis i. Incomplete closure of fossa ovalis between RA and LA ii. Blood is shunted from LA to RA because of pressure imbalances g. Newborn Cyanosis i. Transposition of great arteries 1. Aorta and PA are attached backwards 2. Egg shaped heart - due to the LV not having to pump to systemic circulation and not getting larger 3. Tx: surgery ii. Tetralogy of fallot - No intact septum (VSD) - small PA and narrowing under PV - RV enlargement because blood is spilling back into RV - Aorta lined up in the middle of the 2 ventricles not swung to Lt like normal 1. Harsh systolic murmur at LUSB 2. Single soft S2 3. Boot shaped heart 4. Tx: Use stent to Widen PA and patch the ventricular septum iii. Tricuspid Atresia 1. Tricuspid valve is either missing or abnormally formed 2. Defect blocks blood flow from RA to RV 3. When PDA closes, harsh systolic murmur at LSB 4. Tx: shunt from subclavian to pulm. Artery to decrease cyanosis iv. Pulmonary Atresia 1. Enlarged RV leads to RV impulse 2. Systolic murmur as LUSB

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3. Tx: enlarge/repair Pulmonary artery Cyanosis after PDA closure present with CHF s/s except edema i. Coarctation of Aorta 1. Narrowing of descending portion of aorta 2. Decreased LE pulses 3. Tx: patch, reanastomosis, or temporary bypass ii. Aortic atresia 1. No connection to LV, so no blood flow back to body iii. Hypoplastic Left and Right Heart syndrome 1. Whole side of heart is underdeveloped 2. Tx: many surgeries to return blood flow for adequate perfusion iv. Atrial septal defect 1. Hole btwn the atria, usually closes by 5y/o or at 5yr f/u 2. Grade 1-2 systolic murmur at LUSB 3. Tx: patch or stitches to close hole v. Ventricular septal defect 1. Hole btwn ventricles, usually closes by 1-2 y/o 2. Harsh, holosystolic murmur, radiates to back, grade 3 or higher 3. Tx: surgery after 2 y/o to prevent pulm. HTN. If small, just monitor, if large then patch to close Kawasaki syndrome i. Aneurysm forms in the coronary arteries and thrombosis can occur ii. Tx: high dose ASA, serial Echos Cardiomyopathy i. <2y/o ii. usually viral, URI within the last 3 months iii. then they develop CHF s/s Hypertrophic Cardiomyopathy i. Thickening of LV ii. Murmur would be louder with squatting and valsava