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Congenital Heart Disease, Acyanotic, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

Abnormality in the cardiocirculatory system that is present at birth but does not cause mixing of deoxygenated and oxygenated blood: 
  • L→R shunting lesions:

    • Ventricular septal defect (V...

Diagnosis

Signs and Symptoms

History

  • Many asymptomatic

  • Lethargy, poor feeding, and failure to thrive

  • Dyspnea on exertion

  • Recurrent respiratory infections

Physical Exam

  • VSD and AV canal:

    • Dusky color, hepatomeg...

Treatment

Initial Stabilization/Therapy

  • Maintain warmth and oxygenation.

  • Treat hypoglycemia and acidosis.

  • Establish IV access.

  • Prepare for endotracheal intubation.

High oxygen tensions promote ductal closu...

Follow-Up

Disposition

Admission Criteria

  • All newborns with suspected CHD:

    • Admit to pediatric ICU.

  • CHD with acute worsening of cyanosis or CHF

  • CHD with pneumonia or bronchiolitis

Discharge Criteria

Determine ...

Pearls and Pitfalls

  • Acyanotic lesions presenting at 2–12 wk:

    • Coarctation as DA closes

    • Septal defects as pulmonary vascular resistance drops

  • Classic ECG in AV canal: Superior QRS axis

  • Classic CXR in coarct...

Additional Reading

  • Bonow  RO, Mann  DL, Zipes  DP, et al., eds. Congenital heart disease. Braunwald's Heart Disease. 98th ed. Philadelphia, PA: Saunders Elsevier; 2012:1411–1467.

  • Dolbec  K, Mick  N. ...

Codes

ICD9

  • 745.4 Ventricular septal defect

  • 745.5 Ostium secundum type atrial septal defect

  • 746.89 Other specified congenital anomalies of heart

  • 747.0 Patent ductus arteriosus

  • 745.60 Endocardial cushion def...

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