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Patent Ductus Arteriosus, Emergency Medicine

Steven Lelyveld Reviewed 06/2017
 


Basics

Description

  • Patent vessel in the fetal heart connects the pulmonary trunk to the descending aorta.

  • Shortly after birth, changes normally provoke contraction, closure, and fibrosis:

    • Sudden increase...

Diagnosis

Signs and Symptoms

History

  • Isolated patent ductus arteriosus (PDA), an unanticipated event

  • PDA, as part of a larger congenital cardiac anomaly, may be diagnosed by US during pregnancy.

Physical Exam

Treatment

Supplemental oxygen if CHF 

Pre-Hospital

Monitoring and oxygen 

Initial Stabilization/Therapy

  • Small, asymptomatic shunts may not need closure.

  • Pulmonary support

  • Supplemental oxygen

Ed Treatment/Procedures

Follow-Up

Disposition

Admission Criteria

  • Heart failure

  • Endocarditis

  • Pulmonary hypertension

Discharge Criteria

  • Asymptomatic

  • Prophylactic antibiotics

  • Close follow-up with plans for early surgical closure

Issues for Referral

Pearls and Pitfalls

  • CHF may cause decrease in glomerular filtration rate and urinary output.

  • Indomethacin may cause GI bleeding.

Additional Reading

  • Dorfman  AT, Marino  BS, Wernovsky  G, et al. Critical heart disease in the neonate: Presentation and outcome at a tertiary care center. Pediatr Crit Care Med.  2008;9:193–202.

  • ...

Codes

ICD9

747.0 Patent ductus arteriosus 

ICD10

Q25.0 Patent ductus arteriosus 

SNOMED

  • 83330001 Patent ductus arteriosus (disorder)

  • 125964004 Patent ductus arteriosus with right-to-left shunt (disorder)

  • 125...

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