Pediatric Cardiology: ASD and PDA

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Questions and Answers

What is the incidence of congenital heart disease in births?

6 per 1,000 births

8 per 1,000 births (correct)

4 per 1,000 births

10 per 1,000 births

What is the most common congenital heart defect?

Atrial septal defect

Coarctation of the aorta

Ventricular septal defect (correct)

Patent ductus arteriosus

What determines the amount of flow crossing a ventricular septal defect?

Pulmonary vascular resistance

Neither size of the defect nor pulmonary vascular resistance

Both size of the defect and pulmonary vascular resistance (correct)

Size of the defect

Why are large ventricular septal defects not symptomatic at birth?

Because pulmonary vascular resistance is normally elevated Signup and view all the answers

What is the typical physical finding with a ventricular septal defect?

A pansystolic murmur Signup and view all the answers

What may be present with a ventricular septal defect?

A thrill Signup and view all the answers

What are the electrocardiogram and chest x-ray findings usually like with small ventricular septal defects?

Normal Signup and view all the answers

What happens to the pulmonary vascular resistance over the first 6-8 weeks of life?

It decreases Signup and view all the answers

What is a common symptom of a large PDA?

Heart failure Signup and view all the answers

What is the treatment for a significant ASD at around 3 years of age?

Closure with an ASD closure device Signup and view all the answers

What is the normal function of the ductus arteriosus?

Allowing blood to flow from the pulmonary artery to the aorta Signup and view all the answers

What is a characteristic finding on physical examination of a PDA?

A continuous, machine-like murmur at the left infraclavicular area Signup and view all the answers

What is the percentage of congenital heart disease represented by PDAs in full-term infants?

5-10% Signup and view all the answers

What may be palpable on physical examination of a PDA?

A thrill Signup and view all the answers

What is a common ECG finding in a patient with a small PDA?

Normal ECG Signup and view all the answers

What is a characteristic chest x-ray finding in a patient with a moderate to large PDA?

A full pulmonary artery silhouette Signup and view all the answers

What is the likely outcome for moderate and large PDAs?

Eventual closure Signup and view all the answers

What is the condition characterized by increases in the duration of the murmur and a higher frequency of the sound?

Worsening stenosis Signup and view all the answers

What is the usual heart size in moderate to severe stenosis?

Normal Signup and view all the answers

What is the location of the systolic ejection murmur in pulmonary stenosis?

Second left intercostal space Signup and view all the answers

What is the effect of right ventricular hypertrophy?

Impulse at the lower left sternal border Signup and view all the answers

What percentage of congenital heart disease is accounted for by pulmonary stenosis?

10% Signup and view all the answers

What is the characteristic of valvular stenosis?

A click that varies with respiration Signup and view all the answers

What is the location of the radiation of the systolic ejection murmur in peripheral pulmonary stenosis?

Axillae and back Signup and view all the answers

What is the primary use of echocardiography in valvular pulmonary stenosis?

To estimate the pressure gradient Signup and view all the answers

What is the typical outcome for valvular pulmonary stenosis that is mild?

It usually does not progress Signup and view all the answers

What is the percentage of all congenital heart disease that valvular, subvalvular, or supravalvular aortic stenosis represents?

5% of all congenital heart disease Signup and view all the answers

What is the typical symptom of mild to moderate aortic stenosis?

No symptoms Signup and view all the answers

What is the location where a systolic ejection murmur is heard in aortic stenosis?

Right second intercostal space Signup and view all the answers

What is the characteristic of the murmur in aortic stenosis as the degree of stenosis increases?

It increases in length and becomes higher in frequency Signup and view all the answers

What is the characteristic of the ECG and chest x-ray findings in mild aortic stenosis?

They are normal Signup and view all the answers

What is the characteristic of echocardiography in aortic stenosis?

It shows the site of stenosis, valve morphology, and the presence of left ventricular hypertrophy Signup and view all the answers

Where is the murmur typically best heard?

Left interscapular area of the back Signup and view all the answers

What is often present in approximately 50% of cases?

A systolic ejection click and systolic ejection murmur Signup and view all the answers

What do ECG and chest x-ray typically show in infantile coarctation?

Right ventricular enlargement and hypertrophy Signup and view all the answers

What is often performed in older children with coarctation?

Surgical repair of the coarctation Signup and view all the answers

What is included in the management of an infant presenting with cardiac decompensation?

Intravenous infusion of prostaglandin E1, inotropic agents, diuretics, and other supportive care Signup and view all the answers

What has become more accepted as primary therapy in older patients with coarctation?

Balloon angioplasty and stenting Signup and view all the answers

Study Notes

Congenital Heart Diseases

Congenital heart disease occurs in 8 per 1,000 births, with a spectrum of lesions ranging from asymptomatic to fatal.
Most cases of congenital heart disease are multifactorial, but some lesions are associated with chromosomal disorders, single gene defects, teratogens, or maternal metabolic disease.

Acyanotic Congenital Heart Defects

Left-to-right shunts result in an increase in pulmonary blood flow, including:
- Patent ductus arteriosus (PDA)
- Ventricular septal defect (VSD)
- Atrial septal defect (ASD)
Obstructive lesions include:
- Aortic stenosis
- Pulmonary stenosis
- Coarctation of the aorta
- These lesions usually have normal pulmonary blood flow

Ventricular Septal Defect (VSD)

VSD is the most common congenital heart defect, accounting for 25% of all congenital heart disease.
The location of the VSD is important prognostically and in approach to repair.
The amount of flow crossing a VSD depends on the size of the defect and the pulmonary vascular resistance.
Large VSDs are not symptomatic at birth because the pulmonary vascular resistance is normally elevated at this time.
As the pulmonary vascular resistance decreases over the first 6-8 weeks of life, the amount of shunt increases, and symptoms may develop.
Small VSDs with little shunt are often asymptomatic but have a loud murmur.
Moderate to large VSDs result in pulmonary overcirculation and heart failure.
The typical physical finding with a VSD is a pansystolic murmur, usually heard best at the lower left sternal border.
There may be a thrill.

Patent Ductus Arteriosus (PDA)

The ductus arteriosus allows blood to flow from the pulmonary artery to the aorta during fetal life.
Failure of the normal closure of this vessel results in a PDA.
With falling pulmonary vascular resistance after birth, left-to-right shunting of blood and increased pulmonary blood flow occur.
Excluding premature infants, PDAs represent approximately 5-10% of congenital heart disease.
Symptoms depend on the amount of pulmonary blood flow.
The magnitude of the shunt depends on the size of the PDA and the pulmonary vascular resistance.
Small PDAs are asymptomatic; moderate to large shunts can produce the symptoms of heart failure as the pulmonary vascular resistance decreases.
The physical examination findings depend on the size of the PDA.
A continuous, machine-like murmur can be heard at the left infraclavicular area, radiating along the pulmonary arteries and often well heard over the left side of the back.

Pulmonary Stenosis

Pulmonary stenosis accounts for approximately 10% of all congenital heart disease.
It can be valvular, subvalvular, or supravalvular in nature.
Symptoms depend on the degree of obstruction present.
Mild pulmonary stenosis is asymptomatic.
Moderate to severe stenosis results in exertional dyspnea and easy fatigability.
Newborns with severe stenosis may be more symptomatic and even cyanotic because of right-to-left shunting at the atrial level.
Pulmonary stenosis causes a systolic ejection murmur at the second left intercostal space, which radiates to the back.
A thrill may be present.

Aortic Stenosis

Aortic stenosis represents approximately 5% of all congenital heart disease.
Lesions result from failure of development of the three leaflets or failure of resorption of tissue around the valve.
Mild to moderate obstructions cause no symptoms.
More severe stenosis results in easy fatigability, exertional chest pain, and syncope.
Infants with critical aortic stenosis may present with symptoms of heart failure.
A systolic ejection murmur is heard at the right second intercostal space along the sternum and radiating into the neck.

Coarctation of the Aorta

Coarctation of the aorta represents a significant proportion of congenital heart disease.
The ECG and chest x-ray show evidence of right ventricular enlargement and hypertrophy in infantile coarctation with marked cardiomegaly and pulmonary edema.
Echocardiography shows the site of coarctation and associated lesions.
In older children, the ECG and chest x-ray usually show left ventricular hypertrophy and a mildly enlarged heart.
Echocardiography shows the site and degree of coarctation, the presence of left ventricular hypertrophy, and the aortic valve morphology and function.

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Description

This quiz covers the diagnosis and treatment of atrial septal defects (ASD) and patent ductus arteriosus (PDA) in pediatric cardiology. It includes signs, symptoms, and treatment options for these common congenital heart defects.