Ventricular Septal Defect

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Ventricular Septal Defect by Mind Map: Ventricular Septal Defect

1. Acyanotic (L to R shunt),

1.1. Endocardial cushion and interventricular septum don't align in embryology

1.1.1. may close on it's own

1.1.1.1. 75-80% close by 10 yrs old

1.1.2. perimembranous= most common

1.1.3. muscular and outlet also exist

1.2. usually identified within 2 months of birth

2. Signs/Symptoms

2.1. depend on size and location of defect.

2.2. mixing of oxygenated and deoxygenated blood-cyanotic

2.3. failure to thrive

2.3.1. under 5%

2.4. with exertion/feeding

2.4.1. diaphoresis

2.4.2. dyspnea

2.5. neonatal LV not enlarged=can't accommodate w inc. volume

2.5.1. CHF

2.5.1.1. pulmonary edema

2.5.1.2. edema

2.5.1.3. dec. urine output

2.5.1.4. ascites

2.5.1.5. irritability

2.5.1.6. tachycardia

3. epidemiology

3.1. most common congenital defect

3.2. 5-50/1000 newborns

3.3. slightly more common in women

4. risk factors

4.1. genetic

4.2. mothers lifestyle habits

4.2.1. medications

4.2.2. drugs/alcohol

5. lab

5.1. cbc

5.1.1. infection/anemia

5.2. cmp

5.2.1. dehydration/elec. imbalance

5.3. pulse ox while feeding

5.4. TSH

6. PE

6.1. Pulmonary exam

6.1.1. rales heard bilaterally

6.2. Abdominal exam

6.2.1. normal

6.3. CV exam

6.3.1. S3 holosystolic murmur Grade III-IV blowing @ tricuspid

6.3.1.1. smaller defect = louder murmur heard

6.3.1.2. large defect = may be asymptomatic

6.4. vitals

6.4.1. same birth weight at 2 mo.

6.5. well-baby exam

7. Imaging

7.1. CXR

7.1.1. cardiomegaly CT ratio 6.5

7.2. Echo

8. Treatment

8.1. Pediatric Cardiology referal

8.1.1. surgical repair via cardiac cath, umbrella plug

8.1.2. nonsurgical repair

8.1.2.1. digitalis (digoxin)

8.1.2.2. vasodilator to dec. BP

8.1.2.3. diuretic for CHF

8.1.2.4. prophylactic antibiotic

8.1.2.5. high calorie diet and normal activity

9. Patient Education

9.1. Parent education

9.1.1. Emergent symptoms/CHF

9.1.2. When surgery may be needed ie. medication no longer controls or baby not growing

9.1.3. Surgical repair-may need replacement/repair later in life

9.1.4. No medication/restrictions after surgery

9.1.5. regular checkups

9.1.6. Signs or possibility of Eisenmenger Syndrome

10. Pathophysiology

10.1. 3 hemodynamic consequences of L to R shunt

10.1.1. Inc. L ventricle volume load

10.1.2. Excessive pulmonary bloodflow

10.1.3. Red. systemic cardiac output

10.1.3.1. CO=SV x HR

10.1.3.2. BP=PVR x CO

11. Congenital Heart Defects

11.1. Cyanotic

11.1.1. R to L shunt

11.1.1.1. Tetralogy of Fallot

11.1.1.1.1. 1.Pulmonary stenosis. 2.RVH 3.Overriding Aorta 4. VSD

11.1.1.2. Pulmonary Atresia

11.1.1.3. Hypoplastic L heart

11.1.1.4. Transposition of Great Vessels

11.2. Acyanotic

11.2.1. L to R shunt

11.2.1.1. *VSD

11.2.1.1.1. holosystolic, Lower LSB (depends on severity)

11.2.1.1.2. most common defect

11.2.1.2. *ASD

11.2.1.2.1. 80% septum secundum (embryology)

11.2.1.2.2. PFO

11.2.1.2.3. systolic ejection murmur at 2nd LICS, early/middle systole rumble, RV heave

11.2.1.3. Obstructive

11.2.1.3.1. *Aortic Stenosis

11.2.1.3.2. Coarctation of Aorta

11.2.1.4. Patent Ductus Arteriosus

11.2.1.4.1. Inc. Pul. blood flow, inc. Pul Venous return, Inc. Pul pressure.

11.2.1.5. Atrial Ventricular Canal

11.2.1.5.1. incomplete fusion of endocardial cushions

11.3. Eisenmenger's

11.3.1. VSD/ASD change to R to L shunt

11.3.1.1. more severe

11.4. Gold Standard Diagnostic: Echocardiogram; CXR & EKG