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 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 pulmonary edema edema dec. urine output ascites irritability 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 smaller defect = louder murmur heard 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 digitalis (digoxin) vasodilator to dec. BP diuretic for CHF prophylactic antibiotic 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 CO=SV x HR BP=PVR x CO

11. Congenital Heart Defects

11.1. Cyanotic

11.1.1. R to L shunt Tetralogy of Fallot 1.Pulmonary stenosis. 2.RVH 3.Overriding Aorta 4. VSD Pulmonary Atresia Hypoplastic L heart Transposition of Great Vessels

11.2. Acyanotic

11.2.1. L to R shunt *VSD holosystolic, Lower LSB (depends on severity) most common defect *ASD 80% septum secundum (embryology) PFO systolic ejection murmur at 2nd LICS, early/middle systole rumble, RV heave Obstructive *Aortic Stenosis Coarctation of Aorta Patent Ductus Arteriosus Inc. Pul. blood flow, inc. Pul Venous return, Inc. Pul pressure. Atrial Ventricular Canal incomplete fusion of endocardial cushions

11.3. Eisenmenger's

11.3.1. VSD/ASD change to R to L shunt more severe

11.4. Gold Standard Diagnostic: Echocardiogram; CXR & EKG