Congenital Heart Disease
Any infant < 1 month of age with cyanosis or shock should be considered to have duct-dependent critical congenital cardiac disease until proven otherwise. This is almost always a right heart lesion/ductal dependent lesion such as Tetralogy of Fallot, which almost always benefit from prostaglandins. Shunting or mixing lesions such as VSD or PDA and heart failure typically present later during infancy, usually after 1-6 months of age - Keerat Grewal and Anton Helman
HWN Suggests
Episode 84 – Congenital Heart Disease Emergencies
You might be surprised to learn that the prevalence of critical cardiac disease in infants is almost as high as the prevalence of infant sepsis. And if you’re like me, you don’t feel quite as confident managing sick infants with critical heart disease as you do managing sepsis. Critical congenital heart defects are often missed in the ED. For a variety of reasons, there are currently more children with congenital heart disease presenting to the ED than ever before and these numbers will continue to grow in the future
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A 3-Step Approach for Infants with Congenital Heart Disease
The traditional approach to congenital heart disease (CHD) involves a detailed understanding of the pathophysiology, clinical findings, and management of each particular congenital heart defect. However, this cognitive-heavy approach is not practical for the emergency physician faced with an undifferentiated, unstable infant when decision making must be rapid. Despite improved CHD screening in recent years, a small but significant minority of these patients will be undiagnosed when they present to the emergency department.
Congenital Heart Disease in the ED
Cyanotic heart disease in acute paediatrics is a nightmare. How much oxygen to give? How much fluid to give? How quickly can google explain a Stage II Fontan?
Neonatal Cardiac Emergencies
Babies with severe cyanosis and decreased pulmonary vascular markings on chest x-ray are expected to have severe right ventricular outflow tract (RVOT) narrowing and are likely to be dependent on ductal flow for supplying pulmonary circulation. The ductus arteriosus may be kept patent by administration of prostaglandin E1 intravenously. Various cardiac defects with ductal-dependent PBF in which prostaglandin (PG) is useful are listed in Table 14.2A. The current recommendation is infusion of PGE1 at a dose of 0.05 to 0.1 mcg/kg/min intravenously. The chief advantage of PG use lies in its keeping neonates in a good condition while the infant is being transferred to a tertiary care center. No more than 40% of humidified oxygen is needed in infants with cyanotic CHD because they have fixed intracardiac right-to-left shunt.
Articles of Interest
Adult Congenital Heart Disease in the ED. St Emlyn's
A Fontan circulation7,8 is usually the result of a palliative procedure for CHD. With better paediatric care more of these patients are entering ...
Congenital Heart Disease in Pediatric Patients: Recognizing the Undiagnosed and Managing Complications in the Emergency Department
Congenital heart disease is the most common form of all congenital malformations and, despite advances in prenatal and newborn screening, it may present undiagnosed to the emergency department. Signs and symptoms of congenital heart disease are variable and often nonspecific, making recognition and treatment challenging.
Conquering Congenital Cardiac Lesions
You have two options now: they either have a cyanotic lesion that requires prostaglandins and a dose of 0.05-0.2 mg/kg/min and will need to be intubated. Or they are in full blown heart failure and require lasix at 1 mg/kg and pressors, typically a combination of dobutamine and norepinephrine.
Diagnosing Neonatal Congenital Heart Disease
Neonates with undiagnosed congenital heart disease may present to the emergency department with nonspecific symptoms...
EM@3AM: Blue Baby
You need a reason NOT to give prostaglandins in a sick neonate (< 30 days old),
Management of Congenital Heart Disease: State of the Art—Part II—Cyanotic Heart Defects
In this review management of the most common cyanotic congenital heart defects (CHDs) was discussed; the management of acyanotic CHD was reviewed in Part I of this series. While the need for intervention in acyanotic CHD is by and large determined by the severity of the lesion, most cyanotic CHDs require intervention, mostly by surgery.
