PEDIATRICS
SYMPTOMS/EXAM
■ Small defects are usually asymptomatic early on but associated with loud,
harsh holosystolic murmur at LLSB.
■ Larger defects usually manifest with tachypnea (due to pulmonary overcir-
culation/edema), fatigue, sweating during feeds, and poor weight gain.
■ Progression from L →R shunting to more ominous R →L shunting is
termedEisenmenger syndromedue to progression to a high pulmonary
vascular resistance from long-term pulmonary overcirculation.
TREATMENT
■ Heart failure is treated with digoxin +/– diuretics.
■ Definitive treatment with patch closure if not responsive to medical therapy
or no spontaneous closure over time.
ATRIALSEPTALDEFECT(ASD)
Fixed split S2, loud S1; may be associated with atrial dysrhythmias
PATENTDUCTUSARTERIOSUS(PDA)
Persistence of ductus arteriosus past 1 week of life is considered abnormal.
SYMPTOMS/EXAM
Bounding pulses from aortic to pulmonary artery diastolic runoff; continuous
“machinery-like” heart murmur, radiating to the back
TREATMENT
Indomethacin in premature infants; often surgical closure required
Coarctation of the Aorta
Localized narrowing of the aortic lumen, typically just distal to the origin of
the L subclavian artery
SYMPTOMS/EXAM
Symptoms depend on the degree and location of narrowing. Key clinical find-
ings include upper extremity hypertension and decreased lower extremity pulses,
blood pressure, and O 2 saturations.
TREATMENT
Definitive surgical repair
Chest Pain
Unlike adults, chest pain in children is generally benign. Little workup, other
than attention to vital signs, is needed unless significant historical or physical
exam findings are present.
Dysrhythmias
BRADYCARDIA
Bradycardia is usually secondary to systemic or noncardiac causes in children.
In the infant, hypoxia is a common cause. Other causes include hypothermia,
hypothyroidism, elevated ICP.