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Common Congenital Heart Lesions - page 88 / 126





88 / 126

88 of 126

Pulmonary Exam: Pulmonary rales, rhonchi, wheezing, pleural effusion, tachypnea, and Cheyne-Stokes respiration (alternating periods of hyperventilation and apnea due to circulation time between lungs and respiratory centers in the brain)

Cardiac Exam:

  • 1.

    variation in apical impulse

    • a.

      diffuse PMI: dilated cardiomyopathy

    • b.

      sustained PMI: pressure overload from aortic stenosis or HTN

    • c.

      “lifting” PMI: volume overload from mitral regurgitation

  • 2.

    loud P2

  • 3.

    S3 from abnormal filling of dilated chamber

  • 4.

    S4 from atrial contraction into stiff ventricle

  • 5.

    murmur of mitral regurgitation present if left ventricle is very dilated

  • 6.

    sinus tachycardia (Sympathetic drive)

  • 7.

    pulsus alternans (alternating strong and weak peripheral pulses)

Diagnostic Imaging and Testing:

  • A.

    Chest x-ray: increased cardiothoracic ratio. When P > 15 mmHg, diameter of blood vessels supplying upper lung greater than those supplying lower lung (normally vessels to lower lungs are larger). When P > 20 mmHg, indistinct vessels and Kerley B lines (short linear markings at in lower peripheral lung) indicate interlobular edema. When P > 25 mmHg, opacification of the air space (alveolar edema.) May see pleural effusion.

  • B.

    Echo: assesses ventricular function

  • C.

    Cardiac Cath: determines valvular and ischemic causes of heart failure

Right heart failure

Pathophysiology: impaired CO and elevated venous pressure due to failure of right ventricle. Increases work of the breathing and can cause peripheral edema.

Clinical Presentation:

  • 1.

    abdominal discomfort (because liver becomes enlarged)

  • 2.

    anorexia (edema in GI tract)

  • 3.

    peripheral edema, especially in ankles and feet

  • 4.

    unexpected weight gain (due to increase in interstitial fluid)

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