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Common Congenital Heart Lesions - page 89 / 126

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89 / 126

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Physical Findings: General:

  • 1.

    cachexia (frail, wasted appearance from appetite and metabolic demand)

  • 2.

    dusky appearance (CO)

  • 3.

    diaphoresis (Sympathetic drive)

  • 4.

    Cool extremities (vasoconstriction)

Pulmonary Exam: pleural effusion, tachypnea, Cheyne-Stokes respiration

Abdominal Exam: hepatic enlargement with Right Upper Quadrant tenderness Cardiac Exam:

  • 1.

    RV heave from RV enlargement

  • 2.

    S3 or S4

  • 3.

    murmur of tricuspid regurgitation

  • 4.

    distention of jugular veins

  • 5.

    edema

Diagnostic Imaging and Testing: Chest x-ray: increased cardiothoracic ratio and enlargement of azygous vein due to increased right atrial pressure, may see pleural effusion

Prognosis and Treatment of Left and Right Heart Failure

Prognosis: Poor in the absence of correctable underlying causes

  • 5 year survival from diagnosis is 50%

  • if patient has severe symptoms, 1 year survival is 40%

  • mortality due to refractory heart failure and ventricular arrhythmias

  • ventricular arrhythmias caused by ventricular dysfunction, which is perpetutated by cytokines and neurohormones. Prognosis correlates with concentration of these substances in the body

Treatment: 5 main goals of therapy

  • 1.

    Identify and correct underlying condition causing heart failure

  • 2.

    Eliminate acute precipitating factors

  • 3.

    Manage symptoms: treat pulmonary and systemic congestion and increase CO

  • 4.

    Decrease neurohormonal response

  • 5.

    Improve long term survival

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