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Common Congenital Heart Lesions - page 95 / 126

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95 / 126

95 of 126

PRESENTATION

  • manifestations of CHF (symptoms associated w/ low CO, pulmonary congestion and systemic congestion)

  • see symptoms in boxes from diagram in last page

  • b/c symptoms are insidious, pt may complain only of weight gain (edema) and SOB on exertion

PHYSICAL EXAM

  • Signs of decr CO Æ cool extremities (vasoconstriction), low BP, tachycardia

  • If sig RV failure develops Æ signs of systemic venous congestion Æ JVD, etc.

  • Pulmonary exam Æ crackles and basilar chest dullness on percussion (from possible pleural effusions)

  • Cardiac exam Æ enlarged heart w/ leftward displacement of diffuse apical impulse

  • Auscultation:

    • o

      S3 common (poor systolic fxn)

      • o

        Murmur of mitral valve regurg (holosystolic) is common if sig LV dilation

      • o

        Murmur of tricuspid valve regurg (also holosystolic) will be added if sig RV dilation

TESTS and IMAGING

  • Chest x-ray Æ enlarged cardiac silhouette; possible pulmonary vascular redistribution, alveolar edema and pleural effusions…

  • ECG Æ a whole bunch of things…

    • o

      Atrial and ventricular enlargement (pg 92 and 93 give expls)

      • o

        Wide array of arrhythmias but particularly a-fib and ventricular tachy

      • o

        Conduction defects common (L or RBBB) -- (pg 94 for expl)

      • o

        Diffuse repolarization (ST and T wave) abnormalities common

      • o

        Localized Q waves from myofibrosis (resembles pattern of a previous MI)

  • Echocardiography Æ valuable in diagnosis of DCM Æ demonstrates 4 chamber dilation w/ little hypertrophy and global reduction of systolic contractile fxn… can see the regurgs sometimes

  • Cardiac cath Æ to see if coexistent coronary artery disease is contributing… can also look at pressure differences …

TREATMENT (there is nothing in the objectives about treatment…it is so extensive and so detailed in the book – far more than I think we will need to know, so if you want extra info, look at pgs 241-243, but the main pts are as follows):

  • Goal of therapy is:

    • o

      Relieve symptoms

      • o

        Prevent complications

      • o

        Improve long-term survival

  • Prognosis is poor

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