Congenital Heart Disease – Cyanosis

Last Updated on by FRCEM Intermediate

OVERVIEW

  • multiple types of congenital heart disease
  • classified as acyanotic and cyanotic, and according to the presence of shunt

CLASSIFICATION

HISTORY

  • cyanosis
  • sweating,
  • poor feeding

SYMPTOMS AND CLINICAL SIGNS

  • cyanosis not corrected with oxygen therapy
  • Hepatomegaly
  • Heart Murmur
  • Weak or absent Femoral Pulse,
  • heart failure symptoms
  • Collapse and shock

INVESTIGATIONS

  • Spo2
  • 4 limb BP’s
  • Bloods:
    • FBC: HCT (high), platelets (low)
    • U+E: renal dysfunction from chronic hypoxia
    • Coags: coagulation factor deficiencies common in cyanotic heart disease
  • Chest x-ray – size and shape of the heart/pulmonary markings
  • ECG:  axis deviations/hypertrophy
  • ECHO: diastolic dysfunction, decreased ejection fraction, nature and size of a lesion, flow reversal.

RISK FACTORS

GENERAL MANAGEMENT

  • Administer oxygen
  • Monitor for apnoea
  • consider Prostaglandin infusion -Starting dose of PGE2 is typically 0.05 0.1 mcg/kg/minute
  • Consider volume expansion, Only administer fluid if there is good evidence of hypovolemia and only repeat if there is an improvement
  • Consider inotropes – No improvement with fluid bolus
  • Heart Failure: consider  furosemide IV 1 mg/kg 6 to 12 hourly, if there are good femoral pulses
  • Correct metabolic acidosis
  • consider ETT if shocked
  • Consider Invasive BP monitoring (always be aware of the possibility of coarctation)
  • Consider CVP monitoring
  • Discuss with a pediatric cardiologist early
  • Transfer for echocardiogram

Non-cardiac causes

Readings

Congenital Heart Disease in the Emergency Department

Congenital Heart Disease

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