TABLE 7.12: Acyanotic Congenital Heart Disease
Acyanotic Congenital Heart Disease
Lesion Type | Examination Findings | ECG Findings | Chest Radiograph Findings |
Ventricular septal defect (VSD) | 2–5/6 holosystolic murmur, loudest at the LLSB, ± systolic thrill ± apical diastolic rumble with large shunt With large VSD and pulmonary hypertension, S2 may be narrow | Small VSD: Normal Medium VSD: LVH ± LAE Large VSD: BVH ± LAE, pure RVH | May show cardiomegaly and increased PVMs, depending on amount of left-to-right shunting |
Atrial septal defect (ASD) | Wide, fixed split S2 with grade 2–3/6 SEM at the LUSB May have mid-diastolic rumble at LLSB | Small ASD: Normal Large ASD: RAD and mild RVH or RBBB with RSR′ in V1 | May show cardiomegaly with increased PVMs if hemodynamically significant ASD |
Patent ductus arteriosus (PDA) | 40%–60% in VLBW infants 1–4/6 continuous “machinery” murmur loudest at LUSB Wide pulse pressure | Small – moderate PDA: Normal or LVH Large PDA: BVH | May have cardiomegaly and increased PVMs, depending on size of shunt |
Atrioventricular septal defects | Most occur in Down syndrome Hyperactive precordium with systolic thrill at LLSB and loud S2 ± grade 3–4/6 holosystolic regurgitant murmur along LLSB ± systolic murmur of MR at apex ± mid-diastolic rumble at LLSB or at apex ± gallop rhythm | Superior QRS axis RVH and LVH may be present | Cardiomegaly with increased PVMs |
Pulmonary stenosis (PS) | Ejection click at LUSB with valvular PS; click intensity varies with respiration, decreasing with inspiration and increasing with expiration S2 may split widely with P2 diminished in intensity SEM (2–5/6) ± thrill at LUSB with radiation to back and sides | Mild PS: Normal Moderate PS: RAD and RVH Severe PS: RAE and RVH with strain | Normal heart size with normal to decreased PVMs |
Aortic stenosis (AS) | Systolic thrill at RUSB, suprasternal notch, or over carotids Ejection click that does not vary with respiration if valvular AS Harsh SEM (2–4/6) at second RICS or third LICS, with radiation to neck and apex ± early diastolic decrescendo murmur due to AR Narrow pulse pressure, if severe stenosis | Mild AS: Normal Moderate – severe AS: LVH ± strain | Usually normal |
Coarctation of aorta may present as: 1. Infant in CHF 2. Child with HTN 3. Child with murmur | Male/female ratio of 2:1 2–3/6 SEM at LUSB, radiating to left interscapular area Bicuspid valve is often associated, so may have systolic ejection click at apex and RUSB BP in lower extremities will be lower than in upper extremities Pulse oximetry discrepancy of >5% between upper and lower extremities is also suggestive of coarctation | In infancy: RVH or RBBB In older children: LVH | Marked cardiomegaly and pulmonary venous congestion Rib notching from collateral circulation usually not seen in children younger than 5 years because collaterals not yet established |
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Citation
Hughes, Helen K., and Lauren K. Kahl, editors. "TABLE 7.12: Acyanotic Congenital Heart Disease." Harriet Lane Handbook, 21st ed., Elsevier, 2018. Harriet Lane, www.unboundmedicine.com/harrietlane/view/Harriet_Lane_Handbook/309379/all/TABLE_7_12:_ACYANOTIC_CONGENITAL_HEART_DISEASE.
TABLE 7.12: Acyanotic Congenital Heart Disease. In: Hughes HKH, Kahl LKL, eds. Harriet Lane Handbook. Elsevier; 2018. https://www.unboundmedicine.com/harrietlane/view/Harriet_Lane_Handbook/309379/all/TABLE_7_12:_ACYANOTIC_CONGENITAL_HEART_DISEASE. Accessed February 25, 2021.
TABLE 7.12: Acyanotic Congenital Heart Disease. (2018). In Hughes, H. K., & Kahl, L. K. (Eds.), Harriet Lane Handbook (21st edition). Elsevier. https://www.unboundmedicine.com/harrietlane/view/Harriet_Lane_Handbook/309379/all/TABLE_7_12:_ACYANOTIC_CONGENITAL_HEART_DISEASE
TABLE 7.12: Acyanotic Congenital Heart Disease [Internet]. In: Hughes HKH, Kahl LKL, editors. Harriet Lane Handbook. Elsevier; 2018. [cited 2021 February 25]. Available from: https://www.unboundmedicine.com/harrietlane/view/Harriet_Lane_Handbook/309379/all/TABLE_7_12:_ACYANOTIC_CONGENITAL_HEART_DISEASE.
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