University of Maryland School of Medicine

Department of Emergency Medicine

University of Maryland School of Medicine Department of Emergency Medicine

UMEM Educational Pearls

Category: Pediatrics

Title: Congenital Heart Disease

Keywords: Pediatric Congenital Heart Disease, Hyperoxia test, Prostaglandin E, Shock, CHF (PubMed Search)

Posted: 8/31/2007 by Sean Fox, MD (Updated: 4/19/2014)
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Congenital Heart Disease • Clinical signs and symptoms of pediatric congenital heart disease are often subtle ==> Often misdiagnosed with respiratory illness or sepsis • Can progress to CHF and shock ==> CHF in infants = tachypnea, tachycardia, and hepatomegaly (classic triad) -- JVD, Peripheral Edema, rales are UNCOMMON (unlike adults) • Hyperoxia Test – “Is the etiology of the cyanosis cardiac or noncardiac?” ==> If pulmonary disesase is the cause, 100% FiO2 will increase PaO2 to ~150mmHg and increase the Pulse Ox by ~10%. ==> If Heart Defect is the cause, there will be minimal improvement in condition and values. • PGE1 administration ==> Used to reopen or maintain patency of ductus arteriosus until definitive intervention. ==> Consider it in a neonate presenting in shock (possibly undiagnosed ductal dependent lesion). ==> Side effects are hypotension, bradycardia, seizures, and APNEA. ==> Either intubate before or be prepared to intubate.