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.