Congenital Heart Disease

Clinical Description

Acyanotic e.g. Ventricular Septal Defect (VSD, Atrial Septal defect (ASD), Atrioventricular

Septal Defect (AVSD), truncus arteriosus

Cyanotic e.g., Tetralogy of Fallot, Tricuspid atresia, Transposition of Great arteries

Signs and Symptoms

• Failure to thrive, Diaphoresis, Shortness of breath especially on feeding, Shock, Finger clubbing, Cyanosis, Cyanotic spells

Treatment

If in heart failure, treat as per heart failure protocol

Treatment

• Awake proning
• Active Cycle Breathing Technique
• Light functional exercises

If in shock, treat and discuss with cardiologist

Pharmacological

• Antibiotic prophylaxis against bacterial endocarditis when undergoing dental or any surgical procedure.
• Amoxicillin 45mg/kg PO STAT or Ceftriaxone 50mg/kg IV STAT

Cyanotic congenital heart disease presenting in newborn as cyanosis:

• Consider if blue baby doesn't pink up with oxygen, check oxygen saturations. The baby may or may not have signs of heart failure. It may be difficult to distinguish from persistent pulmonary hypertension
• Investigate with chest x ray and cardiac echo

Management of hyper cyanotic spell

• Place child in knee chest position or
• encourage squatting in older child.
• Give oxygen
• Give 10ml/kg bolus crystalloid
• Give Morphine 0.1mg/kg IV or PO
• Oral Propranolol 0.5mg/kg
• phenylephrine 2-10mcg/kg STAT IV then 1-5mcg/kg/min intravenous infusion
• if acidotic give sodium bicarbonate 8.4% 2ml/kg IV, dilute 1:1 with normal saline
• if not responding to above treatment, consult pediatric cardiologist

Long term management

• Propranolol 0.5 -1mg/kg BD to prevent Spells
• Iron supplementation

Surgical Treatment

Surgery for those with operable congenital heart diseases

Complications

• Pulmonary hypertension
• Infective endocarditis

Cyanotic congenital heart disease complications

• Stroke
• Brain abscess
• Iron deficiency anemia

Complications and Referral Criteria

Refer all patients for diagnosis