| What is the effect of left to right shunt lesions on blood flow within the lungs? | increased flow to the lungs and over circulation of blood within the lungs and left side of the heart | • Pre-tricuspid shunts: ◦Atrial septal defect (ASD): Usually asymptomatic. Presents commonly as incidentally detected murmur • Post-tricuspid shunts: ◦Ventricular septal defect (VSD) ◦Patent ductus arteriosus (PDA) ◦Aorto-pulmonary window (APW) Large post-tricuspid shunts present early (usually by 1.5-2 months of age) with signs of cardiac failure like feeding and breathing difficulty along with failure to thrive • Left to right shunt lesions lead to passage of oxygenated blood from left side of heart to right side and into the lungs • As a result there is increased flow to the lungs and over circulation of blood within the lungs and left side of the heart • Majority of symptoms of shunt lesions are due to this over circulation Cardiomegaly & increased vascular markings in shunt lesion 12-lead ECG showing left axis deviation in a patient with AV septal defect | 563 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651145_5_left_to_right_shunt_lesions.pdf | Presents commonly as incidentally detected murmur • Post-tricuspid shunts: ◦Ventricular septal defect (VSD) ◦Patent ductus arteriosus (PDA) ◦Aorto-pulmonary window (APW) Large post-tricuspid shunts present early (usually by 1.5-2 months of age) with signs of cardiac failure like feeding and breathing difficulty along with failure to thrive • Left to right shunt lesions lead to passage of oxygenated blood from left side of heart to right side and into the lungs • As a result there is increased flow to the lungs and over circulation of blood within the lungs and left side of the heart • | 1 | page=1,block=14 | 0.700 | valid |
| What is the primary cause of symptoms in shunt lesions? | over circulation of blood within the lungs and left side of the heart | • Pre-tricuspid shunts: ◦Atrial septal defect (ASD): Usually asymptomatic. Presents commonly as incidentally detected murmur • Post-tricuspid shunts: ◦Ventricular septal defect (VSD) ◦Patent ductus arteriosus (PDA) ◦Aorto-pulmonary window (APW) Large post-tricuspid shunts present early (usually by 1.5-2 months of age) with signs of cardiac failure like feeding and breathing difficulty along with failure to thrive • Left to right shunt lesions lead to passage of oxygenated blood from left side of heart to right side and into the lungs • As a result there is increased flow to the lungs and over circulation of blood within the lungs and left side of the heart • Majority of symptoms of shunt lesions are due to this over circulation Cardiomegaly & increased vascular markings in shunt lesion 12-lead ECG showing left axis deviation in a patient with AV septal defect | 595 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651145_5_left_to_right_shunt_lesions.pdf | Presents commonly as incidentally detected murmur • Post-tricuspid shunts: ◦Ventricular septal defect (VSD) ◦Patent ductus arteriosus (PDA) ◦Aorto-pulmonary window (APW) Large post-tricuspid shunts present early (usually by 1.5-2 months of age) with signs of cardiac failure like feeding and breathing difficulty along with failure to thrive • Left to right shunt lesions lead to passage of oxygenated blood from left side of heart to right side and into the lungs • As a result there is increased flow to the lungs and over circulation of blood within the lungs and left side of the heart • |
| What type of pulse is associated with PDA and APW? | Bounding (high volume) pulse (in PDA and APW) | • Most common type of congenital heart defects • One of the common causes of infant morbidity and mortality • Majority of the lesions are easily correctable if detected on time WHEN TO SUSPECT? 1. Failure to thrive (weight less than 3rd centile for age, drop in weight by more than 2 major centile lines) 2. Feeding difficulty (suck-rest-suck cycle) with forehead sweating (cold sweats) 3. Repeated chest infections/one life threatening infection 4. Baseline tachypnea with subcostal and intercostal retractions: • Rate > 60/min in less than 1 year old • Rate > 50/min between 1-2 year old 5. Tachycardia: • Rate > 160/min in less than 1 year old • Rate >140/min between 1-2 year old 6. Bounding (high volume) pulse (in PDA and APW) 7. Precordial bulge with active precordium 8. | 687 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651145_5_left_to_right_shunt_lesions.pdf | Tachycardia: • Rate > 160/min in less than 1 year old • Rate >140/min between 1-2 year old 6. Bounding (high volume) pulse (in PDA and APW) 7. | 1 | page=1,block=7 | 0.700 |
| What is the direction of blood flow in left to right shunt lesions? | passage of oxygenated blood from left side of heart to right side and into the lungs | • Pre-tricuspid shunts: ◦Atrial septal defect (ASD): Usually asymptomatic. Presents commonly as incidentally detected murmur • Post-tricuspid shunts: ◦Ventricular septal defect (VSD) ◦Patent ductus arteriosus (PDA) ◦Aorto-pulmonary window (APW) Large post-tricuspid shunts present early (usually by 1.5-2 months of age) with signs of cardiac failure like feeding and breathing difficulty along with failure to thrive • Left to right shunt lesions lead to passage of oxygenated blood from left side of heart to right side and into the lungs • As a result there is increased flow to the lungs and over circulation of blood within the lungs and left side of the heart • Majority of symptoms of shunt lesions are due to this over circulation Cardiomegaly & increased vascular markings in shunt lesion 12-lead ECG showing left axis deviation in a patient with AV septal defect | 455 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651145_5_left_to_right_shunt_lesions.pdf | Presents commonly as incidentally detected murmur • Post-tricuspid shunts: ◦Ventricular septal defect (VSD) ◦Patent ductus arteriosus (PDA) ◦Aorto-pulmonary window (APW) Large post-tricuspid shunts present early (usually by 1.5-2 months of age) with signs of cardiac failure like feeding and breathing difficulty along with failure to thrive • Left to right shunt lesions lead to passage of oxygenated blood from left side of heart to right side and into the lungs • As a result there is increased flow to the lungs and over circulation of blood within the lungs and left side of the heart • |
| What heart defect is associated with Down syndrome? | Atrioventricular septal defect(AVSD) | Loud second heart sound, gallop rhythm, ejection systolic murmur, mid-diastolic murmur (Large shunts may not have loud murmurs) 9. Hepatomegaly 10.Dysmorphic features: Down syndrome are known to be associated with Atrioventricular septal defect(AVSD) 11. Abnormal peripheral pulses especially feeble lower limb pulses INVESTIGATIONS Essential • X-ray Chest, Echo • ECG - To watch for unexpected abnormal axis, rate, rhythm and QRS complex • CBC, Electrolytes - Depending on clinical conditions and specific clinical circumstances Timely referral to higher centre with pediatric cardiac facility • Shunt lesions are confirmed by echocardiography • Large post tricuspid shunts require early referral Drugs • Furosemide: 1-2 mg/kg/dose twice or thrice daily (reduce or temporarily stop during diarrhea or vomiting). Oral suspension contains 10 mg/ml. | 214 | relationship | 0.890 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651145_5_left_to_right_shunt_lesions.pdf | Hepatomegaly 10.Dysmorphic features: Down syndrome are known to be associated with Atrioventricular septal defect(AVSD) 11. | 1 | page=1,block=7 |
| What are some signs of cardiac failure in large post-tricuspid shunts? | feeding and breathing difficulty along with failure to thrive | • Pre-tricuspid shunts: ◦Atrial septal defect (ASD): Usually asymptomatic. Presents commonly as incidentally detected murmur • Post-tricuspid shunts: ◦Ventricular septal defect (VSD) ◦Patent ductus arteriosus (PDA) ◦Aorto-pulmonary window (APW) Large post-tricuspid shunts present early (usually by 1.5-2 months of age) with signs of cardiac failure like feeding and breathing difficulty along with failure to thrive • Left to right shunt lesions lead to passage of oxygenated blood from left side of heart to right side and into the lungs • As a result there is increased flow to the lungs and over circulation of blood within the lungs and left side of the heart • Majority of symptoms of shunt lesions are due to this over circulation Cardiomegaly & increased vascular markings in shunt lesion 12-lead ECG showing left axis deviation in a patient with AV septal defect | 355 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651145_5_left_to_right_shunt_lesions.pdf | Presents commonly as incidentally detected murmur • Post-tricuspid shunts: ◦Ventricular septal defect (VSD) ◦Patent ductus arteriosus (PDA) ◦Aorto-pulmonary window (APW) Large post-tricuspid shunts present early (usually by 1.5-2 months of age) with signs of cardiac failure like feeding and breathing difficulty along with failure to thrive • Left to right shunt lesions lead to passage of oxygenated blood from left side of heart to right side and into the lungs • As a result there is increased flow to the lungs and over circulation of blood within the lungs and left side of the heart • |
| What are two types of murmurs that may be heard in congenital heart defects? | ejection systolic murmur, mid-diastolic murmur | Loud second heart sound, gallop rhythm, ejection systolic murmur, mid-diastolic murmur (Large shunts may not have loud murmurs) 9. Hepatomegaly 10.Dysmorphic features: Down syndrome are known to be associated with Atrioventricular septal defect(AVSD) 11. Abnormal peripheral pulses especially feeble lower limb pulses INVESTIGATIONS Essential • X-ray Chest, Echo • ECG - To watch for unexpected abnormal axis, rate, rhythm and QRS complex • CBC, Electrolytes - Depending on clinical conditions and specific clinical circumstances Timely referral to higher centre with pediatric cardiac facility • Shunt lesions are confirmed by echocardiography • Large post tricuspid shunts require early referral Drugs • Furosemide: 1-2 mg/kg/dose twice or thrice daily (reduce or temporarily stop during diarrhea or vomiting). Oral suspension contains 10 mg/ml. | 40 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651145_5_left_to_right_shunt_lesions.pdf | Loud second heart sound, gallop rhythm, ejection systolic murmur, mid-diastolic murmur (Large shunts may not have loud murmurs) 9. | 1 | page=1,block=7 |
| What symptoms are commonly associated with large post-tricuspid shunts? | feeding and breathing difficulty along with failure to thrive | • Pre-tricuspid shunts: ◦Atrial septal defect (ASD): Usually asymptomatic. Presents commonly as incidentally detected murmur • Post-tricuspid shunts: ◦Ventricular septal defect (VSD) ◦Patent ductus arteriosus (PDA) ◦Aorto-pulmonary window (APW) Large post-tricuspid shunts present early (usually by 1.5-2 months of age) with signs of cardiac failure like feeding and breathing difficulty along with failure to thrive • Left to right shunt lesions lead to passage of oxygenated blood from left side of heart to right side and into the lungs • As a result there is increased flow to the lungs and over circulation of blood within the lungs and left side of the heart • Majority of symptoms of shunt lesions are due to this over circulation Cardiomegaly & increased vascular markings in shunt lesion 12-lead ECG showing left axis deviation in a patient with AV septal defect | 355 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651145_5_left_to_right_shunt_lesions.pdf | Presents commonly as incidentally detected murmur • Post-tricuspid shunts: ◦Ventricular septal defect (VSD) ◦Patent ductus arteriosus (PDA) ◦Aorto-pulmonary window (APW) Large post-tricuspid shunts present early (usually by 1.5-2 months of age) with signs of cardiac failure like feeding and breathing difficulty along with failure to thrive • Left to right shunt lesions lead to passage of oxygenated blood from left side of heart to right side and into the lungs • As a result there is increased flow to the lungs and over circulation of blood within the lungs and left side of the heart • |
| What are some examples of post-tricuspid shunts? | Ventricular septal defect (VSD) ◦Patent ductus arteriosus (PDA) ◦Aorto-pulmonary window (APW) | • Pre-tricuspid shunts: ◦Atrial septal defect (ASD): Usually asymptomatic. Presents commonly as incidentally detected murmur • Post-tricuspid shunts: ◦Ventricular septal defect (VSD) ◦Patent ductus arteriosus (PDA) ◦Aorto-pulmonary window (APW) Large post-tricuspid shunts present early (usually by 1.5-2 months of age) with signs of cardiac failure like feeding and breathing difficulty along with failure to thrive • Left to right shunt lesions lead to passage of oxygenated blood from left side of heart to right side and into the lungs • As a result there is increased flow to the lungs and over circulation of blood within the lungs and left side of the heart • Majority of symptoms of shunt lesions are due to this over circulation Cardiomegaly & increased vascular markings in shunt lesion 12-lead ECG showing left axis deviation in a patient with AV septal defect | 151 | list | 0.780 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651145_5_left_to_right_shunt_lesions.pdf | Presents commonly as incidentally detected murmur • Post-tricuspid shunts: ◦Ventricular septal defect (VSD) ◦Patent ductus arteriosus (PDA) ◦Aorto-pulmonary window (APW) Large post-tricuspid shunts present early (usually by 1.5-2 months of age) with signs of cardiac failure like feeding and breathing difficulty along with failure to thrive • Left to right shunt lesions lead to passage of oxygenated blood from left side of heart to right side and into the lungs • As a result there is increased flow to the lungs and over circulation of blood within the lungs and left side of the heart • |
| What is a sign of baseline tachypnea in children aged one to two years? | Rate > 50/min between 1-2 year old | • Most common type of congenital heart defects • One of the common causes of infant morbidity and mortality • Majority of the lesions are easily correctable if detected on time WHEN TO SUSPECT? 1. Failure to thrive (weight less than 3rd centile for age, drop in weight by more than 2 major centile lines) 2. Feeding difficulty (suck-rest-suck cycle) with forehead sweating (cold sweats) 3. Repeated chest infections/one life threatening infection 4. Baseline tachypnea with subcostal and intercostal retractions: • Rate > 60/min in less than 1 year old • Rate > 50/min between 1-2 year old 5. Tachycardia: • Rate > 160/min in less than 1 year old • Rate >140/min between 1-2 year old 6. Bounding (high volume) pulse (in PDA and APW) 7. Precordial bulge with active precordium 8. | 555 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651145_5_left_to_right_shunt_lesions.pdf | Baseline tachypnea with subcostal and intercostal retractions: • Rate > 60/min in less than 1 year old • Rate > 50/min between 1-2 year old 5. | 1 | page=1,block=7 | 0.700 |