PANCE Blueprint Cardiology (16%)

Congenital Heart Disease (PEARLS)

The NCCPA™ Cardiology PANCE and PANRE Content Blueprint covers 5 different types of congenital heart disease.  Congenital heart disease can be divided into two categories: Cyanotic and Noncyanotic



Noncyanotic heart defects
Atrial septal defect Systolic ejection murmur at 2nd left intercostal space with an early to mid-systolic rumble and fixed splitting of the 2nd heart sound (s2)

Coarctation of aorta Higher blood pressures in the arms than in the legs and pulses are bounding in the arms but decreased in the legs.

Patent ductus arteriosus A continuous "machinery murmur" at the upper left sternal border, treat with indomethacin

  • The ductus arteriosus is a blood vessel which connects the pulmonary artery to the aorta. In utero this allows most of the blood to bypass the lungs.  Treat with indomethacin

** remember the patient got a patent for his machine!

Ventricular septal defect VSD is the most common pathologic murmur in childhood, loud, harsh, holosystolic murmur at the lower left sternal border

Cyanotic defects
Tetralogy of Fallot Crescendo-decrescendo, holosystolic at LSB radiating to the back - cyanosis, clubbing,

Four features, "tet spells", baby with cyanosis and LOC with crying

  • Right ventricular hypertrophy
  • VSD
  • Overriding aorta
  • Right ventricular outflow obstruction
Tetrology of Fallot

Tetralogy of Fallot

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Torsades de pointes (Prev Lesson)
(Next Lesson) Brian Wallace PA-C Podcast: Congenital Heart Disorders
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