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


Non Cyanotic heart defects

Atrial septal defect Noncyanotic Foramen ovale fails to close. Ostium secundum is most common

Physical Exam: Wide fixed split second heart sound (S2). Systolic ejection murmur at second left intercostals space with an early to mid-systolic rumble. Failure to thrive.

Diagnosis: Best diagnosed by passing catheter through defect

Treatment:

  • Symptomatic: Diuretics, ACE inhibitors, digoxin
  • Definitive: Surgical closure
Coarctation of aorta Noncyanotic

Population: Turner’s syndrome

Physical exam: Higher blood pressures in the arms than in the legs and pulses are bounding in the arms but decreased in the legs

  • The murmur associated with coarctation of the aorta may be nonspecific yet is usually a systolic murmur in the left infraclavicular area and under the left scapula

Chest radiograph: “Figure of 3 sign”

The figure 3 sign is seen in aortic coarctation and is formed by prestenotic dilatation of the aortic arch and left subclavian artery, indentation at the coarctation site (also known as the "tuck"), and poststenotic dilatation of the descending aorta.

The figure 3 sign is seen in aortic coarctation and is formed by prestenotic dilatation of the aortic arch and left subclavian artery, indentation at the coarctation site (also known as the "tuck"), and poststenotic dilatation of the descending aorta.

Patent ductus arteriosus Noncyanotic

  • 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

Population: Preterm infants

Physical exam:

  • Wide pulse pressures. Bounding pulses
  • A continuous "machinery murmur" at the upper left sternal border (mnemonic: ** remember the patient got a patent for his machine)

Treatment: Indomethacin if preterm

Ventricular septal defect Noncyanotic - VSD is the most common pathologic murmur in childhood

Presentation: Variable- asymptomatic to symptoms of heart failure

Physical exam: Loud, harsh, pansystolic murmur at the lower left sternal border

Treatment: Most close by age 6, surgery if large

Cyanotic defects

Tetralogy of Fallot Cyanotic

Presentation: Difficult feeding, failure to thrive. "tet spells", baby with cyanosis and loss of consciousness with crying

Four features: PROVe

  1. ulmonary Stenosis
  2. R ight ventricular hypertrophy
  3. verriding aorta
  4. V entricular septal defect

Physical exam: Crescendo-decrescendo, holosystolic at LSB radiating to the back

Chest radiograph: Boot shaped heart

Tetrology of Fallot

Tetralogy of Fallot

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