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\author{Eeveepuff (NKeeveepuff)}
\pdfinfo{
  /Title (pediatric-cardio-part-1.pdf)
  /Creator (Cheatography)
  /Author (Eeveepuff (NKeeveepuff))
  /Subject (Pediatric Cardio Part 1 Cheat Sheet)
}

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\noindent
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Pediatric Cardio Part 1 Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Eeveepuff (NKeeveepuff)} via \textcolor{DarkBackground}{\uline{cheatography.com/149511/cs/34746/}}}
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\noindent
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Eeveepuff (NKeeveepuff) \\
  \uline{cheatography.com/nkeeveepuff} \\
  \end{tabulary}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 18th October, 2022.\\
   Updated 18th October, 2022.\\
   Page {\thepage} of \pageref{LastPage}.
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Cyanotic VS. Acyanotic CHD}}  \tn
% Row 0
\SetRowColor{LightBackground}
\{\{bb=2\}\} {\bf{Acyanotic heart disease}} & \{\{bb=2\}\} {\bf{Cyanotic heart disease}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
L to R shunt & R to L shunt \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{obstruction occurring \{\{nl\}\} ~ beyond lungs} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
blood passes through pulmonic circulation & blood bypasses the lungs \tn 
% Row Count 7 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\{\{ac\}\}  \{\{fa-arrow-down\}\} & \{\{ac\}\} \{\{fa-arrow-down\}\} \tn 
% Row Count 9 (+ 2)
% Row 5
\SetRowColor{white}
oxygenation takes place & no oxygenation occurs \tn 
% Row Count 11 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\{\{ac\}\} \{\{fa-arrow-down\}\} & \{\{ac\}\} \{\{fa-arrow-down\}\} \tn 
% Row Count 13 (+ 2)
% Row 7
\SetRowColor{white}
\{\{fa-arrow-down\}\} levels of deoxygenated blood in systemic circulation & \{\{fa-arrow-up\}\} levels of deoxygenated blood enters systemic circulation \tn 
% Row Count 17 (+ 4)
% Row 8
\SetRowColor{LightBackground}
\{\{ac\}\} \{\{fa-arrow-down\}\} & \{\{ac\}\} \{\{fa-arrow-down\}\} \tn 
% Row Count 19 (+ 2)
% Row 9
\SetRowColor{white}
no cyanosis & cyanosis \tn 
% Row Count 20 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Cyanosis: blue mucous membranes, nail beds, \& skin secondary to an absolute conc. of deoxygenated Hb of at least 30 g/dL}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Description}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{ACYANOTIC}} \{\{bb\}\}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{L to R shunt lesions} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- extra blood displaced through communication frm L to R side of heart \{\{fa-arrow-right\}\} \{\{fa-arrow-up\}\} pulm. blood flow \{\{fa-arrow-right\}\} \{\{fa-arrow-up\}\}pulm. pressures \{\{nl\}\} - shunt vol. dependent upon 3 factors:\{\{nl\}\} ~ ~ ~ 1) size of defect \{\{nl\}\} ~ ~ ~ 2) pressure gradient b/w chambers / vessels, and \{\{nl\}\} ~ ~ ~ 3) peripheral outflow resistance \{\{nl\}\} - untreated shunts can result in pulm. vascular disease, L ventricular dilatation \& dysfunction, R ventricular HTN \& RVH, and ultimately R to L shunts} \tn 
% Row Count 14 (+ 13)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Obstructive lesions} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- present w/ \{\{fa-arrow-down\}\} urine output, pallor, cool extremities \& poor pulses, shock, or sudden collapse} \tn 
% Row Count 18 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{CYANOTIC}} \{\{bb\}\}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- syst. venous return re-enters syst. circulation directly \{\{nl\}\} - most prominent feature = cyanosis (O2 sat. \textless{}75\%) \{\{nl\}\} - hyperoxic test differentiates b/w cardiac \& other causes of cyanosis \{\{nl\}\} ~ ~ ~ -{}-\textgreater{} obtain preductal, R radial ABG in room air, then repeat after child inspires 100\% O2 \{\{nl\}\} ~ ~ ~  -{}-\textgreater{} if PaO2 improves to \textgreater{}150 mmHg, cyanosis less likely cardiac in origin \{\{nl\}\} - pre-ductal \& post-ductal pulse oximetry \{\{nl\}\} ~ ~ ~ -{}-\textgreater{} \textgreater{}5\% diff. suggests R to L shunt} \tn 
% Row Count 31 (+ 13)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{1. Acyanotic incl.: \{\{nl\}\} - ASD, VSD, PDA \{\{nl\}\} - Coarctation of aorta, Aortic stenosis, Pulm. stenosis \newline \{\{nl\}\} 2. Cyanotic incl.: \{\{nl\}\} - Tetralogy of Fallot \{\{nl\}\} - TGA, Total Anomalous Pulm. Venous Return, Truncus Arteriosus, Hypoplastic L Heart Syndrome}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Atrial Septal Defect}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{3 types:}}`} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- {\emph{ostium primum}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}-{}- common in DS \{\{nl\}\} -{}- defect located @ mitral / tricuspid valve} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- {\emph{ostium secundum}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}-{}- most common type \{\{nl\}\} -{}- 50-70\% \{\{nl\}\} -{}- defect located @ septum b/w L \& R atria} \tn 
% Row Count 7 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- {\emph{sinus venosus}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}-{}- defect located @ entry of SVC into R atrium} \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Epidemiology}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- 6-8\% of congenital heart lesions \{\{nl\}\} - common in pts. w/ certain congenital disorders (eg. DS, FAS)} \tn 
% Row Count 13 (+ 4)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Natural history}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- 80-100\% spontaneous closure rate if ASD diameter \textless{}8mm \{\{nl\}\} - if remains patent, CHF \& pulm. HTN can develop in adult life} \tn 
% Row Count 17 (+ 4)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Clinical features}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- hist.: often asymp. in childhood \{\{nl\}\} - phy. exam: grade 2-3/6 pulm. outflow murmur, widely split, \& fixed S2 \{\{nl\}\} - children w/ large ASDs may hv. signs of heart failure \{\{nl\}\} ~ ~ ~ -{}-\textgreater{} tachypnea, FTT, hepatomegaly, pulmo. rales/retractions} \tn 
% Row Count 24 (+ 7)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Investigations}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- ECG: RAD, mild RVH, RBBB (normal ECG doesn't rule out) \{\{nl\}\} - CXR: \{\{fa-arrow-up\}\} pulmo. vasculature, cardiac enlargement (normal ECG doesn't rule out) \{\{nl\}\} - echo: diagnostic} \tn 
% Row Count 29 (+ 5)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- elective surgical / catheter closure b/w 2-5 yr, though majority req. no surgery \{\{nl\}\} - size \textless{}8 mm will likely spontaneously close} \tn 
% Row Count 33 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Ventricular Septal Defect}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{most common congenital heart defect} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}(30-50\%)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{{\emph{SMALL VSD}}}} (majority)} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Clinical Features}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- hist.: asymp., normal growth, \& development \{\{nl\}\} - phy. exam: early systolic to holosystolic murmur, best heard at LLSB, thrill} \tn 
% Row Count 7 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Investigations}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- echo to confirm diagnosis \{\{nl\}\} ~ ~ ~ (ECG \& CXR are normal)} \tn 
% Row Count 10 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- most spontaneously close} \tn 
% Row Count 12 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{{\emph{MODERATE-TO-LARGE VSD}}}}} \tn 
% Row Count 13 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Epidemiology}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- CHF by 2 mo \{\{nl\}\} - late secondary pulm. HTN if left untreated} \tn 
% Row Count 16 (+ 3)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Clinical features}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- hist.: delayed growth, \{\{fa-arrow-down\}\} exercise tolerance, recurrent URTIs or "asthma" episodes \{\{nl\}\} - phy. exam: holosystolic murmur at LLSB, \{\{nl\}\} ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ mid-diastolic rumble @ apex, \{\{nl\}\} ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ size of VSD inversely related to intensity of murmur, \{\{nl\}\} ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ loss of splitting of 2nd heart sound \& loud P2 suggests pulm. HTN} \tn 
% Row Count 29 (+ 13)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Investigations}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- ECG: LVH, LAH, RVH (normal ECG doesn't rule it out) \{\{nl\}\} - CXR: \{\{fa-arrow-up\}\} pulm. vasculature, cardiomegaly, CHF (normal CXR doesn't rule out) \{\{nl\}\} echo: diagnostic} \tn 
% Row Count 34 (+ 5)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Ventricular Septal Defect (cont)}}  \tn
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- tx. of CHF \& surgical closure by 1 yr, if surgery req.} \tn 
% Row Count 3 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{* Size of VSD inversely related to sound of murmur \newline ~ ~ -{}-\textgreater{} loud murmur = smaller hole}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Patent Ductus Arteriosus}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Patent vessel b/.w descending aorta \& L pulm. artery} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- normally, func. closure w/i first 15 hr of life \{\{nl\}\} - anatomical closure w/i first days of life} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Epidemiology}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- 5-10 \% of all CHD \{\{nl\}\} - delayed closure of ductus common in premature infants (1/3 of infants \textless{}1750 g) \{\{nl\}\} ~ ~ ~ -{}-\textgreater{} this is diff. frm PDA in term infants} \tn 
% Row Count 10 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Natural history}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- spontaneous closure common in premature infants \{\{nl\}\} - less common in term infants} \tn 
% Row Count 13 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Clinical features}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- hist.: aymp. , or have apneic / bradycardic spells, poor feeding, accessory muscle use, CHF \{\{nl\}\} - phy. exam: tachycardia \{\{fa-plus\}\}/\{\{fa-minus\}\} gallop rhythm, \{\{nl\}\} ~ ~ ~ ~ ~ ~ ~ bounding pulses, \{\{nl\}\} ~ ~ ~ ~ ~ ~ ~ hyperactive precordium, \{\{nl\}\} ~ ~ ~ ~ ~ ~ ~ wide pulse pressure, \{\{nl\}\} ~ ~ ~ ~ ~ ~ ~ cont. "machinery" murmur best heard @ L infraclavicular area} \tn 
% Row Count 25 (+ 12)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Investigations}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- ECG: may show L atrial enlargement, LVH, RVH \{\{nl\}\} - echo = diagnostic \{\{nl\}\} - CXR: may show normal to mildly enlarged heart, \{\{fa-arrow-up\}\} pulm. vasculature, prominent pulm. artery} \tn 
% Row Count 30 (+ 5)
\end{tabularx}
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\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Patent Ductus Arteriosus (cont)}}  \tn
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- indomethacin (Indocid): antagonizes prostaglandin E2, which maintains ductus arteriosus patency \{\{nl\}\} ~ ~ ~ ~ -{}-\textgreater{} only effective in premature infants \{\{nl\}\} - catheter or surgical closure if PDA causes resp. compromise, FTT, or persists beyond 3rd mo of life} \tn 
% Row Count 7 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Coarctation of aorta}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Narrowing of aorta} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- almost always at lvl. of ductus arteriosus} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Epidemiology}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- commonly ass. w/ bicuspid aortic valve (50\%) ; Turner synd. (35\%)} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Clinical features}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- hist.: often asymp. \{\{nl\}\} - phy. exam: \{\{nl\}\} ~ ~ ~ -{}- BP discrepancy b/w upper \& lower extremities (\{\{fa-arrow-up\}\} sus. / severity if \textgreater{} 20 mmHg diff.) \{\{nl\}\} ~ ~ ~ -{}- diminished / delayed femoral pulses relative to brachial pulses (i.e. brachial-femoral delay) \{\{nl\}\} ~ ~ ~ -{}- possible systolic murmur w/ late peak @ apex, L axilla, \& L back \{\{nl\}\} ~ ~ ~ -{}- if severe, presents w/ shock in neonatal period when ductus arteriosus closes} \tn 
% Row Count 17 (+ 12)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Investigations}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- ECG shows RVH early in infancy, LVH later in childhood \{\{nl\}\} - echo / MRI for diagnosis} \tn 
% Row Count 20 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Prognosis}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- can be complicated by HTN \{\{nl\}\} - if ass. w/ other lesions (e.g. PDA, VSD) can lead to CHF} \tn 
% Row Count 23 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- give prostaglandins to keep ductus arteriosus patent for stabilization \& perform surgical correction in neonates \{\{nl\}\} - for older infants \& children balloon arterioplasty may be an alternative to surgical correction} \tn 
% Row Count 29 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Aortic Stenosis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{4 types}}`} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- valvular (75\%) \{\{nl\}\} - subvalvular (20\%) \{\{nl\}\} - supravalvular, \& idiopathic hypertrophic subaortic stenosis (5\%)} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Clinical features}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- hist.: often asymp. , b/ may be ass. w/ CHF, exertional chest pain, syncope, or sudden death \{\{nl\}\} - phy. exam: SEM @ RUSB w/ aortic ejection click @ apex (only for valvular stenosis)} \tn 
% Row Count 9 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Investigations}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- echo for diagnosis} \tn 
% Row Count 11 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- valvular stenosis usually treated w/ balloon valvuloplasty, pts. w/ subvalvular or supravalvular stenosis require surgical repair, exercise restriction req.} \tn 
% Row Count 16 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Pulmonary Stenosis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{3 types}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- valvular (90\%) \{\{nl\}\} - subvalvular \{\{nl\}\} - or supravalvular} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Definition of critical Pulm. S.}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Inadequate pulm. blood flow, \{\{nl\}\} Dependent on ductus arteriosus for oxygenation, \{\{nl\}\} Progressive hypoxia \& cyanosis} \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Natural history}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- may be part of other congenital heart lesions (e.g. Tetralogy of Fallot) \{\{nl\}\} - or in ass. w/ syndromes (e.g. congenital rubella, Noonan synd.)} \tn 
% Row Count 12 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Clinical features}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- hist.: spectrum frm asymp. to CHF \{\{nl\}\} - phy. exam: wide split S2 on expiration, \{\{nl\}\} ~ ~ ~ ~ ~ ~ SEM @ LUSB, \{\{nl\}\} ~ ~ ~ ~ ~ ~ pulmonary ejection click (for valvular lesions)} \tn 
% Row Count 19 (+ 7)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Investigations}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- ECG findings: RVH \{\{nl\}\} - CXR: post-stenotic dilation of main pulm. artery (due to \{\{fa-arrow-up\}\} velocity jest past stenotic valve) \{\{nl\}\} - echo: diagnostic} \tn 
% Row Count 24 (+ 5)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- surgical repair if critically ill or if symp. in older infants/children} \tn 
% Row Count 27 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Tetralogy of Fallot}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Epidemiology}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- 10\% of all CHD \{\{nl\}\} - most common cyanotic heart defect diagnosed beyond infancy w/ peak incidence @ 2-4 mo} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pathophysiology}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- embryological defect due to ant. \& superior deviation of outlet septum leading to: VSD, RVOTO (i.e. pulm. stenosis \{\{fa-plus\}\}/\{\{fa-minus\}\} subpulm. valve stenosis), overriding aorta, \& RVH \{\{nl\}\} ~ ~ ~ -{}-\textgreater{} infants may initially hv. a L \{\{fa-arrow-right\}\} R shunt (∴ no cyanosis) \{\{nl\}\} ~ ~ ~ -{}-\textgreater{} however, RVOTO = progressive, leading to \{\{fa-arrow-up\}\} R \{\{fa-arrow-right\}\} L shunting w/ hypoxemia \& cyanosis \{\{nl\}\} ~ ~ ~ -{}-\textgreater{} degree of RVOTO determines direction \& degree of shunt, \& ∴, extent of clinical cyanosis \& degree of RVH} \tn 
% Row Count 18 (+ 14)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Clinical features}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- hist.: hypoxic "tet" spells \{\{nl\}\} ~ ~ ~ -{}-\textgreater{} during exertional states (crying, exercise), increasing pulm. vascular resistance \& decrease in sys. resistance causes \{\{fa-arrow-up\}\} in R-to-L shunting \{\{nl\}\} ~ ~ ~ -{}-\textgreater{} clinical features incl. \{\{nl\}\} ~ ~ ~ ~ ~ ~ ~ ~ ~ paroxysms of rapid \& deep breathing, ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ irritability \& crying, \{\{nl\}\} ~ ~ ~ ~ ~ ~ ~ ~ \{\{fa-arrow-up\}\} cyanosis, \{\{nl\}\} ~ ~ ~ ~ ~ ~ ~ ~ \{\{fa-arrow-down\}\} intensity of murmur \{\{\{fa-arrow-down\}\} flow across RVOTO), \{\{nl\}\} ~ ~ ~ ~ ~ ~ ~ ~ ~ pt. squatting for relief (\{\{fa-arrow-up\}\} peripheral resistance, \{\{fa-arrow-down\}\} R to L shunting) \{\{nl\}\} ~ ~ ~ -{}-\textgreater{} if severe, can lead to \{\{fa-arrow-down\}\} lvl. of consciousness, seizures, death \{\{nl\}\} \{\{nl\}\} phy. exam: \{\{nl\}\} ~ ~ ~ -{}-\textgreater{} single loud S2 due to severe pulm. stenosis (i.e. RVOTO) \{\{nl\}\} ~ ~ ~ -{}-\textgreater{} SEM @ LLSB} \tn 
% Row Count 44 (+ 26)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Tetralogy of Fallot (cont)}}  \tn
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Investigations}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- ECG: RAD, RVH \{\{nl\}\} - CXR: boot-shaped heart, \{\{fa-arrow-down\}\} pulm. vasculature, R aortic arch (in 25\%) \{\{nl\}\} - echo: diagnostic} \tn 
% Row Count 4 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management of spells}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}O2, knee-chest position, fluid bolus, morphine sulfate, propranolol, phenylephrine} \tn 
% Row Count 7 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Treatment}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- surgical repair @ 4-6 mo of age \{\{nl\}\} - earlier if marked cyanosis or "tet" spells} \tn 
% Row Count 10 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Transposition of the Great Arteries}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Epidemiology}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- 3-5 \% of all congenital cardiac lesions \{\{nl\}\} - most common cyanotic CHD in neonates} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pathophysiology}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}parallel pulm. \& syst. circulations \{\{nl\}\} - Systemic: body \{\{fa-arrow-right\}\} RA \{\{fa-arrow-right\}\} RV \{\{fa-arrow-right\}\} aorta \{\{fa-arrow-right\}\} body \{\{nl\}\} - Pulmonary: lungs \{\{fa-arrow-right\}\} LA \{\{fa-arrow-right\}\} LV \{\{fa-arrow-right\}\} pulm. artery \{\{fa-arrow-right\}\} lungs \{\{nl\}\} - survival dependent on mixing through PDA, ASD, or VSD} \tn 
% Row Count 12 (+ 9)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Physical exam}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- neonates: ductus arteriosus closure causes rapidly progressive severe hypoxemia unresponsive to O2 therapy, acidosis, \& death \{\{nl\}\} - VSD present: cyanosis not prominent ; CHF w/i first wks of life \{\{nl\}\} - VSD absent: no murmur} \tn 
% Row Count 18 (+ 6)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Investigations}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- ECG: RAD, RVH, or may be normal \{\{nl\}\} - CXR: egg-shaped heart w/ narrow mediastinum ("egg on a string") \{\{nl\}\} - echo: diagnostic} \tn 
% Row Count 22 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- symptomatic neonates: prostaglandin E1 infusion to keep ductus open until balloon atrial septostomy \{\{nl\}\} - surgical repair: arterial switch performed in first 2 wk in those w/o VSD while LV muscle still strong} \tn 
% Row Count 28 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Total Anomalous Pulmonary Venous Return}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Epidemiology}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}1-2\% of CHD} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pathophysiology}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- all pulm. veins drain into R-sided circulation (syst. veins, RA) \{\{nl\}\} - no direct oxygenated pulm. venous return to L atrium \{\{nl\}\} - often ass. w/ obstruction @ connection sites \{\{nl\}\} - ASD must be present for oxygenated blood to shunt into LA \& syst. circulation} \tn 
% Row Count 9 (+ 7)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}surgical repair in all cases \& req. urgently for severe cyanosis} \tn 
% Row Count 12 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Truncus Arteriosus}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pathophysiology}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- single great vessel gives rise to aorta, pulm. \& coronary arteries \{\{nl\}\} - truncal valve overlies a large VSD \{\{nl\}\} - potential for coronary ischemia w/ fall in pulm. vascular resistance} \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}surgical repair w/i first 6 wk of life} \tn 
% Row Count 8 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Hypopplastic Left Heart Syndrome}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Epidemiology}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- 1-3\% of CHD \{\{nl\}\} - most common cause of death frm CHD in first mo of life} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pathophysiology}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- LV hypoplasia may incl. \{\{nl\}\} ~ ~ ~ -{}-\textgreater{} atretic / stenotic mitral and/or aortic valve \{\{nl\}\} ~ ~ ~ -{}-\textgreater{} small ascending aorta \{\{nl\}\} ~ ~ ~ -{}-\textgreater{} coarctation of aorta w/ resultant syst. hypoperfusion} \tn 
% Row Count 10 (+ 7)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{{\emph{Systemic circulation dependent on ductus patency}}}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Upon closure of ductus, infant presents w/ circulatory shock \& metabolic acidosis} \tn 
% Row Count 14 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}- intubate \& correct metabolic acidosis \{\{nl\}\} - IV infusion of prostaglandin E1 to keep ductus open \{\{nl\}\} - surgical palliation (overall survival 50\% to late childhood) or heart transplant} \tn 
% Row Count 20 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}