Summary
Definition
History and exam
Key diagnostic factors
- presentation in infancy
Other diagnostic factors
- tachypnea/shortness of breath (SOB)
- failure to thrive
- exercise intolerance
- widened pulse pressure
- machine-like continuous murmur/Gibson murmur in children born at full-term
- apnea
- low diastolic blood pressure (BP)
- irritability
- diaphoresis
- increased respiratory symptoms with upper respiratory infection
- murmur heard only during systole
- hyperdynamic precordium
- systolic thrill
- third heart sound heard at apex
- mid-diastolic rumble heard at apex
- bounding peripheral pulses
- pulmonary rales
Risk factors
- prematurity
- maternal rubella
- female sex
- respiratory distress syndrome (RDS)
- high altitude
- family history
- black race
Diagnostic tests
1st tests to order
- chest x-ray
- ECG
- echocardiogram
Tests to consider
- cardiac catheterization and angiography
Treatment algorithm
premature very low birth weight infants: prophylactic therapy
premature infants (<32 weeks)
term infants and children: small-to-moderate-sized ducts
term infants and children: large ducts and/or symptomatic infants too small for device closure
adults
Contributors
Authors
Kenneth M. Coca, MD
Pediatric Resident
Johns Hopkins All Children’s Hospital
Saint Petersburg
FL
Disclosures
KMC declares that he has no competing interests.
Joyce T. Johnson, MD, MS
Director, Fetal Cardiology
Johns Hopkins All Children’s Hospital
Saint Petersburg
FL
Disclosures
JTJ declares that she has no competing interests.
Nelangi M. Pinto, MD
Associate Professor, Pediatrics
University of Washington
Seattle Children’s Hospital
Seattle
WA
Disclosures
NMP declares that she has no competing interests.
Acknowledgements
Dr Kenneth M. Coca, Dr Joyce T. Johnson, and Dr Nelangi M. Pinto would like to gratefully acknowledge Dr Anji T. Yetman, a previous contributor to this topic.
Disclosures
ATY declares that she has no competing interests.
Peer reviewers
Michael Cheung, BSc (Hons), MB ChB, MRCP, FRACP
Acting Head
Department of Cardiology
Royal Children's Hospital
Melbourne
Australia
Disclosures
MC declares that he has no competing interests.
Rajat Bhatt, MD
Assistant Professor
Internal Medicine
Texas Tech University Health Sciences Center (TTUHSC)
Lubbock
TX
Disclosures
RB declares that he has no competing interests.
Henry M. Sondheimer, MD
Professor of Pediatrics
Clinical Director
Pediatric Cardiology
The Children's Hospital
Denver
CO
Disclosures
HMS declares that he has no competing interests.
Differentials
- Venous hum
- Coronary artery fistula
- Left-sided shunts (ventricular septal defect, atrioventricular septal defect)
More DifferentialsGuidelines
- Guidelines and recommendations for performance of the fetal echocardiogram
- Pulmonary hypertension in congenital heart disease: a scientific statement
More Guidelines
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