小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 婴儿期表现
其他诊断因素
- 呼吸急促/呼吸短促 (SOB)
- 生长迟缓
- 运动不耐受
- 脉压增宽
- 足月出生的儿童中闻及机器样连续性杂音/Gibson 杂音
- 呼吸暂停
- 低舒张压
- 易怒
- 发汗
- 加重呼吸道症状的上呼吸道感染
- 仅在收缩期闻及杂音
- 心前区搏动增强
- 收缩期震颤
- 心尖部闻及第三心音
- 心尖部闻及舒张中期隆隆样杂音
- 外周脉搏呈洪脉
- 肺部啰音
危险因素
- 早产
- 母体风疹
- 女性
- 呼吸窘迫综合征 (RDS)
- 高海拔
- 家族史
- 黑人
诊断性检查
首要检查
- 胸部 X 线检查
- 心电图 (ECG)
- 超声心动图
需考虑的检查
- 心导管检查和血管造影术
治疗流程
极低出生体重早产儿：预防性疗法
早产儿（＜32 周）
足月儿和儿童：小至中型导管
足月儿和儿童：大型导管和/或有症状但因太小而无法接受介入封堵术的婴儿
成人
撰稿人
作者
Joyce T. Johnson, MD, MS
Assistant Professor, Pediatric Cardiology
Ann & Robert H. Lurie Children's Hospital of Chicago
Northwestern University Feinberg School of Medicine
Chicago
IL
利益声明
JTJ declares that she has no competing interests.
Nelangi M. Pinto, MD
Associate Professor, Pediatrics
University of Utah
Salt Lake City
UT
利益声明
NMP declares that she has no competing interests.
鸣谢
Dr Joyce T. Johnson and Dr Nelangi M. Pinto would like to gratefully acknowledge Dr Anji T. Yetman, a previous contributor to this topic.
利益声明
ATY declares that she has no competing interests.
同行评议者
Michael Cheung, BSc (Hons), MB ChB, MRCP, FRACP
Acting Head
Department of Cardiology
Royal Children's Hospital
Melbourne
Australia
利益声明
MC declares that he has no competing interests.
Rajat Bhatt, MD
Assistant Professor
Internal Medicine
Texas Tech University Health Sciences Center (TTUHSC)
Lubbock
TX
利益声明
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
利益声明
HMS declares that he has no competing interests.
鉴别诊断
- 静脉哼鸣
- 冠状动脉瘘
- 左向右分流（室间隔缺损、房室隔缺损）
更多 鉴别诊断指南
- 2020 年 ESC 成人先天性心脏病管理指南
- 2018 AHA/ACC 先天性心脏病成人患者管理指南：美国心脏病学会/美国心脏协会临床实践指南工作组报告
更多 指南
Log in or subscribe to access all of BMJ Best Practice
内容使用需遵循免责声明