Congenital Heart Defects: NCLEX Priorities
Acyanotic vs cyanotic CHDs: ASD, VSD, PDA, ToF, transposition.
Congenital heart defects are categorized by cyanosis. NCLEX tests common defects and presentations.
Acyanotic (L-to-R shunt)
ASD (atrial septal defect), often asymptomatic in childhood. VSD (most common CHD), pansystolic murmur. PDA (patent ductus arteriosus), continuous machinery murmur. Coarctation of aorta, BP higher in arms than legs. AS, PS (stenoses).
Cyanotic (R-to-L shunt or mixing)
Tetralogy of Fallot (4 defects, VSD, pulmonic stenosis, overriding aorta, RVH). Tet spells: knee-chest position calms. Transposition of great arteries, duct-dependent; prostaglandin E1 to keep PDA open until surgery. Truncus arteriosus, TAPVR, tricuspid atresia, HLHS.
PDA closure
Indomethacin (premature infants). Surgical or catheter closure in larger children.
Frequently asked
Cyanotic infant, first thing?
Hyperoxia test, echo. Start PGE1 if duct-dependent suspected.
Tet spell, what to do?
Knee-chest position. O2. Morphine. IV fluid.
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