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Patent Ductus Arteriosus

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Topic updated on 11/01/17 11:17am

Snap Shot
  • An intern notes that a newborn in the nursery has a pink torso and upper extremities with blue lower extremities. It is also noted that the newborn has bounding pulses and a "to-and-fro" machine-like murmur
Introduction
  • Failure of the patent ductus arteriosus to close in the first few days of life 
    • causes blood to flow from aorta to pulmonary artery
    • effectively causes a left-to-right shunt 
    • starves the periphery of O2 
    • oxygenated blood reaches all vessels proximal to entry of the ductus arterious into the aorta through normal circulatory route
      • results in subclavian artery receiving oxygenated blood (upper extremity)
      • all tissue below receives deoxygenated blood
  • Risk factors include
    • prematurity
    • rubella infection in 1st trimester 
Presentation
  • Symptoms
    • asymptomatic
    • mild dyspnea
    • cyanosis of lower limbs with normal perfusion of upper body 
      • resulting in lower extremity clubbing 
    • congestive heart failure
  • Physical exam
    • bounding peripheral pulses with hyperactive precordium
    • "machinery murmur" continuous during systole and diastole at the 2nd intercostal space (LUSB) 
Treatment
  • Indomethacin
    • indications
      • first line of treatment
      • administered to close the PDA
    • contraindications
      • transposition of the great vessels
        • PDA is necessary for survival in patients with transposition
        • use prostaglandin E to keep PDA open in TGV
  • Surgical closure
    • indications
      • required if indomethacin fails in a child >6-8 months


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Qbank (1 Questions)

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(M1.CV.75) A 14-year-old male presents to his primary care physician with complaints of shortness of breath and easy fatigability when exercising for extended periods of time. He also reports that, when he exercises, his lower legs and feet turn a bluish-gray color. He cannot remember visiting a doctor since he was in elementary school. His vital signs are as follows: HR 72, BP 148/65, RR 14, and SpO2 97%. Which of the following murmurs and/or findings would be expected on auscultation of the precordium? Topic Review Topic

1. Mid-systolic murmur loudest at the right second intercostal space, with radiation to the right neck
2. Holodiastolic murmur loudest at the apex, with an opening snap following the S2 heart sound
3. Left infraclavicular systolic ejection murmur with decreased blood pressure in the lower extremities
4. Continuous, machine-like murmur at the left infraclavicular area
5. Right supraclavicular continuous murmur which disappears with pressure on the internal jugular vein

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