Pediatric emergency medicine trisk 1705 1705
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TABLE 86.3
AGE AND VITAL SIGNS OF INFANTS WITH CYANOSIS OR
CHF/PULMONARY OVERCIRCULATION
Age
Weight gain
Oxygen saturation
RR
HR
BP
Cyanosis
CHF/Pulmonary
overcirculation
2 wks
Normal
<95%
Normal
Normal
Normal
2 mo
Poor after 6–8 wks
>95%
>50/min
Slightly high
Normal or arm HTN or
leg lower than arm
Normal, UE HTN, or LE
< UE
CHF, congestive heart failure; RR, respiratory rate; HR, heart rate; BP, blood pressure; HTN, hypertension;
UE, upper extremity; LE, lower extremity.
Categorization of a patient into one of these four groups requires knowing the
patient’s age, weight, vital signs, and physical examination findings, which all
may be gathered quickly. This simplified method of understanding heart disease
can help the provider identify and treat emergencies due to CHD ( Table 86.3 and
e-Table 86.1 ).
Ductal Dependent Lesions
After birth, circulating prostaglandins decrease and the DA naturally closes.
Cardiac defects, which depend on ductal patency for stable circulation, will
present at this time, typically within the first 2 weeks of life. Either pulmonary or
systemic blood flow may be dependent on a PDA. These lesions will present with
either cyanosis or shock, respectively.
Ductal Dependent Pulmonary Blood Flow
Cardiac defects in which the pulmonary outflow tract is atretic depend completely
on patency of the DA for survival. When the ductus closes, these patients become
extremely hypoxic and present with severe cyanosis and shock. Defects such as
critical pulmonary stenosis, pulmonary atresia with intact ventricular septum, and
severe TOF present in this dramatic fashion.
