Acyanotic Congenital Heart Disease

[Intro: 88 BPM. The track opens with the sound of a dusty vinyl record dropping onto a turntable. A heavy, boom-bap drum break kicks in immediately. The jazzy upright bass starts walking a smooth baseline. A DJ scratches a vocal sample to build the hype before the MC steps up to the mic.] [Verse 1 / The Ventricular Defect: The MC delivers these lines with a steady, confident, and rapid-fire flow, landing perfectly on the snare drum hits.] VENTRICULAR SEPTAL DEFECT VSD, VSD, VSD; VSD the most common congenital heart defect Perimembranous, most common Large VSDs are not symptomatic at birth the first 6−8 weeks of life pulmonary vascular resistance decreases the shunt increases, symptoms may develop a pansystolic murmur at the LLSB Large shunts flow across the mitral valve So, a mid-diastolic murmur at the apex Small, usually close spontaneously for moderate to large, diuretics initially poor growth or pulmonary hypertension requires closure some with devices, Mostly surgically Complete AV canal defect associated with Down syndrome [Chorus 1 / The Atrial Defect: A cool, looping jazz horn sample joins the beat. The MC switches up his cadence, making the "ASD" repetition a catchy, bouncy hook.] ATRIAL SEPTAL DEFECT ASD, ASD, ASD; ASD secundum defect is the most common Even with large ASDs rarely symptomatic May cause exercise intolerance and atrial fibrillation A prominent right ventricular impulse A soft systolic ejection murmur, fixed split S2 A larger shunt, a mid-diastolic murmur at the LLSB Due to the volume across the tricuspid. right axis deviation and RVH. Medical management rarely indicated Still significant shunt at around age 3, close For many secundum use an ASD closure device [Verse 2 / The Patent Ductus: The beat strips back down to just the heavy drums and the bass. The MC spits this section with an aggressive, punchy rhythm, emphasizing the mechanical sounds of the murmur.] PATENT DUCTUS ARTERIOSUS PDA, PDA, PDA, PDA Small are asymptomatic moderate - large the symptoms of heart failure, pulmonary edema as the pulmonary vascular resistance decreases. A widened pulse pressure A continuous, machine-like murmur at the left infraclavicular area, often well heard over the left side of the back. Larger shunts - flow across the mitral valve, a mid-diastolic murmur at the apex Splitting of S2 and intensity of P2 - depend on the pulmonary artery pressure. left ventricular hypertrophy, If pulmonary hypertension also right After the first few weeks, spontaneous closure rare Moderate and large managed initially with diuretics, eventually require closure by either coil embolization or a PDA closure device In premature infants can cause significant left-to-right shunt lead to systemic hypoperfusion A large PDA left untreated can lead to pulmonary hypertension, then Eisenmenger [Bridge / The Stenosis Twins: The DJ scratches rapidly between these two sections. The MC delivers both blocks back-to-back with a fast, breathless, double-time flow.] PULMONARY STENOSIS, STENOSIS STENOSIS Moderate to severe exertional dyspnea and easy fatigability. Newborns with severe stenosis may be symptomatic even cyanotic because of right-to-left shunting at the atrium. a systolic ejection murmur S2 may be widely split and RVH Balloon valvuloplasty is often successful in symptomatics AORTIC STENOSIS, STENOSIS STENOSIS Mild to moderate no symptoms. severe stenosis, easy fatigability, exertional chest pain, syncope. critical stenosis, heart failure. LVH Balloon valvuloplasty for significant cases [Verse 3 / The Coarctation Finale: The jazz horns return, echoing loudly. The beat becomes incredibly heavy and dramatic. The MC delivers this final section with absolute authority, dropping the diagnostic signs like heavy rhythmic punches.] COARCTATION OF THE AORTA Coarctation Coarctation Coarctation almost always juxtaductal Timing depends on the severity and associated defects a differential saturation between the right arm and leg the femoral pulses weaker and delayed compared with the right radial blood pressure in the lower extremities is lower than the upper classic age of presentation at 2 weeks of age Older children usually asymptomatic, or leg discomfort The murmur in the left interscapular area of the back significant collaterals, continuous murmurs throughout the chest RVH in infants with marked cardiomegaly and pulmonary edema in older children, LVH, Rib notching, 3 sign for an infant presenting with cardiac decompensation infusion of prostaglandin E1, inotrops, diuretics Balloon angioplasty or surgical repair [Ending: The heavy boom-bap beat plays for four more bars. The DJ executes a long, descending turntable scratch. The upright bass plays one final, low note that echoes out. Total silence.]