Patent ductus arteriosus history and symptoms: Difference between revisions
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{{Patent ductus arteriosus}} | {{Patent ductus arteriosus}} | ||
{{CMG}}; '''Associate Editor-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com], {{CZ}}; | {{CMG}}; '''Associate Editor-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com], {{CZ}};[[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu] | ||
== Overview == | |||
[[Patent ductus arteriosus]] is usually an [[asymptomatic]] diagnosis, which may cause [[heart failure]] and [[dyspnea]]. Clinical manifestation differs due to the size of [[Patent ductus arteriosus|PDA]]. If the closure does not happen, it may progress to high right-sided [[hypertension]] which may cause irreversible [[vascular]] damage. | |||
==History and Symptoms== | ==History and Symptoms== | ||
* Usually asymptomatic or may present with symptoms of [[heart failure]] and [[dyspnea]]. | |||
* Depending on the size of the PDA, a [[cardiac murmur]] can be missed during the first physical exam of the [[newborn]] because of the high pulmonary pressure that avoids the [[left-to-right shunt]] at that time, when the pulmonary pressure drops, the [[murmur]] is evident.<ref name="de Freitas MartinsIbarra Rios2018">{{cite journal|last1=de Freitas Martins|first1=Fernando|last2=Ibarra Rios|first2=Daniel|last3=F. Resende|first3=Maura Helena|last4=Javed|first4=Henna|last5=Weisz|first5=Dany|last6=Jain|first6=Amish|last7=de Andrade Lopes|first7=Jose Maria|last8=McNamara|first8=Patrick J.|title=Relationship of Patent Ductus Arteriosus Size to Echocardiographic Markers of Shunt Volume|journal=The Journal of Pediatrics|volume=202|year=2018|pages=50–55.e3|issn=00223476|doi=10.1016/j.jpeds.2018.06.045}}</ref> | |||
*Size and length of the PDA | * Clinical manifestation of [[patent ductus arteriosus]] depends on the degree of [[left-to-right shunt|left to right shunting]] which in turn is affected by: | ||
*Difference between pulmonary and systemic vascular | ** Size and length of the [[Patent ductus arteriosus|PDA]] | ||
** Difference between [[pulmonary vascular resistance|pulmonary]] and [[systemic vascular resistance]]s. | |||
===Small PDA=== | ===Small PDA=== | ||
* May be asymptomatic. | * May be [[asymptomatic]].<ref name="pmid7833075">{{cite journal| author=Skelton R, Evans N, Smythe J| title=A blinded comparison of clinical and echocardiographic evaluation of the preterm infant for patent ductus arteriosus. | journal=J Paediatr Child Health | year= 1994 | volume= 30 | issue= 5 | pages= 406-11 | pmid=7833075 | doi=10.1111/j.1440-1754.1994.tb00689.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7833075 }}</ref> | ||
* Sometimes identified incidentally on routine physical examinations (due to the presence of continuous flow | * Sometimes identified incidentally on routine physical examinations (due to the presence of [[murmur#continous murmurs|continuous flow murmur]]s) or on [[echocardiography]] performed for some other conditions. | ||
===Moderate PDA=== | ===Moderate PDA=== | ||
*Qp:Qs between 1.5 and 2.2 to 1 | |||
*The moderate [[left-to-right shunt]] increases the volume overload on the left side of [[heart]] and may present with [[exercise intolerance]]. | |||
===Large PDA=== | |||
* | * Presentation of large [[Patent ductus arteriosus|PDA]] in [[infant]] and [[children]] are symptoms due to [[heart failure]] like- | ||
** [[Failure to thrive]] | |||
** [[Poor feeding]] | |||
**[[Respiratory distress]] | |||
* Presentation of large PDA in adults. | |||
Presentation of large PDA in | |||
* It can cause left ventricular overload. However, if the condition goes uncorrected progressive rise in pulmonary artery pressure may occur that in turn can cause a reversal of [[shunt]] i.e. [[right-to-left shunt|right to left-sided shunting]]. | |||
* The right to left shunt can cause [[cyanosis]] and in later stages may progress to [[Eisenmenger syndrome]]. | |||
It can cause left ventricular overload. However, if the condition goes uncorrected progressive rise in pulmonary artery pressure may occur that in turn can cause a reversal of shunt i.e. right to left sided shunting. The right to left shunt can cause cyanosis and in later stages may progress to Eisenmenger syndrome | |||
==References== | ==References== | ||
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[[Category:Congenital heart disease]] | [[Category:Congenital heart disease]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 21:52, 10 March 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Priyamvada Singh, M.B.B.S. [2], Cafer Zorkun, M.D., Ph.D. [3];Kristin Feeney, B.S. [4]
Overview
Patent ductus arteriosus is usually an asymptomatic diagnosis, which may cause heart failure and dyspnea. Clinical manifestation differs due to the size of PDA. If the closure does not happen, it may progress to high right-sided hypertension which may cause irreversible vascular damage.
History and Symptoms
- Usually asymptomatic or may present with symptoms of heart failure and dyspnea.
- Depending on the size of the PDA, a cardiac murmur can be missed during the first physical exam of the newborn because of the high pulmonary pressure that avoids the left-to-right shunt at that time, when the pulmonary pressure drops, the murmur is evident.[1]
- Clinical manifestation of patent ductus arteriosus depends on the degree of left to right shunting which in turn is affected by:
- Size and length of the PDA
- Difference between pulmonary and systemic vascular resistances.
Small PDA
- May be asymptomatic.[2]
- Sometimes identified incidentally on routine physical examinations (due to the presence of continuous flow murmurs) or on echocardiography performed for some other conditions.
Moderate PDA
- Qp:Qs between 1.5 and 2.2 to 1
- The moderate left-to-right shunt increases the volume overload on the left side of heart and may present with exercise intolerance.
Large PDA
- Presentation of large PDA in infant and children are symptoms due to heart failure like-
- Presentation of large PDA in adults.
- It can cause left ventricular overload. However, if the condition goes uncorrected progressive rise in pulmonary artery pressure may occur that in turn can cause a reversal of shunt i.e. right to left-sided shunting.
- The right to left shunt can cause cyanosis and in later stages may progress to Eisenmenger syndrome.
References
- ↑ de Freitas Martins, Fernando; Ibarra Rios, Daniel; F. Resende, Maura Helena; Javed, Henna; Weisz, Dany; Jain, Amish; de Andrade Lopes, Jose Maria; McNamara, Patrick J. (2018). "Relationship of Patent Ductus Arteriosus Size to Echocardiographic Markers of Shunt Volume". The Journal of Pediatrics. 202: 50–55.e3. doi:10.1016/j.jpeds.2018.06.045. ISSN 0022-3476.
- ↑ Skelton R, Evans N, Smythe J (1994). "A blinded comparison of clinical and echocardiographic evaluation of the preterm infant for patent ductus arteriosus". J Paediatr Child Health. 30 (5): 406–11. doi:10.1111/j.1440-1754.1994.tb00689.x. PMID 7833075.