Congenital Heart Disease Patent Ductus Arteriosus (PDA) Etiology Usually closes after birth, adults are usually asymptomatic 80% of neonates <1200 grams Hemodynamically significant F>M Need antibiotic prophylaxis if unrepaired and complicated by Eisenmenger syndrome or cyanotic pulmonary hypertension, or within 6 months of surgical repair, or residual deficit after surgery Murmur Continuous machine-like murmur Best heard over left upper sternal border Small: Left infraclavicular region Moderate: wide pulse pressure, bounding pulses, laterally displaced apical impulse Large: LV overload in early childhood Tachycardia, dyspnea, poor growth Left to right shunt May radiate to the back Symptoms Differential Cyanosis Clubbed toes, normal fingers May develop pulmonary vascular congestion and eventual RHF May develop Endarteritis Diagnosis CXR: Calcification of the ductus arteriosus in adults Complications Treatment Prostaglandin E1 (alprostadil) to keep it open until surgical intervention Indomethacin < Ibuprofen Prostaglandin synthesis inhibitor more than 2 weeks: Unlikely to close, Surgical closure more than 6-8 months: Surgery Adults: Surgical, endovascular approach to close Anomalous Coronary Artery 2nd mcc of SCD with strenuous exercise in athletes behind HCM (17%) Usually, benign retroaortic course and 30-40 y/o Symptoms Exertional chest pain, syncope during exercise in a young individual Exertional syncope is never normal Diagnosis: Coronary CTA or MRA