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Aygestin 5 mg
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Most popular medical Questions
Is mitral valve prolapse (MVP) always pathologic?Some studies show that up to 13% of normal children have some degree of posterior leaflet prolapse on echocardiography. There likely is a spectrum of anatomic abnormalities, the most minor of which are a variation of normal. Those children with clinical features of mitral valve insufficiency constitute the pathologic category. Whenever auscultation reveals the classic findings of MVP, referral to a pediatric cardiologist is recommended. This allows for evaluation of the child for possible accompanying cardiac abnormalities (e.g., mitral insufficiency, secundum atrial septal defects) and confirmation of the diagnosis.
What connective tissue diseases may be associated with MVP?
Marfan syndrome, Ehlers-Danlos syndrome, pseudoxanthoma elasticum, osteogenesis imperfecta, and Hurler syndrome.
Do patients with MVP require prophylaxis against subacute bacterial endocarditis?
This is controversial. The incidence of endocarditis in patients with MVP and systolic murmur is 1 in 2,000 per year. Three factors-male gender, advanced age, and the presence of systolic murmur-seem to be associated with an increased risk of endocarditis in patients with MVP. Some experts argue that all patients should receive treatment, and others recommend selectively treating only patients with MVP and systolic murmur (mitral regurgitation) or thickened leaflets.
Can a patient with heart disease simultaneously be polycythemic and iron deficient?
Yes. Patients with cyanotic heart disease may develop both clinical entities. Initially, as a response to cyanosis, the hematocrit rises. In patients with iron deficiency, the hematocrit may remain elevated, and the mean corpuscular volume will be lower than normal. Detailed studies of iron stores often reveal a concurrent deficiency. Those children with a history of poor nutrition and blood loss (e.g., previous surgery) are especially at risk for developing iron deficiency.
What are the most common vascular rings and slings?
Vascular rings occur when the trachea and/or the esophagus are encircled by aberrant vascular structures. Vascular slings are compressions (typically anterior) that are caused by non-encircling aberrant vessels.
How often does a PDA reopen after indomethacin therapy?
Reopening after successful closure with indomethacin occurs in approximately 25% of infants (33% of infants 1,000 gm). The ductus is more likely to reopen when indomethacin therapy is initiated beyond the first week of life. In most cases, permanent constriction does not occur after a single dose; second and third doses are recommended at 12 and 36 hours after the initial dose.
When should the ductus arteriosus be surgically ligated?
Surgical ligation is generally indicated in symptomatic infants who have failed two courses of medical management, including indomethacin. Although controversial, surgery is commonly chosen for infants weighing ?1,000 gm in whom there has been a single "failed-course" of indomethacin.
What are the contraindications for indomethacin therapy?
Indomethacin is contraindicated if the blood urea nitrogen level is 30 mg/dL, the creatinine level is >1.8 mg/dL, the platelet count is 60,000/mm3, and if there is evidence of a bleeding diathesis.
How do an ostium primum and an ostium secundum defect differ?
Atrial septal defects are categorized in large part by their location. Defects may be isolated to the atrial septum itself, or they may extend into the ventricles (e.g., endocardial cushion defects). An ostium secundum is an isolated defect that involves a persistently enlarged opening at the fossa ovalis, which is approximately in the center of the septum. An ostium primum defect is located more inferiorly and is part of an atrioventricular(AV) canal defect, often in association with a regurgitant mitral valve.
How do the presenting symptoms of ventricular septal defect (VSD) and atrial septal defect (ASD) differ?
VSD: In an infant with a large VSD, signs indicative of congestive heart failure generally appear at 4-8 weeks of age, when the pulmonary vascular resistance drops and pulmonary blood flow increases. Congestive heart failure can occasionally be seen at 1-2 weeks of age in infants with large shunts in whom vascular resistance falls more quickly. The child with a small VSD may have a systolic murmur during the first few weeks of life. These infants do not develop congestive heart failure, and spontaneous closure often occurs.
ASD: Most children with an isolated ASD are not diagnosed until they are 3-5 years old. The majority are asymptomatic at the time of diagnosis. Rarely, infants with an ASD demonstrate signs of congestive heart failure during the first year of life. The congestive heart failure is due to a large left-to-right shunt and increased pulmonary blood flow, and it may be associated with failure to thrive or recurrent lower respiratory infections.
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