pediatrics
Patent Ductus Arteriosus (PDA)
Symptoms and Signs of PDA
Clinical presentation depends on patent ductus arteriosus size and gestational age at delivery. Infants and children with a small PDA are generally asymptomatic; infants with a large PDA present with signs of Heart failure (eg, failure to thrive, poor feeding, tachypnea, dyspnea with feeding, tachycardia). Preterm infants may present with respiratory distress, apnea, worsening mechanical ventilation requirements, or other serious complications (eg, Most children with a small PDA have normal first and second heart sounds and peripheral pulses. A grade 1 to 3/6 continuous murmur is heard best in the upper left sternal border (see table). The murmur extends from systole to beyond the second heart sound (S2) into diastole and typically has a different pitch in systole and diastole. Full-term infants with a significant PDA shunt have full or bounding peripheral pulses with a wide pulse pressure. A grade 1 to 4/6 continuous murmur is characteristic. If the murmur is loud, it has a “machinery sounding” quality. An apical diastolic rumble (due to high flow across the mitral valve) or gallop rhythm may be audible if there is a large left-to-right shunt or heart failure develops. Preterm infants with a significant shunt have bounding pulses and a hyperdynamic precordium. A heart murmur occurs in the pulmonary area; the murmur may be continuous, systolic with a short diastolic component, or only systolic, depending on the pulmonary artery pressure. Some infants have no audible heart murmur. 