Congenital Heart Disease

Subsets: (see also notes below)

Important points in the history

Important points on examination

Relevant investigations

Indications for admission


(a) Cyanotic congenital heart disease presenting as cyanosis in the newborn

Cyanosed term infant who does not pink-up with oxygen. He/she may or may not have other cardiac signs such as a cardiac murmur, and may appear otherwise well.

Examples of defects
Transposition of the great arteries, Pulmonary atresia, Tetralogy of Fallot, Tricuspid atresia, Ebsteins anomaly

Note: Cyanotic congenital heart disease may be difficult to distinguish from persistent pulmonary hypertension of the newborn (PPHN) due to persistent foetal circulation.
Suspect PPHN if there has been foetal distress, the need for resuscitation at birth, or neurological signs of birth asphyxia.


(b) Congenital heart disease causing neonatal collapse

Baby presents in shock/ state of collapse in the first 2 weeks after patent ductus shuts.
These babies are difficult to distinguish clinically from those with collapse from other causes eg. sepsis/ inborn errors of metabolism.


Prostaglandins to maintain the patency of the ductus arteriosus as a temporary measure are not available. The surgery that would be required following this is also unavailable in Malawi.

(c) Cyanotic congenital heart disease presenting as cyanosis in the older child

Management of spell

Long-term Management of TOF

(d) Congenital heart disease causing cardiac failure

Examples of defects


(e) Asymptomatic murmurs

Some general points for children with structural heart disease: