20.Congenital heart disease Flashcards
types causes of congenital heart defects
cyanotic
non cyanotic
cyanotic causes of congenital heart defects
tetralogy of fallot
transposition of great arteries
persistent truncus arteriousus
ebsteins anomaly
tricuspid atresia
non cyanotic causes of congenital heart defects
VSD ASD patent ductus arteriousus aortic stenosis pulmonary stenosis coarctation of the aorta
epidemiology of congenital heart defects
affects 4-9/1000 fulterm live born babies
most common dg congenital condition
risk factors of congenital heart defects
parent w/ congenital heart defect (higher risk in mothers)
intrauterine infections
intake of lithium/ alcohol during preg
genetic condtns
maternal phenylketonuria
lack of folic acid in first trimester assoc w/ neural tube defects
which genetic conditions show risk of congenital heart defects
down’s (21 trisomy
digeorge (22 del)
turner (loss of X)
what is digeorge syndrome
deletion of a small segment of chromosome 22 congenital heart problems, specific facial features, frequent infections, developmental delay, learning problems and cleft palate.
examples of duct dependant congenital heart disease
hypoplastic left heart syndrome
pulmonary atresia
transposition of great arteries
critical aortic stenosis
interupted aortic arch
sx children not dg at birth
murmurs tachycardia HF failure to thrive SOB cyanotic episodes during feeding
when are murmurs d/2 CHD heard
first week-month of life
why dont some pt w/ CHD present w/ murmurs
pulmonary vascular resistenc changes w/ cLOSURE OF DUCTUS ARTERIOUSUS
why do older children w/ cyanotic CHD squat
to improve venous return
investigations in CHD w/ severe R and CV distress
CXR,
blood gases,
assessment of renal function
assesment of electrolytes
assessment of other possible causes of
cardiovascular collapse, e.g full infection screen
cardiac catheterisation
echocardiography
management of CHD in abscence of sx`
prophylaxis of infectious endocarditis
management of CHD in Acute severe presentations
resuscitation
prostaglandin infusion for ductus dependant lesions
when is prostaglandin indicated
utilized to maintain the patency of the ductus arteriosus until surgical ligation is performe
when is balloon valvotomy indicated in CHD
if CHD causes imparied circulation and the oxygenation of the blood, or to put a strain
on the heart or lungs,
when is a heart transplant indicated
severe cases e.g. hypoplastic heart
what is Hypoplastic left heart syndrome (HLHS)
a rare congenital heart defect in which the left side of the heart is severely underdeveloped.
which CHD has infectious endocarditis as a complication
all except ASD
COMPLICATIONS OF CHD
infective endicarditis
failure to thrive
stroke d/2 embolism (in R-L shunts
cyanosis d.2 EISENMENGER COMPLEX
polycytemia d/2/ cyanosis in R-L shunts
what is eisenmenger complex
L-R shunts dont cause cyanosis but high volume pumped by the right side may result
inpulmonary hypertensionand, if this builds up and exceeds systemic pressure, the shunt may reverse from right
to left.
what is tetralogy of Fallot (TOF)
a cardiac anomaly that refers to a combination of four related heart defects that commonly occur together.
1) large ventricular septal defect (VSD), which is a hole between the two ventricles or pumping chambers in the heart; 2) pulmonary stenosis, which is narrowing beneath or in the blood vessel leading to the lungs; 3) overriding of the aorta, in which the aorta lies directly above the ventricular septal defect; and 4) as a result of these events, the right ventricle becomes thickened or hypertrophied.
ebstein’s anomaly
he leaflets are malformed and are positioned too low in the right ventricle. Sometimes, one of the leaflets is displaced downward into the ventricle, while another leaflet is larger than usual and may be abnormally attached to the wall of the ventricle. This causes enlargement of the atrium, and it can lead to congestive heart failure — a back-up of blood flow that results in a fluid buildup in the body.
