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Paediatrics > Acyanotic congenital Heart Defects > Flashcards

Acyanotic congenital Heart Defects Flashcards

1
Q

What are some of the causes of congenital heart diseases?

A
  1. Maternal alcohol consumption
  2. Rubella in the first trimester
  3. Phenytoin ingestion in pregnancy
  4. Trisomy 21-at least 40% will have CHD
  5. Trisomy 13 and 18-at least 90% will have CHD
  6. Marfans syndrome
  7. Diabetic moms
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2
Q

What is the usual pressure in the right atrium?

A

5mmHg

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3
Q

What is the usual pressure in the right ventricle?

A

15-20mmHG

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4
Q

What is the usual pressure in the left atrium?

A

5-10mmHg

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5
Q

What is the usual pressure in the left ventricle?

A

60 mmHg

-it is usually 4 times higher than the right ventricle

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6
Q

What are a cyanotic heart defects?

A

These are congenital heart defects that do not cause cyanosis in babies
They are broken up into:
-acyanotic with left to right shunts
-acyanotic with normal pulmonary blood flow

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7
Q

Name acyanotic congenital defects with left to right shunts?

A
  1. VSD
  2. ASD
  3. AVSD
  4. PDA
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8
Q

HOW DO THE BABIES WITH LEFT TO RIGHT SHUNTS USUALLY PRESENT?

A
  • Interrupted feeds and sweating when eating which leads to failure to thrive
  • recurrence of LRTI
  • Chest deformities like Harrison’s sulcus, pectus carinatum, precordial bulge, chest asymmetry
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9
Q

Name the acyanotic congenital defects with normal blood flow?

A
  1. Coarctation of the aorta
  2. Atrial stenosis
  3. Pulmonary stenosis
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10
Q

In which babies does PDA occur in?

A

-preterm babies with respiratory distress

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11
Q

In preterm babies, how long does the patent ductus arterious remain open for?

A

For about a week after birth

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12
Q

What type of murmur do babies with PDA present with?

A

-systolic continuous murmur usually heard below the left clavicle

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13
Q

What is the management of PDA?

A

We usually give NSAIDS-like ibuprofen or indomethacin or paractemol

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14
Q

What is the management in infants?

A

They usually require surgical ligation or device closure before 6-12 months even if they are asymptotic

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15
Q

What are the presenting symptoms that we should look for in patients in PDA?

A
  1. Bounding peripheral pulses
  2. Wide pulse pressure
  3. Palpable dorsal is pedis
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16
Q

Where is the foramen ovale located?

A

Between the atria

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17
Q

What does prostaglandin E2 do?

A

It keeps the patent ductus arterious open

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18
Q

With the increased pulmonary volume what is the risk?

A

Pulmonary hypertension is a huge risk

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19
Q

When does a large VSD usually develop?

A

Between 2-6 weeks of life

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20
Q

What is the most common type of congenital heart disease?

A

Ventricular Septal Defect

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21
Q

Why would children experience failure to thrive in VSD?

A

Because they are breathless when eating

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22
Q

What murmur do we expect to hear in VSD babies?

A

Pansystolic murmur at the left sternal edge

-mid diastolic murmur if large VSD at the apex

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23
Q

What would we hear if there is pulmonary hypertension?

A

-A loud P2

24
Q

What co-existing issues should we suspect if the baby does not respond to anti-failure therapy?

A
  • coarcation of aorta

- PDA

25
Q

When do VSD’s normally close by themselves?

A

-by two years of life

26
Q

Why should we give prophylactic amoxicillin before teeth extraction?

A

To prevent infective endocarditis from occurring in the right ventricle(the ventricle opposite the defect)

27
Q

What two septal defects cause atrial septal defects?

A
  1. Ostium primum (in the left atrium)

2. Ostium secundum (in the right atrium)

28
Q

Why is there right ventricular hypertrophy in ASD patients?

A

Because of the increased volume into the pulmonary circulation

29
Q

What murmur can we expect with ASD?

A

-we can expect a grade2/6 pulmonary ejection systolic murmur with fixed splitting of the second heart sound(S2)

30
Q

What can we expect on Chest X-Ray?

A

Large pulmonary artery with plethoric lung fields

31
Q

What is the most common defect between ostium secundum and primum?

A

Ostium secundum is the most common defect and most require surgery or device closure before school going age

32
Q

What is a AVSD defect?

A

They are broken into partial or complete

33
Q

What is a partial AVSD?

A
  • It only involves the ostium primum ASD only and not the VSD
  • it is usually associated with mitral valve regurgitation which a left to right shunt from the left ventricle to the right atrium
34
Q

What syndrome is associated with AVSD?

A

-Down syndrome-at least 50% of the patient have Down’s syndrome

35
Q

What kind of murmurs can we expect from these patients?

A
  1. Pansystolic murmur at the left lower sternal border or apex due to mitral regurgitation
  2. Ejection systolic murmur due to increased blood flow through the pulmonary valve
36
Q

What is a complete AVSD?

A
  • Usually involves the ASD and VSD

- presents with a pansystolic murmur at the left lower sternal edge or the apex

37
Q

What can we expect to see on ECG?

A
  • left anterior hemiblock
  • left QRS axis between 0 and -90 degrees
  • RSr’ patten in lead V1 indicating right ventricular hypertrophy due top volume overload
38
Q

Who is affected the most in aortic stenosis?

A
  • it usually occurs in males, especially after the third decade of life
  • if it occurs in infancy it is most likely congenital-rheumatic fever
39
Q

How many leaflets are usually present in the aortic valve?

A

-3 leaflets (left, right and posterior leaflets)

40
Q

What murmur can we expect in an older child?

A
  • palpable thrill

- long ejection systolic murmur radiating from the second intercostal space to the neck (crescendo-decrescendo)

41
Q

What do we expect to see on the chest x-ray?

A

We can expect an enlarged proximal aorta

42
Q

What size are normal aortic valves? And what is the size of a stenosed valve?

A

Normal: 3-4 cm2
Stenosed: <1cm2

43
Q

What is a complication of aortic stenosis?

A

Microangipathic haemolytic anaemia which causes schistyocytes (breakdown of red blood cells)

44
Q

Is pulmonary stenosis mostly symptomatic or asymptomatic?

A

Mostly asymptomatic
But if symptomatic it causes right heart failure due to the right to left shunt that occurs through the foramen ovale causing cyanosis

45
Q

What kind of murmur do we expect in patients with pulmonary stenosis?

A

Ejection systolic at the left second ICS+ ejection systolic click

46
Q

What is the management of pulmonary stenosis?

A

Cardiac catheterisation- balloon valvuloplasty

47
Q

What does coarctation of the aorta mean?

A

-it means the narrowing of the aorta

48
Q

Where does the coarctation usually occur?

A

After the subclavian artery and before the patent ductus arterious

49
Q

How do we diagnose coarctation of aorta?

A

The arm pulses are usually more palpable than the femoral pulses
-there is a large pulse pressure between the systolic and diastolic pressures >20mmHg

50
Q

What murmur do we expect in coarcation of the aorta?

A

Systolic murmur at the back(between the spine and the left scapula)

51
Q

How many babies have associated abnormalities like ASD and VSD?

A

2/3 of babies

52
Q

What may present in older children and adults?

A

-headaches, chest pain and cerebrovascular accidents(like berry aneurysms because of the increased pressure)

53
Q

What can we expect on chest X-ray for older children and adults for coarctation of the aorta?

A
  • Left ventricular hypertrophy due to concentric hypertrophy-
  • the ascending aorta is enlarged and figure 3 sign
  • a big radiological sign is the notching of the inferior edges of the 3rd and 8th ribs
54
Q

What causes the notching of the inferior edges of the 3rd and 8th ribs?

A

-it is caused by enlarged collateral intercostal arteries

55
Q

By when should we ensure we do the elective surgical repair?

A

By 2 years

56
Q

When should we be worried by Takayasu’s?

A

If the child is presenting with congestive cardiac failure and is above 1 years old

57
Q

What are the chest wall deformities that children with acyanotic heart lesions present with?

A
  1. Harrisons sulcus
  2. Pectus excavatum
  3. Precocial bulge
  4. Chest wall asymmetry

Paediatrics (40 decks)

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