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Week 5 - Cardiology > Adult congenital heart disease > Flashcards

Adult congenital heart disease Flashcards

1
Q

What happens in undercirculation?

A

Low saturations, blue baby

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2
Q

What happens in over circulation?

A

Pulmonary vascular disease , unrestricted blood flow and they may need a band

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3
Q

In shunt lesions which chamber of the heart gets bigger?

A

The one receiving blood in diastole

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4
Q

What is the morphology of the right ventricle?

A
  • Trabeculated endocardium
  • Insertion of chordae to IVS
  • Moderator band
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5
Q

What is the morphology of the left ventricle?

A
  • Smooth endocardium

* Ellipsoid cavity

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6
Q

What is the most common atrial septal defect?

A

Secundum

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7
Q

What are the atrial septal defects?

A

•Secundum
•primum
(•sinus venosus and coronary sinus defects)

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8
Q

What is the shunt in an isolated secundum atrial septal defect?

A

Left to right

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9
Q

What would you find on examination in a patient with an secundum atrial septal defect?

A
  • Pulmonary flow murmur

* Fixed, split second heart sound

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10
Q

What could a secundum atrial septal defect lead to?

A
  • right ventricular failure
  • Tricuspid regurgitation (due to increased size of heart)
  • Atrial arrhythmias (due to fibrotic changes)
  • Pulmonary hypertension
  • Eisenmenger syndrome
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11
Q

What is the shunt in a ventricular septal defect?

A

Left to right

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12
Q

What would be found on examination in a patient with a ventricular septal defect?

A
  • Occasionally no murmur

* Pansystolic murmur

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13
Q

What may a ventricular septal defect lead to?

A
  • LV failure
  • Aortic valve regurgitation
  • RV outflow tract obstruction
  • Arrhythmia
  • Pulmonary hypertension
  • Eisenmenger syndrome
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14
Q

What is a juxta-ductal position of a coarctation of the aorta?

A

After the left subclavian artery

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15
Q

What are the sings of coarctation of the aorta?

A
  • upper body hypertension (can be different in the side of limbs)
  • rib notching may be present on a chest x ray
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16
Q

What is the cause of rib notching in the coarctation of the aorta?

A

Retrograde flow from high pressure anterior intercostal arteries to low pressure posterior

17
Q

What is the cause of rib notching in the coarctation of the aorta?

A

Retrograde flow from high pressure anterior intercostal arteries to low pressure posterior

18
Q

What are the surgical interventions for coarctation of the aorta?

A

Via thoracotomy:
•Subclavian flap
•End to end
•Jump graft

19
Q

What are the components of tetralogy of fallot?

A
  • Ventricular septal defect
  • Overiding aorta
  • right ventricular outflow tract obstruction
  • Right ventricular hypertrophy
20
Q

What are the components of tetralogy of fallot?

A
  • Ventricular septal defect
  • Overiding aorta
  • right ventricular outflow tract obstruction
  • Right ventricular hypertrophy
21
Q

What are the options for the operative surgeries for tetralogy of fallot?

A
  • BT shunt (will need a full repair later on)
  • complete repair- pulmonary artery and right ventricle enlarged using a patch, muscular obstruction removed, VSD closed
22
Q

What should you look out for with a repaired tetralogy of fallot?

A
  • Significant pulmonary regurgitation
  • Arrhythmia (particularly ventricular tachycardia)
  • Pulmonary arterial/branch PA stenoses
23
Q

Describe foetal circulation

A
  • In utero oxygenation is by the maternal placenta
  • Pulmonary circulation is minimal and at high resistance
  • Oxygenated blood returns to the right atrium via the inferior vena cava
  • It then bypasses the right ventricle and pulmonary artery via the foramen ovale
  • Of the blood that is pumped to the pulmonary artery via the right ventricle, most passes to the aorta via the ductus arteriosus
24
Q

What is the surgical treatment of the transposition of the great arteries?

A
  • Atrial switch

* Arterial switch

25
Q

What is a univentricular heart?

A

• on functional ventricle reliant on shunts for mixing of the blue and red blood

26
Q

What are the treatment options for univentricular heart?

A
  • first aim of surgery should be to create two functioning ventricles
  • If not feasible then a Fontan circulations will be created
27
Q

What is Fontan circulation?

A
  • The single functional ventricle is used to support the systemic circulation
  • the IV and the SVC are directly plumbed into the pulmonary arteries bypassing the heart so the blue blood does not enter the heart
28
Q

What are the issues with Fontana circulation?

A
  • Pulmonary circulation is dependent on high systemic venous pressure and low pulmonary vascular resistance
  • Anything that causes an imbalance can cause catastrophic haemodynamic compromise (PE, arrhythmia, dehydration, bleeding)
29
Q

What are the common issues in adult congenital heart disease?

A
  • Heart failure
  • Arrhythmia
  • Endocarditis
  • Pulmonary arterial hypertension

Week 5 - Cardiology (8 decks)

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