Adult congenital heart disease Flashcards
What is congenital heart disease?
any structural heart abnormality that is present from birth
Name 4 common congenital heart malformations
atrial septal defect
ventricular septal defect
coarctation of aorta
Tetralogy of Fallot
Potential complications in adult congenital heart disease
endocarditis
right ventricular dysfunction
Eisenmenger syndrome
polycythaemia
arrhythmia
pregnancy risks
contraception
genetics
social issues
Describe atrial septal defect
(pre-tricuspid shunt)
high pulmonary flow
right heart dilatation
- right atrial dilation
- right ventricle dilation
- pulmonary artery dilation
When does atrial septal defect present?
young child - adult (not neonate)
How can small atrial septal defects present in young children and adults?
small = incidental murmur in child - paradoxical embolus stroke in adult
How can medium atrial septal defects present in young children and adults?
medium = recurrent pneumonia, poor growth and incidental murmur in child - exercise intolerance, recurrent pneumonia and atrial arrhythmia in adult
How can large atrial septal defects present in young children and adults?
large = exercise intolerance, fatigue and poor growth in children - atrial arrhythmia, tricuspid regurgitation, heart failure and pulmonary htn in adult
CXR signs in atrial septal defect in older child/adult
cardiomegaly
dilation of RA
dilation of RV
prominent main pulmonary artery
increased pulmonary vascular markings
[LA normal in size, aortic arch small/normal]
Atrial septal defect signs in older child/adult?
prominent RV impulse
soft, ejection systolic murmur - pulmonary area
widely split, soft S2, fixed in all stages od respiration
Atrial septal defect indications for closure
symptomatic
RA and RV enlargement
net left to right shunt Qp;Qs>1.5
no cyanosis at rest or exercise
systolic PA pressure <50% systemic pressure
PVR < 1/3 SVR
Describe ventricular septal defect
ventricular level shunt
high pulmonary blood flow
left heart dilatation:
- LA dilatation
- LV dilatation
Presentation of young child/adult with small ventricular septal defect
young child = incidental murmur
adult = incidental murmur, endocarditis
Presentation of neonate/young child/adult with medium ventricular septal defect
neonate = >4 weeks, incidental murmur, sweatiness with feeds
young child = poor growth, murmur, frequent chest infections
adult = incidental murmur, endocarditis
Presentation of neonate/young child/adult with large ventricular septal defect
neonate = >4 weeks, tachypnoea, poor feeding, failure to thrive
young child = frequent chest infections, exercise intolerance, fatigue, poor growth
adult = breathlessness, fatigue, heart failure, pulmonary htn
Indications for ventricular septal defect closure
symptomatic
LA and LV enlargement
net L to R shunt Qp:Qs>1.5
no cyanosis at rest or exercise
systolic PA pressure <50% systemic pressure
PVR <1/3SVR
What is the main complication from small ventricular septal defect?
infective endocarditis
Where would infective endocarditis vegetations occur in a patient with a small ventricular septal defect?
at the tricuspid valve
opposite or around the defect
on the aortic valve
How is infective endocarditis prevented in congenital heart disease patients?
good dental hygiene = best protection
avoid tattoos + piercing
prophylactic antibiotics for high risk congenital heart disease only (right to left shunts (cyanosis), valve replacements, previous endocarditis)
Describe Eisenmenger syndrome
typically presents in children and young adults who have uncorrected ventricular septal defect
progresses over time as a result of the effects of high blood pressure in the lungs due to congenital defects that cause a left-to-right shunt
Eisenmenger syndrome problems/considerations
polycythaemia
iron deficiency
acne
gout
hypertrophic polyarthropathy
high pregnancy risk
paradoxical embolus at IV sites
individual medical management of vasodilator therapy
arrhythmia risks
What is coarctation of the aorta?
discrete luminal narrowing anywhere in aorta
What is coarctation of aorta associated with?
bicuspid aortic valve
ventricular septal defects
What methods can be used to repair coarctation of the aorta?
end to end repair (resection)
left subclavian flap repair (neonate)
What are the 4 components of Tetralogy of Fallot?
ventricular septal defect
aortic override
pulmonary valve stenosis
right ventricular hypertrophy
What surgeries can be done in the 1st year of life to fix Tetralogy of Fallot?
RVOT enlargement
patch closure of VSD
patch enlargement of the PA if necessary
What physiological changes occur in the circulatory system during pregnancy?
increased cardiac output
increased heart rate
increased stroke volume
decreased pulmonary vascular resistance
What predictors of maternal risk can be used for adult congenital heart disease patients?
prior cardiac event (TIA, stroke, arrhythmia, heart failure)
NYHA>grade 2 pre-pregnancy
left heart obstruction - mitral or aortic stenosis, CoA
LV EF <40%
Which 2 heart defects cause definite high risks to pregnancy?
Eisenmenger
sevrere aortic stenosis
