Adult Congenital Heart Disease Flashcards
List some common defects
- Bicuspid aortic valve
- Atrial setal defect
- Ventricular septal defect
- Tetralogy of fallot
- Coarctation of aorta
What happens with bicuspid aortic valve?
- Turbulent flow causes valve thickening and stiffening
- Ultimately valvular dyfunction (earlier than typical degenerative aortic valve disease)
- Can be associated with aortic dilatation
- Can be associated with coarctation (narrowing)
- Treatment - as for degenerative aortic valve disease - AVR/aortic surgery
Atrial septal defect
- Often well tolerated until 4th/5th decade
- Closure indicated if right heart dilated (and becomes breathless on exertion)
- Percutaneous closure
- Surgical closure
Ventricular septal defect
Small VSDs may be well tolerated and may not need closure. Closure may be required if evidence of decompensation (dilated ventricles).
- Surgical closure
- Percutaneous closure
Tetralogy of fallot
Infants present with cyanosis (blueish cast to skin)
Children have tetralogy spells - cyanotic, tired/sleepy (unresponsive), irritable
Spells relieved by squatting
Right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, overriding aorta
Coarctation of aorta
Significant narrowing of descending aorta
Can present dramatically in infancy, can present later in life as HTN with murmur
Repair by stenting, surgical repair, may require further stenting later in life
What are long term complications of CHD?
- HF (drug therapy, cardiac resynchronisation therapy, left ventricular assist device, transplant)
- Valvular dysfunction (stenosis, regurgitation)
- Arrhythmias
Give examples of arrhythmias
Atrial - atrial fibrillation, atrial flutter, supraventricular tachycardia
Ventricular - vent tachycardia, vent fibrillation
Why arrhythmias?
- Atrial dilatation
- Ventricular dilatation
- Scar tissue following surgery
Treatment options for arrhythmias?
- Meds for tachyarrhythmias - BB, digoxin, amiodarone
- Pacemaker for bradyarrhythmias
- Implantable cardiac defibrillator - for ventricular arrhythmias, provides pacing capability too, can be combined with CRT
What are potential limitations in treating arrhythmias?
- Certain drugs CI’ed in structurally abnormal heart - flecainide, dronedarone
- Complex plumbing can limit pacing devices
Contraception in ACHD
- Needs to be reliable - pregnancy may be advised against or planned/timed
- Oestrogen-containing preps may be hazardous - HTN hazardous in repaired coarctation and aortic dilatation, thrombogenic - CI’ed
- Progesterone-only preps - short term window, depot and implant effiacacious and easy
- IUCD - intense vasovagal - problematic in Fontan circulation
Pregnancy in ACHD
- Haemodynamic changes - pregnancy, labour, delivery
- Increased risk to mother and foetus
- Risk of recurrence of congenital heart disease - certain defects may be familial e.g. bicuspid aortic valve
- Mother’s informed choice
- When is it not safe - risk of maternal death - severe pulmonary HTN/Eisenmenger’s syndrome (50%), severe obstructive lesions (17%)
- Timing of investigations, meds, timing of interventions/surgery
Exercise in ACHD
- Safe in symptomatic limits
- Change in exercise tolerance an important guide to timing of further investigatioon or treatment
- Heavy weights not good (esp in aortopathy)
- Breath holding not good in Fontan circulation
- Contact sport - warfarin, ICD
Endocarditis prophylaxis
- Previous endocarditis
- Valve replacements - mech/bio
- Less than 6 months of prosthetic material
- Residual intracardiac shunts at/near site of previous repair with prosthetic material/device
- Uncorrected cyanotic heart disease
