incomplete fusion of septum secundum & septum primum - those in hypercoagulable state at increased risk for stroke d/t emboli being pushed into systemic circulation

ASD, VSD, Tetralogy Flashcards by Emma Osowski

primum ASD

incomplete fusion of septum primum & the AV endocardial cushions

common in down syndrome

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secundum ASD

most common

excessive resorption of septum primum or interrupted septum secundum development

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patent foramen ovale

incomplete fusion of septum secundum & septum primum

those in hypercoagulable state at increased risk for stroke d/t emboli being pushed into systemic circulation

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sx & PE findings with ASDs

sx: exertional dyspnea, heart failure
PE: systolic ejection murmur, fixed split S2

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what do you see on ECG with ASDs?

incomplete or complete RBBB
RAD in secundum ASD (LAD in primum)
RVH
R atrial enlargement
Afib or flutter

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what do you see on CXR with ASDs?

enlarge pulmonary arteries
increased pulmonary vascularity
enlarged R ventricle
enlarged R atrium

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transthoracic echo with ASDs

saline injection w/ bubble contrast can demonstrate R to L shunt ; pulsed & color flow doppler

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TEE

transesophageal echo
-used if transthoracic echo quality is not optimal

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who should be treated with ASDs?

left to right shunts over 1.5:1
leads to RV volume overload if left untreated
pulm HTN precludes closure if pulm systolic pressure > 2/3 of systemic systolic pressure

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complications of untreated septal defects

Afib
heart failure
paradoxical systemic embolization

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Down’s Syndrome & heart defects

AtrioventricularSD 45%
VSD 35%
ASD 8%
patent ductus arteriosus 7%
-Tetralogy of Fallot 4%

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type A, outflow tract VSD

rare; in ventricular septum directly below the pulmonary valve

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type B, membranous VSD

in membranous septum, in upp ventricular septum, near valves ; most commonly operated on

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type C, inlet VSD

near atrioventricular canal

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type D, muscular VSD

in the lower muscular portion of ventricular septum; most common VSD; large # of them close spontaneously

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complete AVSD

central endocardial cushion defect allows blood to flow b/n all 4 heart chambers / one common atrioventricular valve instead of separate valves

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most commonly occurring congenital heart defect

VSD

VSD in a baby presentation

poor eating, failure to thrive, fast tachypnea, dyspnea, easy tiring

VSD in a child presentation

dyspnea on exertion, not gaining weight, dyspnea when eating or crying

VSD in adult presentation

dyspnea on exertion, orthopnea, irregular heart beat, fatigue/weakness

small shunt VSDs

loud, harsh holosystolic murmur in left 3rd & 4th interspaces along the sternum

large shunt VSDs

RV volume & pressure overload, pulmonary regurg
- late finding of cyanosis

what do you see on ECG with VSDs

right, left or biventricular hypertrophy

what do you see on CXR with VSDs

LVH, left atrial enlargement, enlarged pulmonary arteries & increased pulmonary vascularity

what pressure makes a VSD inoperable?

PA pressure/systemic pressure greater than 0.67 is inoperable

large VSD prognosis

heart failure / survival beyond 40 years is unusual without tx

surgical management of VSD

- left to right shunt greater than 1.5 & pulm systolic pressure less than 2/3 of systemic systolic pressure

list some cyanotic heart diseases

- tetralogy of fallot - transposition of the great arteries - truncus arteriosus - tricuspid atresia

transposition of the great arteries

aorta & pulmonary artery switch places -detected prenatally or shortly after birth -prompt surgical correction

truncas arteriosus

normal mitral & tricuspid valves but only 1 valve b/n aortic & pulmonic valves - needs prompt surgical correction

tricuspid atresia

hypoplastic R ventricle - tx w/ prostaglandin to maintain patent ductus arteriosis to supply blood to the lungs

Tetralogy of Fallot

VSD with R ventricular outflow obstruction secondary to infundibular stenosis - RVH - overriding aorta in 50%

Tetralogy severities

- lesser obstruction: left to right shunt, allows for oxygenation - great obstruction: right to left shunt, cyanosis

congenital disorders associated with Tetralogy

- Down's syndrome - DiGeorge syndrome -velocardiofacial syndromes

PE findings with Tetralogy

- crescendo-decrescendo harsh systolic ejection murmur - loudest at left mid to upper sternal border - radiates posteriorly - normal S1 & single S2 d/t diminished P2 - cyanosis of lips & nail beds

Tet spells

- hypercyanotic episodes precipated by sudden increase in R to L shunting of blood elicited by feeding/crying - squatting releases this

what do you see on ECG with Tetralogy

-RVH -RAD -RBBB after repair -QRS > 180 msec

what do you see on CXR with tetralogy

- boot shaped heart - prominent R ventricle - concave R ventricular outflow tract - enlarged R sided aorta sometimes

Tetralogy echo pre repair

- unrestricted VSD - R ventricular infundibular stenosis - enlarged aorta

Tetralogy echo post repair

- pulm valve regurg - R ventricular & L ventricular function - aortic regurg

types of repair for Tetralogy

- VSD patch - RV outflow tract patch - takedown of arterial-pulmonary artery shunt