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#Phase 2.2: Paediatrics > Atrial Septal Defect > Flashcards

Atrial Septal Defect Flashcards

1
Q

What is Atrial Septal Defect?

A

Hole between septum between the 2 atria

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2
Q

What is the normal embryological formation of the Septum? (5 steps)

A
  1. At start, L + R atria are one
  2. 2 walls grow downwards from top of heart (aka Septum Primum n Secondum)
  3. 2 walls fuse together w the Endocardial cushion @ middle
  4. Small hole left in Septum Secondum called: Foramen Ovale
  5. Foramen Ovale normally closes at birth
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3
Q

What happens when Foramen Ovale doesn’t close?

A

Patent Foramen Ovale… aka ASD

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4
Q

What does ASD lead to in terms of blood movement?

A

Shunt… aka blood moving between 2 atria

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5
Q

What shunt is most common in ASD? Why?

A

Left to Right, bc pressure in LA higher than RA

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6
Q

Does the shunt in ASD lead to Cyanosis?

A

No

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7
Q

Why does the shunt in ASD not lead to Cyanosis?

A

Blood still continues to flow from Pulmonary vessels to Lungs to get oxygenated

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8
Q

What conditions can ASD lead to? (2 things)

A
  1. RHF
  2. Pulmonary HTN

(bc increased blood flow to R heart –> overload + strain to R heart)

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9
Q

What are the types of ASD? (5 things)

A
  1. Patent Foramen Ovale (most common)
  2. Ostium secondum defect
  3. Ostium primum defect
  4. Sinus venosus defect
  5. Coronary sinus defect
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10
Q

What are the RF for ASD? (5 things)

A
  1. FHx
  2. Maternal smoking in 1st trimester
  3. Maternal alcohol + cocaine
  4. Maternal DM
  5. Maternal rubella
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11
Q

What are the CF of ASD in kids? (5 things)

A
  1. Usually asymptomatic (n only picked up on Antenatal scans / newborn exams)
  2. SOB
  3. Difficulty feeding
  4. Poor weight gain
  5. LRTI
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12
Q

How can a asymptomatic ASD present later in adulthood? (3 things)

A
  1. SOB
  2. HF
  3. Stroke
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13
Q

What are the features of an ASD murmur? (4 points)

A
  1. Mid-systolic
  2. Crescendo-decrescendo
  3. Loudest @ Pulmonary valve
  4. Fixed split S2
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14
Q

What are some differentials that present similarly to ASD? (4 things)

A
  1. AVSD
  2. VSD
  3. Innocent murmur (more softer n nasheedical)
  4. Pulmonary Stenosis murmur (more turbulent)
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15
Q

What is the GOLD standard investigation for Dx an ASD?

A

Transthoracic Echocardiogram

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16
Q

What does a Transthoracic Echocardiogram tell you about the ASD? (3 things)

A
  1. Size
  2. Direction of blood flow (using Doppler)
  3. Pulmonary artery pressure
17
Q

What other imaging can be used for ASD? (2 things)

A
  1. Cardiac MRI
  2. CXR
18
Q

What will a Cardiac MRI tell you about the ASD? (2 things)

A
  1. Identifies RV overload (in large ASD)
  2. Pulmonary vs Systemic blood flow ratio (aka Qp/Qs)
19
Q

What does the Pulmonary vs Systemic blood flow ratio (aka Qp/Qs) tell you about the ASD?

A

How significant shunt is

20
Q

What will a CXR tell you about the ASD?

A

Identifies cardiomegaly

21
Q

What size of ASD should be managed conservatively?

A

Under 5mm

22
Q

What are the CONSERVATIVE Mx options for ASD in KIDS?

A

Watch n wait: should close within 12 months of birth

23
Q

What is the CONSERVATIVE Mx options for ASD in ADULTS?

A

If no RHF CF –> ECHO every 2-3 yrs

24
Q

What are the MEDICAL Mx options for ASD? (2 things)

A
  1. Anti-arrhythmics
  2. Anticoag

(b4 definitive surgery)

25
Q

What is the point of Anticoag in ASD?

A

To reduce risk of TIA / stroke

26
Q

What are the MEDICAL Mx options for ASD presenting with HF?

A

Diuretics

27
Q

What is the definitive Tx for ASD?

A

Surgical closure

28
Q

What are the indications for Surgical closure of ASD? (5 things)

A
  1. 1cm +
  2. TIA / stroke
  3. Ostium primum defects
  4. Sinus venous defects
  5. Coronary sinus defects
29
Q

How can Surgical closure be carried out for ASD? (2 things)

A
  1. Percutaneously (transcatheter)
  2. Open chest (central stenotomy)
30
Q

What are the CI for Surgical closure of ASD?

A

Pulmonary HTN

31
Q

Why is Pulmonary HTN a CI for Surgical closure of ASD?

A

Can induce RV failure when ASD closed up

32
Q

What are the complications of Percutaneous Surgical closure of ASD? (3 things)

A
  1. Arrhythmias
  2. AV block
  3. Thromboembolism
33
Q

What are the complications of untreated ASDs? (5 things)

A
  1. Arrhythmias
  2. Pulmonary HTN –> Eisenmenger Syndrome –> Cyanosis
  3. HF (CF: Peripheral Oedema)
  4. AF / Atrial Flutter
  5. TIA / Stroke
34
Q

How does Pulm HTN lead to Eisenmenger Syndrome? (4 steps)

A
  1. Pulmonary pressure > Systemic pressure
  2. Shunt reverses –> R to L shunt
  3. Blood bypasses lungs
  4. Pt becomes Cyanotic
35
Q

What are the CF of Eisenmenger Syndrome? (5 things)

A
  1. Chronic cyanosis
  2. Exertional dyspnoea
  3. Syncope
  4. Increased risk of inf
  5. Increased pulm vasc resistance

#Phase 2.2: Paediatrics (18 decks)

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