BLONDER Flashcards
Most common congenital heart disease at birth
VSD
4 types of VSD
- Infundibular
- Membranous
- Inlet defect
- Muscular vsd
Infundibular VSD
below the aortic and pulmonary valves
leads to aortic regurg
Membranous VSD
deficiency in the membranous septum
Inlet defect VSD
Downs syndrome
muscular VSD
in the trabecular system
large VSD clinical presentation
usually early presentation with CHF in infancy or Eisenmenger’s in late childhood, early adulthood
Medium VSD clinical presentation
either asymptomatic or mild CHF in children, usually gets smaller with growth and may have AR
VSD sound in PE
holosystolic, left sternal border, 2-3rd intercostal space, thrill
tetrology of fallot
- Right ventricular outflow tract obstruction
- Ventral Septal Defect
- Aorta overrides VSD
- Concentric right ventricular hypertrophy
Patent foramen ovale
a foramen covered by the septum primum but is not sealed shut in 20% of normal subjects
How to diagnose an ASD
echocardiogram
Second most common adult congenital abnormality
ASD
Complications of ASD
o Atrial arrhythmias (atrial fibrillation)
o Paradoxical embolus- DVT then stroke
o Cerebral Abscess- infection is embolized across ASD to brain
o Right heart failure
o Pulmonary hypertension > Eisenmenger syndrome
Types of ASD
- Secundum
- Primum
- Sinus venosus
Secundum ASD
o Due to defects in the foramen ovalis. Usually not associated with other cardiac defects. More common in females.
Primum ASD
o Large. Almost always associated with defects in the AV vales or ventricular septum.
• Right above the ventricles
o AV canal, or endocardial cushion defect is the complete form
Sinus venosus
o Often associated with >90% with anomalous pulmonary vein insertion
o 2 types
o Superior sinus venosus- SVC defect
o Inferior sinus venosus- IVC defect
scimitar syndrome
- Partial anomalous venous return- to the systemic venous drainage, rather than directly to the left atrium
- Hypoplasia of a lobe of the right lung
- Thoracic aorta > Pulmonary artery collaterals
Pathophysiology of ASD
• The shunt depends on the size of the defect, the compliance of the right and left ventricles, and the phases of contraction- systole/diastole, atrial ventricular, early or late in phase
o Most shunts starts L to R, but all large shunts have some R to L
• Shunt flow leads to a useless circuit of blood through the defect
o Into the RA, RV, PA, LA, back to RA
• This leads to right heart volume overload, well tolerated for years, but can cause pulmonary hypertension and Eisenmengers
What are ASDs associated with?
• Usually associated with concomitant pulmonic valve stenosis or Eisenmengers
PE for ASD
o RV heave
o Palpable Pulmonary artery at upper LSB
Heart sounds of ASD
o Wide fixed split S2
o Increased P2 with pulmonary HTN
o S1 split with increase in Tricupsid component
Heart murmurs of ASD
o SEM Upper LSB from increased flow
o Early DM, upper LSB from PI secondary to pulmonary HTN
