Blonder - Adult Congenital Heart Disease

Question 1

Are volume or pressure problems more serious?

Answer 1

Pressure problems are far worse than volume problems; pts can live for a very long time with volume problems, but resistance problems cause severe complications

Question 2

How common are ASDs?

Answer 2

Second most common congenital heart disease, after bicuspid aortic valve

Question 3

What is the most common type of ASD? Which pts are the most commonly affected? Are they associated with other defects?

Answer 3

Secundum ASD accounts for 70% of all ASDs. They are more common in women and usually not associated w/ other cardiac defects

Question 4

Describe Primum ASDs

Answer 4

Less common than other ASDs, 15-20% incidence. Tend to be large. Almost always associated w/ defects in AV valves or VSDs.

Question 5

What is the most rare type of ASD?

Answer 5

Sinus venosus defect, 5-10% of total defects. Often associated with anomalous pulmonary vein insertion.

Question 6

What is the pathophysiology of sinus venosus defects?

Answer 6

One or more of the four pulmonary veins inserts into the R heart instead of the L heart. This effectively creates a L to R shunt

Question 7

What do shunts depend on?

Answer 7

Size of defect, elasticity of ventricles, and phases of contraction

Question 8

What conditions can be associated with ASDs?

Answer 8

Arrhythmias
Stroke
Paradoxical stroke
Systemic emboli
Migraine cephalgia
Pulmonary hypertension (can lead to Eisenmenger's syndrome)