Cardiac Conditions

Question 1

What are SMALL VENTRICULAR SEPTAL DEFECTS?

Answer 1

Small VSD = <3mm Aortic Valve

• Asymptomatic (innocent murmur)
• Loud pansystolic murmur at lower left sternal edge
• Loud = smaller defect
• Quiet second sound

These will close spontaneously
* Maintain good dental hygiene to reduce risk of infective endocarditis *

Question 2

What are LARGE VENTRICULAR SEPTAL DEFECTS?

Answer 2

Large VSD = >3mm

• Hear failure symptoms with breathlessness and faltering growth
• Recurrent chest infections
• Signs: Tachypnoea, tachycardia, hepatomegaly, active precordium
• Loud second sound from raised pulmonary arterial pressure
• Cardiomegaly, enlarged pulmonary arteries, oedema, biventricular hypertrophy

Management: Diuretics, surgery (to prevent Eisenmenger Syndrome), additional calorie input

Question 3

What is a PATENT DUCTUS ARTERIOSUS?

Answer 3

A continuous murmur beneath the left clavicle into diastole. Increased pulmoanry blood flow with Heart

• Presents with collapsing pulse
• Increased pulmonary blood flow with HF and increased pulmonary hypertension

Signs:

• Left subclavicular thrill
• Continuous ‘machinery’ murmur
• Large volume, bounding, collapsing pulse
• Wide pulse pressure
• Heaving apex beat

Question 4

What are the CYANOTIC Congenital Heart Diseases? (3)

Answer 4

• Tetralogy of Fallot (presents 1 - 2 months)
• Transposition of Great Arteries (around birth)
• Tricuspid Atresia
• (Pulmonary valve stenosis)
• The presence of cyanosis in pulmonary valve stenosis depends on the severity and other coexistent defects *

Question 5

What are the ACYANOTIC Congenital Heart Diseases? (5)

Answer 5

Most to least common:

• VSDs (Ventricular Septal Defects) [~30%]
• ASDs (Atrial Septal Defects) [More common in adults]
• PDAs (Patent Ductus Arteriosus)
• Coarctation of the aorta
• Aorta/Pulmonary valve stenosis

Question 6

What is the presentation of ATRIAL SEPTAL DEFECTS?

Answer 6

2 Types:
ASD Primum: Defect between atrial septum and AV valves. Abnormal valves = tends to leak
ASD Secondum: Defect in the centre of the atrial septum

Symptoms: Recurrent chest infections, arrhythmias, can be asymptomatic!

Signs: Ejection systolic murmur, fixed + widely split S2 sound, cardiomegaly, enlarged pulmonary arteries, increased pulmonary vascular markings

Management: Cardiac catheterisation around ages 3-5 to prevent right heart failure and arrhythmias in later life

Question 7

What is TETRALOGY OF FALLOT?

Answer 7

Presents between 1-2 months ~ 6 months

4 Features:

• Ventricular Septal Defect (VSD)
• Right Ventricular Hypertrophy
• Overriding aorta
• Pulmonary Stenosis (this determines the degree of cyanosis + clinical severity. Also determines the ejection systolic murmur)

Other features:

• ‘Boot-shaped’ heart from right ventricular hypertrophy
• Left-to-right shunt

Management: Surgical repair (taken in 2 parts), beta blockers from cyanotic episodes to decrease infundibular spasm

Question 8

What is TRANSPOSITION OF THE GREAT ARTERIES?

Answer 8

Aorta leaving the right ventricle, and pulmonary trunk leaves the left ventricle. Caused by failure of the aorticopulmonary septum to spiral during septation

Risk factor: Diabetic mother

Clinical Features: Cyanosis, tachypnoea, loud single S2, prominent right ventricular impulse, ‘egg-on-side’, on CXR.
* Apparent within hours of birth*

Management: Surgical correction; maintain ductus arteriosus with prostaglandins

Question 9

What is the management of a PATENT DUCTUS ARTERIOSUS?

Answer 9

Indomethacin or ibuprofen - given to the neonate to inhibit prostaglandin synthesis. This can close the connection in the majority of cases

Surgical closure to abolish lifelong risk of bacterial endocarditis and pulmonary vascular disease