cardiac septal defects

Question 1

ventricular septal defects

Answer 1

commonest cause of congenital heart disease
- close spontaneously in 50%

Question 2

ventricular septal defect causes

Answer 2

assoc with chromosomal disorders
- downs
- edwards
- patau
- cri-du-chat syndrome

congenital infections
acquired causes -> post MI

Question 3

VSD presentation

Answer 3

in utero at 20wk anomaly scan
post natal px -
- failure to thrive
- fx of heart failure - tachypnoea/cardia, hepatomegaly, pallor

pan-systolic murmur - louder in smaller defects

Question 4

management of ventricular septal defects

Answer 4

small/asymptomatic - close spontaneously, monitor

mod-large -> heart failure in 1st few months
- nutritional support
- meds for heart failure - diuretics
- surgical closure

Question 5

complications of ventricular septal defect

Answer 5

aortic regurgitation - cusp prolapse
infective** endocarditis**
Eisenmengers complex
right heart failure
pulmonary hypertension

Question 6

Eisenmenger’s syndrome

Answer 6

the reversal of a left to right shunt in a congenital heart defect due to pulmonary hypertension

• when uncorrected left-to-right shunt leads to remodelling of pulmonary microvasculature, eventually causing obstruction to pumonary blood + pulmonary hypertentions

Question 7

what is Eisenmenger’s syndrome assoc with

Answer 7

• ventricular septal defect
• atrial septal defect
• patent ductus arteriosus

Question 8

Eisenmenger’s syndrome features

Answer 8

original murmur may disappear
cyanosis
clubbing
right ventricular failure
haemoptysis
embolism

polycytaemia sx (due to chronic hypoxia)
signs of pulmonary hypertension
- RV heave
- raised JVP
- peripheral oedema

Question 9

Eisenmenger’s syndrome management

Answer 9

heart-lung transplant is required

prognosis - can reduce life by 20yrs, 50% mortality in preg

Question 10

atrial septal defect murmur

Answer 10

mid-systolic crescendo-decrecendo murmur

loudest at upper left sternal border

Question 11

ventricular septal defect murmur

Answer 11

pan systolic murmur
- loudest at L lower sternal border

Question 12

patent ductus arteriosus murmur

Answer 12

continous crescendo-decrescendo “machinery” murmur

Question 13

atrial septal defects

Answer 13

most likely congenital heart defects to be found in adulthood
- significant mortality, 50% dead at 50yrs

Question 14

types of atrial septal defect

Answer 14

ostium secundum - commonest (70%)

ostium primum

Question 15

atrial septal defect features

Answer 15

ejection systolic murmur, fixed splitting of S2

stroke - venous embolism passing to left side

Question 16

ostium secundum vs primum on ECG

Answer 16

secundum = RBBB with RAD

primum = RBBB with LAD, prolonged