Cardiology Flashcards
What is the most common form of heart defect?
Ventricular Septal Defect
Pathophysiology of VSD
A congenital hole in the septum between the ventricles. Blood typically flows from left-right through the hole as there is increased pressure in the left ventricles therefore they remain acyanotic If severe, can cause pulmonary HTN as there is extra blood flow in the pulmonary vessels If this continues, pressure in the right heart may become higher than the left causing a right to left shunt: cyanosis - this is Eisenmenger’s syndrome
VSD causes a ____ to ____ shunt.
Causes a left to right shunt
Associated conditions with VSD
Down’s and Turner’s Syndrome
Moderate VSD can cause
Enlarged atria and ventricles can lead to pulmonary HTN and congestive heart failure
Severe VSD can cause
Severe pulmonary HTN and early onset heart failure
Risk factors for VSD
- Premature birth - Certain genetic conditions such as Down’s syndrome, Edward’s, Patau - Family history of congenital heart defects
Symptoms of VSD
Often can by symptomless but can have:
- Poor feeding
- Tachypnoea
- Dyspnoea
- Failure to thrive
Signs of VSD
Pansystolic murmur at the lower left sternal border + High resp rate / SOB
3 forms of investigations for VSD
Echo + ECG + Chest X-ray
Which Ix is used to confirm dx of VSD?
Echo
What might you see on X-ray for VSD?
Cardiomegaly
Initally you monitor the VSD - why?
Small VSDs often close spontaneously
Treatment of VSD
Diuretics + ACEi+ Surgical Repair (for large VSDs)
Tx of VSD : Diuretics - what for?
to relieve pulmonary congestion
Tx: ACEi - what for in VSD ?
to reduce systemic pressure
Name 3 complications of VSD
Eisenmengers - Endocarditis - Heart failure
What is Eisenmenger’s Syndrome?
-Left to right shunt causes pulmonary HTN -Right sided heart pressure now exceeds left sided heart pressure leading to an irreversible cyanotic shunt -Management is heart+lung transplant
Define Atrial Septal Defect (ASD)
Defect in the septum between the 2 atria causing a left to right shunt due to the higher pressure in the left atria
Pathophysiology of ASD
A congenital hole in the septum between the atria. This causes a left to right shunt due to higher pressure in the left atria compared to the right and so blood is still oxygenated and so there is no cyanosis However, over time this can cause strain on the right heart leading to right heart failure and pulmonary HTN This can again lead to Eisenmenger’s syndrome
Aetiology of ASD
- Maternal smoking in 1st trimester
- Family History of CHD
- Maternal diabetes
- Maternal rubella
Symptoms of ASD
Tachypnoea - Poor weight gain - Recurrent chest infections
Signs of VSD - auscultation ?
- Soft, systolic ejection murmur heard in 2nd intercostal space
- Wide, fixed split S2 sound
Ix for ASD
ECG + Echo