Cardiovascular Flashcards
What are the most common acyanotic congenital heart diseases?
- Ventricular septal defects
- Atrial septal defects
- Patent ductus arteriosus
- Coarctation of the aorta
- Aortic valve stenosis
What is the most common congenital heart disease type?
Ventricular septal defects (accounts for ~30%)
What are the most common cyanotic congenital heart diseases?
- Tetralogy of Fallot
- Transposition of the great arteries
- Tricuspid atresia
What is the difference between cyanotic and acyanotic heart diseases?
- Cyanotic = heart defects that reduce the amount of oxygen delivered to the rest of the body
- Acyanotic = heart defects where blood contains sufficient oxygen but is pumped throughout the body abnormally
What is a VSD?
Hole in the septum separating the ventricles of the heart
What is the murmur associated with VSDs?
Loud, harsh pansystolic murmur, loudest at the left lower sternal edge
What is the pathophysiology of VSDs?
Blood is shunted from the left to the right ventricle, this:
- Increases pressure on the right hand side of the heart
- Increases load delivered to the left side (more blood is pumped to the lungs and returned to the left side)
What is Eisenmenger’s syndrome?
- Due to prolonged pulmonary hypertension from left to right shunt
- Right ventricular hypertrophy and increased right ventricular pressure eventually exceeding the left ventricle and reversing the shunt
- Results in cyanosis and clubbing
- Indication for heart and lung transplant
How are VSDs classified?
Congenital and acquired (post MI impacting the septum)
What are congenital VSDs associated with?
Chromosomal disorders:
- Down’s syndrome
- Edward’s syndrome
- Patau syndrome
- Cri-du-chat syndrome
Congenital infections
Acquired causes
- Post-MI affecting the septum
When can VSDs be detected in utero?
During the routine 20 week scan
What are the post-natal presentations of VSDs?
Failure to thrive
Features of heart failure:
- Hepatomegaly
- Tachypnoea
- Tachycardia
- Pallor
Murmur
What are the complications of VSDs?
- Aortic regurg (poorly supported right coronary cusp resulting in cusp prolapse)
- Infective endocarditis
- Eisenmenger’s syndrome
- Right heart failure
- Pulmonary hypertension
What would ECG demonstrate in VSD?
- Left ventricular hypertrophy
- P pulmonale
- Biventricular hypertrophy
Which investigation is used to definitively diagnose VSDs?
Transthoracic echocardiogram
What is the management of VSDs?
Small VSDs that are asymptomatic usually close spontaneously and require simple monitoring
Moderate - large VSDs usually result in some degree of heart failure in the first few months:
- Nutritional support
- Medication for heart failure eg. diuretics
- Surgical closure of defect
Which is the most likely congenital heart defect to be found in adulthood?
Atrial septal defects
50% of patients are dead at 50 years
What are the three types of ASD?
- Ostium secundum (defect in septum secundum)
- Ostium primum (defect in septum primum)
- Patent ductus arteriosus
Ostium secundum more common
What can play a role in ASD development?
- Maternal alcohol consumption
- Rubella infection during pregnancy
- Maternal diabetes
What are the general features of ASDs?
- Ejection systolic murmur, fixed splitting of S2
- Embolism may pass from venous system to the left side of the heart causing a stroke
What are the features of ostium secundum ASD?
- Associated with Holt-Oram syndrome (tri-phalangeal thumbs)
- ECG: RBBB with RAD
What are the features of ostium primum?
- Present earlier than ostium secundum defects
- Associated with abnormal AV valves
- ECG: RBBB with LAD, prolonged PR interval
How are ASDs usually detected?
Often an incidental finding of ejection systolic murmur, loudest lower-left sternal edge due to flow of blood through pulmonary valve
- Patients can present as decompensated in heart failure
What is the management of ASDs?
Management depends on severity:
- Most managed conservatively
- Surgical closure may be necessary for larger defects (or those causing significant symptoms/ complications)
- Routine ECGs used for monitoring ASDs