Common Cardiac Diseases Flashcards
What are septal defects?
hole in the heart - a gap between the:
1. 2 atria (atrioseptal defect)
2. 2 ventricles (ventriculoseptal defect)
3. at endocardial cushion (where all 4 meet)
What are vessel abnormalities?
- transposition of the great arteries
- coarctation of the aorta
- pulmonary stenosis
- patent ductus arteriosus
What are valve abnormalities?
- tricuspid atresia
- aortic stenosis
Major structural abnormalities?
- Fallot’s tetralogy
- hypoplastic left heart
Failure of transition?
- patent ductus arteriosus
- persistent foetal circulation
Which congenital structural lesions produce stenosis?
- Transposition of the great arteries
- Tetralogy of Fallot
- Critical pulmonary stenosis
What is meant by “duct-dependant” heart disease?
- Some structural abnormalities of the heart are incompatible with life outside the womb once the ductus arteriosus closes.
- This event is often delayed compared to normal, but inevitably the baby will collapse within the first 2-3 weeks of life
Note: Giving oxygen may precipitate/ accelerate duct closure
Acyanotic congenital heart diseases?
- pre-ductal coarctation of the aorta
- ventricular septal defect
- atrial septal defect
- atrioventircular septal defect
- patent ductus arteriosus
What are the 4 components of Tetralogy of Fallot?
- Pulmonary Stenosis
- Right ventricular hypertrophy
- ‘Perimembranous’ VSD
- Overriding Aorta
Incidence of TOF?
Usually presents in infancy/early childhood
Physical signs of TOF?
- persistent cyanosis
- the child may be noted to be dusky from early life, gradually increasing over time - an ejection systolic murmur corresponding to the pulmonary stenosis
- Polycythaemia occurs
- hyper-cyanotic spells, which may be the presenting feature
CXR of TOF?
shows boot shaped heart
Diagnosis of TOF?
echocardiogram
Treatment of TOF?
- definitive treatment - surgical
- medical management
- Antibiotic prophylaxis
- Anticoagulation
- Treatment of Cyanotic Spells
What are hyper-cyanotic spells in TOF?
severe episodes of severe cyanosis due to decreased pulmonary blood flow secondary to increased right ventricular outflow tract obstruction
- Right ventricular outflow obstruction tends to get worse over time, and acute episodes of “pulmonary infundibular spasm” occur.
Precipitation of tet spells?
Spells precipitated by activity e.g. feeding, playing
- and may last minutes and then resolve, or progress
Signs of hyper-cyanotic spells in TOF?
- deepening cyanosis
- agitation
- tachypnoea
- pallor
- ultimately floppiness and loss of consciousness
- with which brain damage may occur
Treatment of cyanotic spells?
- Put the child in a squatting or knee-chest position
– to increase systemic vascular resistance and promote systemic venous return to the heart - Give oxygen
- to decrease peripheral pulmonary vasoconstriction - Analgesia (e.g. morphine)
- to decrease release of catecholamines thereby decrease heart rate (increasing filling time) and relaxation of the infundibular spasm - i.v. fluid bolus
- to improve right ventricular preload
Congenital lesions which may give heart failure?
- VSD
- ASD
- PDA
- Coarctation of the aorta
What is ventricular septal defect?
A connection between the 2 ventricles causing left to right blood flow
- Commonest cause of heart failure in infancy
Note: A large ventricular septal defect does not produce a murmur in the newborn period because the initially high pulmonary vascular resistance results in minimal shunting across the defect
What does a VSD sound like?
The bigger the hole, the quieter the murmur
Note: Harsh pansystolic murmur loudest at left lower sternal edge