Congenital cardiac abnormalities Flashcards
What are the main types of VSD?
Subaortic
Perimembranous
Muscular
What is VSD associated with?
Down’s
Turner’s
What is the presentation of VSD?
Pansystolic murmur- harsh, loudest at lower left sternal edge
Poor feeding
Dyspnoea, tachypnoea
Failure to thrive
LR shunt- right heart failure, pulmonary hypertension
Severe- heart failure
What is the management of VSD?
Closure- trans catheter or surgical
What is a complication of VSD?
Eisenmenger syndrome
What is Eisenmenger’s syndrome?
Pressure in R heart greater than L heart, so shunt reverses R to L –> cyanosis
What is the presentation of ASD?
Generally well in early childhood
Failure to thrive, poor feeding, dyspnoea
Wide fixed splitting of 2nd heart sound
Pulmonary flow murmur- cresendo decrescendo murmur
L–> R shunt- right heart failure, pulmonary hypertension
What is the management of ASD?
Good chance of spontaneous closure
Closure- trans catheter, surgical
What are the complications of ASD?
AF
Heart failure
Pulmonary hypertension
Eisenmenger’s syndrome
What is AVSD?
Single AV valve with ostrium primum ASD and high VSD
What is AVSD associated with?
Down’s
What is patent ductus arteriosus?
Connection between pulmonary trunk and descending aorta- usually closes with first few days due to prostaglandins
Who is PDA common in?
Pre term babies
What is the presentation of PDA?
Left subclavicular thrill
Continuous murmur
Large volume bounding collapsing pulse
What is the management of PDA?
Indomethacin- works in majority of cases
Closure with umbrella device
What is coarctation of the aorta?
Congenital narrowing of descending aorta
What is coarctation of the aorta associated with?
Turner’s
Males > females
What is the presentation of coarctation of the aorta?
Heart failure Radio femoral delay Weak femoral pulses Hypertension in arms, hypotension in legs Midsystolic murmur, maximal over back
What is th management of coarctation of aorta?
Mild= watch and wait Severe= prostaglandin A to keep PDA open until surgery
What are the pathologies in tetralogy of Fallot?
VSD
Overriding aorta
Pulmonary stenosis
RV hypertrophy
What are the risk factors for Tetralogy of Fallot?
Maternal rubella
What s the presentation of Tetralogy of FAllot?
Ejection systolic murmur
Heart failure before 1 yo
Cyanosis
Tet spells- R to L shunt becomes worse upon exertion
What investigations are done for tetralogy of FAllot?
Echo and Doppler
CXR- boot shaped heart
What is th management of tetralogy of FAllot?
Total surgical repair by open heart surgery
What is transposition of the great arteries?
Aorta connected to RV and pulmonary trunk to LV
What is essential for survival with TGA?
Shunt between circulations- ASD, VSD, PDA
What is the presentation pf TGA?
Failure to thrive, cyanosis, tachycardia
What is the diagnosis and management of TGA?
Often diagnosed during pregnancy
Immediate arterial switch procedure
What is aortic stenosis associated with?
William’s
What is the presentation of aortic stenosis?
Usually asymptomatic
Ejection systole murmur- upper R sternal border, radiation to carotids
Slow rising pulse, narrow pulse pressure
What is the presentation of severe aortic atenosis?
Reduced exercise tolerance
Exertional chest pain
Syncope
What investigations are done for aortic stenosis?
Echo
ECG
Exercise tolerance test
What is the management of aortic stenosis?
Percutaneous balloon valvuloplasty
Surgical valvotomy
Valve replacement
What is associated with pulmonary stenosis?
Noonan
Tetralogy of Fallot
What is the presentation of pulmonary stenosis?
Mild= asymptomatic
Ejection systolic murmur- upper left sternal border. radiation to back
Severe- severe external dyspnoea, fatigue, raised JVP, RV heave and hypertrophy
How is pulmonary stenosis investigated?
Echo
What is the management of pulmonary stenosis?
Mild= watch and wait
Balloon valvuloplasty
Failure= open heart surgery
What is Ebstein’s anomaly?
Low insertion of tricuspid valve resulting in large R atrium and small ventricle
What is Ebstein’s anomaly associated with?
Lithium in utero
Wolff Parkinson White
What is the management of Ebstein’s anomaly?
Surgery
