Congenital Cardiovascular Disease Flashcards
what is congenital heart disease?
heart disease the patient is born with
what are the causes of of congenital heart disease?
- genetic defects
- chromosomal abnormalities
- intrauterine infection
- drugs
- maternal alcohol
- maternal diabetes
what are common classes of congenital cardiovascular abnormalities?
failure of septation, failure of development, failure to or incorrect rotation, abnormalities of the great vessels, failure of closure
what congenital defects result from failure to develop?
obstruction- tricuspid, pulmonary atresia, pulmonary stenosis
coarctation
hypoplasia- hypoplastic left heart
what congenital abnormalities arise from failure or incorrect rotation?
transposition of the great arteries TGA
congenitally corrected transposition of the great vessels
dextrocardia
what ways can congenital cardiovascular disease present?
incidental- lots result in heart murmurs which can be heard during auscultation
heart failure
central cyanosis
pulmonary hypertension
what symptoms could a patient with congenital heart disease present with?
normal heart failure symptoms difficulty feeding failure to thrive tachypnoea cyanosis clubbing squatting=tetralogy of fallot syncope
what congenital heart defects can a patient have if they are acyanotic and have shunts?
atrial or ventricular septal defects
persistent ductus arteriosus
what congenital defects are indicated by a patient who is acyanotic and has no shunts?
pulmonary stenosis
aortic coarctation
aortic/left heart obstruction
what congenital heart defects could a patient have if they are cyanotic and have shunts?
all with pulmonary hypertension
transposition of the great vessels
fallots tetralogy
what congenital heart defects could a patient have is they are cyanotic and have no shunts?
hypo plastic left heart
severe pulmonary stenosis
pulmonary/tricuspid atresia with or without infarct septum
what preventative measure can be taken for congenital cardiovascular disease?
foetal echocardiography
what palliative treatment can be provided for congenital cardiovascular disease?
allow growth for definitive treatment
maintain arterial duct
PA bonding
arterial septostomy
what are the methods of long term treatment for congenital cardiovascular disease?
creation of systemic to pulmonary shunt: subclavian, central pulmonary artery to aorta
-idea is constrict blood flow to pulmonary artery to reduce blood flow in through lungs
what definitive treatment is there available for congenital cardiovascular disease?
radical correction of TGA, tetralogy of fallot
percutaneous closure devices for: persistent ductus arteriosus, atrial and ventricular septal defects
what transplants can be carried out to treat congenital cardiovascular disease?
heart
heart and lungs for conditions complicated by pulmonary hypertension
what are the functional consequences of pulmonary hypertension? how does it arise?
- it makes radical correction pointless or dangerous, left to right shunt reversed to a right to left shunt leading to cyanosis
- arises as are ult of high flow through pulmonary bed and genetic influences
what are the 2 types of atrial septal defects?
ostium secundum
ostium primum
what are the functional complications of ostium secundum and primum ASDs?
secundum- partial right bundle branch block, right axis
primum- partial right BBB, left axis
how are atrial septal defects managed?
nothing done
percutaneous closure
how do patients with ASDs present? explain how patients with secundum and primum present
uncomplicated= heart failure or failure to thrive
secundum is usually uncomplicated
primum is complicated by other lesions= mitral valve clefts, anomalous venous drainage
what are the functional complications of Ventricular septal defects?
perimembranous is most common
can range fro trivial to large when associated with other lesions
small VSDs restrict shunt to trivial levels
large shunts- have a hydrostatic murmur
how are large shunt VSDs treated?
palliated until definitive treatment
what are the functional complications of PDA? explain the complications of both small and large
- if larger will present as heart failure with continuous murmur and wide pulse pressure
- can cause pulmonary hypertension and only show lower body cyanosis
-small causes characteristic continuous murmur with normal pulse pressure
how is PDA treated?
mainly closed percutaneously
in infancy prostaglandin inhibition may close duct
what is coarctation of the aorta?
large range of narrowing from complete interruption to small low grade stenosis
what are the functional complications of coarctation of aorta ?
- causes systemic hypertension in adults
- associated with intracranial aneurysms
- absent or delayed femoral pulses
what is the treatment for coarctation of the aorta?
balloon dilation
surgery
how does TGA present?
presents rapidly after closure of duct with blue and failing body if septum intact
how is TGA diagnosed?
echo diagnosis
what palliative treatment is available for TGA?
pharmacologic maintenance of arterial duct
atrial septostomy
radical switch procedure
Mustard procedure
what are the 4 features of tetralogy of Fallot?
pulmonary infundibular stenosis
overriding aorta
ventricular septal defect
right ventricular hypertrophy
what are the functional complications of tetralogy of fallot?
cause of cyanotic heart disease
severity determined by degree of RV outflow obstruction
squatting is characteristic since it raises systemic pressure
what complicates tetralogy of fallot?
pulmonary regurgitation
if severe causes RV dilation and venous thrombosis
what are the treatment options for tetralogy of fallot?
corrective surgery if possible
