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MD3001 - Cardiology Disease and Pathology > Congenital Cardiovascular Disease > Flashcards

Congenital Cardiovascular Disease Flashcards

1
Q

What are congential heart defects?

A

Problems with the hearts structure that are present at brith

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2
Q

What are the main categories of defects of the heart?

A

Defects in the:

  • interior wall of the heart
  • valves inside the heart
  • arteries and veins that cary blood to the heart or the body
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3
Q

How common are CHDs?

A

8 out of every 1000 births

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4
Q

What are the 2 sub types of CHD?

A

Non-cyantoic

Cyanotic (blue coloured skin caused by lack of O2)

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5
Q

What are the non-cyanotic CHDs?

A
  • Ventricular septal defect
  • Atrial septal defect
  • Patent ductus arteriosus
  • Pulmonary stenosis
  • Aortic stenosis
  • Atrioventricular canal (endocardial cushion defect)
  • Ebstei’s anomaly (mild)
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6
Q

What are the cyanotic CHDs?

A
  • Tetralogy of Fallot
  • Total anomalous pulnoary venous return
  • Transposition of the great vessels
  • tricuspid atresia
  • Truncus arteriosus
  • Hypoplastic left heart
  • Pulmonary atresia
  • Ebstein’s anomaly (severe)
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7
Q

Acyanotic CHDs with shunt

A
  • Ventricular septal defect
  • Atrial septal defecr
  • Patent ductus arteriosus
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8
Q

Acyantoic CHDs without shunts

A
  • Coarctation of the aorta
  • Pulmonary stenosis
  • Aortic/left heart obstruction
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9
Q

Cyanotic CHDs with shunts

A
  • All but with PHT (Eisenmenger’s complex)
  • Transposition of the great vessels
  • FAllot’s tertralogy
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10
Q

Cyanotic CHDs without shunts

A
  • Hypoplastic left heart
  • Very sevre pulmonary stenosis
  • Pulmonary/tricuspid atresia without or without intact septum
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11
Q

What occurs in acyanotic conditions?

A
  • Increased pulmonary blood flow
    • Atrial septal defect
    • Ventricular septal defect
    • Patent ductus arteriosus
    • Atrioventricular canal
  • Obstruction of blood flow from the ventricles
    • Coarctation of the aorta
    • Aortic stensis
    • Pulmonary stenosis
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12
Q

What occurs in cyanotic conditions?

A
  • Reduced pulmonary blood flow
    • Tetraology of Fallot
    • Tricuspid atresia
  • Mixed blood flow
    • Transposition of great vessels
    • Total anomalous pulmonary venous return
    • Truncus arteriosus
    • Hypoplastic left heart syndrome
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13
Q

Give examples of genetic and chromosomal disorders that can cause heart problems

A
  • Downs Syndrome
  • DiGeorge Syndome
  • Edward Syndrome
  • Turner Syndrome
  • Marfan Syndome
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14
Q

Where do most extracardiac anomalies occur?

A

in the musculoskeletal system or are associated with a specific sundrome

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15
Q

Other major causes of CHD?

A
  • Drugs - retinoic acid
  • Chemicals
  • Alcohol - Foetal Alcohol Spectrum Disorder
  • Infection during pregnancy (rubella)
  • Poorly controlled blood sugar in women who have diabetets during pregnancy
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16
Q

Symptoms of CHDs

A
  • Depend on the condition
  • May not appear at birth
  • Some nerve cause a problem
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17
Q

Symptoms of heart failure in infants with CHD

A
  • Cyanosis (>5g/dl of deoxyghaemoglobin)
  • Rapid breathing (tachypnoea)
  • Extra work of breathing
  • Grunting (preventing lungs from collapsing)
  • Tachycardia
  • Poor blood circulation
  • Fatigue
  • Sweating
  • Enlarged liver
  • Murmurs
  • Poor capillary refill
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18
Q

Complications of CHDs

A
  • Faltering growth
  • Paradoxical embolus (venous to arterial)
  • Bacterial endocarditis
  • Pulmonary hypertension
  • Polycythaemia (blood = viscous and sludgy)
  • Haemoptysis (coughing up blood from the lungs)
  • Arrhythmias
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19
Q

What is the most common CHD?

A

Ventricular septal defect

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20
Q

What is the effect of a small ventricular septal defect?

A

no problems and may close on their own?

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21
Q

What is the effect of a medium ventricular septal defect?

A

Less liekly to close on their own and may require treatment

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22
Q

What is the effect of large ventricular septal defects?

A

allow a lot of blood flow from the left ventricle to the right ventricle. The left side of the heart must work harder than normal. Extra blood floe increases the pressure in the RHS iof the heart and lungs

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23
Q

What is a consequence of a ventricular septal defect not being closed?

A

High blood pressure can scar the arteries in the lungs leading to the complication of pulmonary hypertension and irreversible damagenleading to shunt reversal and Eisenmenger’s syndrome

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24
Q

How is a ventricular septal defect repaired?

A

Intervention radiology

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25
Q

What is the effect of a small atrial septal defect?

A

allows a little blood to leak from one atrium to the other. Doesnt affect how the heart works

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26
Q

What is the effect of medium and large atrial septal defects?

A

allows more blood to leak between atria. Treatment required using a catheter procedure or open-heart surgery

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27
Q

What occurs if there is a long-standing left to right shunt through the ASD

A

increased blood flow through the lungs can scar the arteries in the lungs leading to pulmonary hypertension/shunt reversal and Eisenmenger’s syndrome

28
Q

What are the subtypes of ASD?

A
  • Sinus venosus
  • Ostium secundum
  • ostium primum
  • unroofed coronary sinus
29
Q

What is Patent Ductus Arteriosus?

A

persistent communciation between the descending thoracic aorta and the pulmonary artery that results from failure of normal physiological closure of foetal ductus

30
Q

What is used to close a PDA?

A
  • IV indomethacin or iburofen if administered in the first 10-14 days of life
  • Catheter closure
  • Surgical ligation
31
Q

What is patent foramen ovale?

A

a flap like opening between the atroal and sepra primum and secundum at the location of the fossa ovalis that persists 1 year after birth

32
Q

How many people have PFO?

A

25%

33
Q

Why is PFO not considered to by an atrial septal defect?

A

no septal tissue missing and no signficiant shunting

34
Q

What is coarctation of the aorta?

A

Arch of the aorta hasn’t properly developed

35
Q

Where is a classic CoA located?

A

in the thoracic aorta distal to the origin of the left subclavian artery at the level of the ductal structure

36
Q

What is the effect of CoA?

A

significant afterload on the left ventricle, which results in increased wall stress and hypertrophy

37
Q

Clinical presentation of CoA?

A
  • Varies according to the degree of stenosis and associated abnormalities
  • Angina pectoris
  • leg claudication
  • Diminished femoral pulses
  • differential blood pressure between upper and lower limbs
38
Q

Treatment of CoA?

A
  • Primary surgical repair with excision of the coarction and end-to-end anastomosis
  • ballin angioplasty
  • subclavian flap repair - origin and proximal left subclavian artery is excised, opened up and sutured into the aorta

**If the subclavian is ligated, it is usually anastomosed onto the left common carotid artery

39
Q

Valve atresia?

A

This defect occurs if a valve doesnt form correctly and lacks a hole for blood to pass through (complex)

40
Q

Valve stenosis?

A

Defect occurs if the flaps of a valve thicken, stiffen or fuse together. Valve cannot fully open so heart works harder

41
Q

Valve regurgitation?

A

occurs if the valve doesn’t close tightly. Blood leaks back through the valve

42
Q

What is pulmonary stenosis?

A

Narrowing of the pulmonary valve

43
Q

Sign of pulmonary stenosis?

A

Heart murmur

44
Q

How to treat severe pulmonary stenosis?

A

Catheter procedure

45
Q

What occurs in aortic stenosis?

A

mild to severe obstruction of the LV outflow that may be associated with other left heart obstructive leisons, varying degrees of left heart hypoplasia or extracardiac malformations

46
Q

First line treatment of aortic stenosis?

A

Balloon aortic valvuloplasty

47
Q

What treatment is used for aortic stenosis if a balloon valvuloplasty doesnt work?

A

surgical repair or replacement

48
Q

What is the most complex heart defect?

A

Tetralogy of Fallot (TOF)

49
Q

What are the 4 defects combined in TOF?

A
  • Pulmonary valve stenosis
  • A large VSD
  • An overrising aorta
  • Right ventricular hypertrophy
50
Q

What is an overrising aorta?

A

aorta is located between the left and right ventrciles, directly over the VSD

51
Q

What is a tet spell?

A

episodes of profound cyanosis and hypoxia;

triggered by an event that slightly decreases oxygen saturation or that suddenly decreases sytemic vascular resistance or sudden onset of tachycardia or hypovolemia

52
Q

What is the palliative surgery for TOF?

A

Forming a side-to-end anastomosis between the sublavian artery and the pulmonary artery

Redirecting blood

53
Q

What is hypoplastic left heart syndrome?

A

Closure of the ductus arteriosus means blood flows to the lungs and then to the LHS of the heart where it is blocked and can’t circulate through the rest of the body

54
Q

How is HLHS treated?

A

Surgery

Heart transplant

55
Q

How is ductus arteriosus kept open at birth?

A

IV infusion of prostaglandin E1 to keep it open immediately after birth and let oxygen reach the body

56
Q

What is transposition of the great arteries?

A

Pulmonary arteries supplied by the left ventricle and the aorta by the right ventricle

57
Q

How do infants survive transposition of the great vessels?

A

If there is a shunt between 2 sides of the hear; ASD can be enlarged to allow free mixing for blood

58
Q

What is truncus arteriosus?

A

Origin of the ‘great vesses’ (pulmonary arteries and aorta) is abnormal. Both arise from a common trunk

59
Q

What occurs in truuncus arteriosus?

A

Blood from both ventricles mixes together as it all exits through the single valve exiting from the heart

60
Q

What is the treatment of truncus arteriosus?

A

Sewing a flexible tube wuth its own valve from the right ventricle to bring blood to the pulmonary arteries

61
Q

What is the primary anaomaly in ebstein’s anomaly?

A

tricuspid valve is leaky

62
Q

What is total anamolous pulmonary venous drainage?

A

pulmonary veins are not connected to the LA. Instead they are connected to one of the veins from the main circulation so blood drains back into the RHS of the heart

63
Q

What is a Atrioventricular septal defect?

A

Holes between the chambers of the right and left sides of the heart

64
Q

Who is AVSD common in?

A

People with Downs Syndrome

65
Q

What is Eusennmenger’s syndrome?

A
  • shunt reversal
  • large left to right shunt such as a large VSD
66
Q

What do patients with eisennmenger’s syndrome develop?

A

Pulmonary arterial hypertension to the point where pressure on the right exceeds the left and development of cyanosis

MD3001 - Cardiology Disease and Pathology (10 decks)

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