Congenital CV Conditions Flashcards
Name 9 congenital CV conditiosn
Tetralogy of Fallot Ventricular Septal Defect (VSD) Atrial Septal Defect (ASD) Coarctation of the Aorta Double Aortic Arch Transposition of the Great Vessels Aberrant Subclavian Artery Patent Ductus Arteriosus Bicuspid Aortic Valve
What are the 4 characteristics of the tetralogy of fallot
- VSD
- Aorta overiding the VSD
- Pulmonary Stenosis
- Right Ventricular Hypertrophy
What causes the tetralogy of fallot?
An abnormality in the seperation of the truncus arteriosus into the aorta & pulmonary trunk
What are the symptoms of the tetralogy of Fallot?
Pulmonary Stenosis Murmur Cyanosis Clubbing RV heave Small children may show agitation, crying, feeding difficulty, failure to thrive and squatting (they do this because it increases TPR)
How would you investigate tetralogy of fallot/
CXR - Boot shaped heart
Echo - Degree of Stenosis
CT/MRI - Helps you plan surgery
FBC - Polycythaemia
What treatments can be given for tetralogy of fallot?
O2 and morphine acutely
Surgery to close the VSD and correct the pulmonary stenosis
B-blockers to reduce the strain on the right ventircle in particular
How does a VSD arise non-congenitally?
The ventricular septum can rupture in an MI
What are symptoms of VSD?
Heave
Systolic Thrill
Pansystolic Murmur
cysanosis & dyspnoea with occasionally severe heart failure
How do we investigate/treat a VSD?
An ECG, CXR & Echo
Medical treatment until it closes spontaneously and failing that surgery
In what section of the atrial septum is are ASDs most often found?
The upper part or ostium secundum
What are the sympoms/signs of an ASD?
Cyanosis - arrhythmia - Haemoptysis - Chest pain - Dyspnoea
Pulmonary Hypertension - High JVP - Pulmonary Ejection Murmur - Atrial Fibrillation
How do we investigate/treat and ASD?
ECG - CXR - Echo
Treat with a transcatheter closure or surgical closure
What is coarctation of the aorta>
A narrowed Aorta, mainlt on the arch close to the ligamentum arteriosus
What are the signs/symptoms of a coarctated aorta?
Heart Failure - Failure to Thrive Radial-Radial and Radial-Femoral delay Weak Femoral Pulse + Cold Legs Systolic Murmur Hypotension in lower limbs + ~hypertension above coarctation
What is a double aortic arch?
A 2nd arch grows from the ascending aorta and passes behind the trachea & oesophagus before rejoing the left
This can cause difficulty swallowing and breathing
What is transposition of the great vessels:
Due to the neural crest cells migrating defectively and the aorticopulmonary septum failing to spiral.
The Aorta feeds off the RV & the Pulmonary trunk off the LV
What are the symptoms of great vessel transposition?
Cyanosis.
Regularly comes with ASD, VSD & PDA which are needed to keep blood passing between the circulations and the patient alive
What is an aberrant subclavian artery:
The right 4th aortic arch and dorsal aorta regress abnormally.
So the right subclavian emerges from the aortic arch on your left side & crosses behind the oesophagus to supply the right arm.
What is patent ductus arteriosus? (PDA)
The ductus arteriosum (connecting aorta & pulmonary trunk) fails to close & become the ligamentum arteriosum after birth
What are the symptoms of PDA?
Icnreased work of breathing
Poor weight gain
Congestive heart failure as you age
Continuous murmur and large pulse pressure
What can a bicuspid aortic valve develop and how can we fix it?
Aortic Stenosis
Aortic Regurgitation
Aortic Dissection
Aortic Valve Replacement Surgery
How do we investigate and fix a coarctated Aorta?
By CXR (rib notching) and CTA or MRA.
We can fix it with bypass surgery or angioplasty + Stenting.
What is persistant truncus arteriosus?
A failure of the aorticopulmonary septum to form leading to a combined pulm trunk and aorta along with a VSD at their base
How does Persistant Truncus Arteriosus present?
Cyanosis - HF within weeks - Wide Pulse Pressure - Loud Second Heart Sound - Systolic Ejection Murmur - Pulm Hypertension
How do we investigate and treat Persistant truncus arteriosus?
An ECHO and CXR Surgery: - Repair VSD - Add Pulm Artery - The Truncus Arteriosus becomes the Aorta
How do we investigate Transposition of the great vessels?
CXR - Egg on a string heart
Echo
How do we treat transposition of the great vessels?
Surgery
In the mean time prostoglandins to keep the ductus arteriosus from closing
How do we investiate and treat PDA?
CXR/ECG/ECHO - all show LVH
Surgery if after birth
Prostoglandin synthesis inhibitors if you catch it neonatally or in premature babies
