Congenital Heart Defect Flashcards
diagnostics for VSD
- CXR - Unreliable; may indicate LAE, RV hypertrophy, LV hypertrophy, or pulmonary artery enlargement
- Echo - Determines location and size
- MRI - Use if echo does not diagnose
- Cardiac cath : Used if echo/MRI did not diagnose, but still has pulmonary HTN
- ECG - LV hypertrophy; basically whole heart is enlarged
aycanotic conditions
- ASD
- VSD
- PDA
- PV Stenosis
- Coarctation of the Aorta
- Aortic Stenosis
cyanotic conditions
- Tetralogy of Fallot
- Pulmonary Atresia
- Tricuspid Atresia
- Hypoplastic Left Heart Syndrome Transposition of the Great Arteries
- Total Anomalous Pulmonary Venous Return
acyanotic heart disease pathology and cause?
- Caused by fetal heart malformation, can lead to HF
- ASD, PDA, and VSD
- All three cause L-to-R shunt
- oxygenated blood flows redundantly through pulmonary circulation
- becomes Eisenmenger syndrome over time
s/s of acyanotic heart disease
Sometimes asx, but can lead to heart failure, Eisenmenger syndrome
- Heart failure - poor feeding/failure to thrive, fluid retention, pulmonary congestion, hepatomegaly, rsp distress, elevated jugular venous pressure
- Eisenmenger syndrome - With exertion: cyanosis, palpitations dyspnea, chest pain, syncope
Left-to-Right Shunt Lesions
- atrial septal defect (ASD)
- ventricular septal defect (VSD)
- atrioventricular septal defect (AV canal)
- patent ductus arteriosus (PDA)
- outflow obstruction
- pulmonary stenosis
- aorti stenosis
- coarctation of aorta
A hole in the heart wall dividing left/right atria (left-to-right shunt)
atrial septal defect
- at the site of the foramen ovale and ostium secundum
- MC ASD - accounts for 10-15 % of congenital heart defects
- Associated with fetal alcohol syndrome
which ASD type?
Ostium secundum
- at the level of the TV and MV, “endocardial cushion defect
- found in 25 % of Down’s Syndrome; still fwer cases for for congenital heart defects
Ostium primum
s/s of ASD
- Fixed, split S2 and pulmonic ejection murmur (louder with age)
- Infants and children :Respiratory infections, Failure to thrive
- Adults (before 40): Palpitations, exercise intolerance, dyspnea, fatigue
dx for ASD
- CXR
- R heart dilation
- prominent pulmonary vascularity - TEE
- visualize size and location accurately - Right heart catheterization
ASD - Increased oxygen saturation in which parts of the heart with R heart cath?
R atrium
R ventricle
pulmonary artery
tx ASD
Percutaneous surgical closure
- asx child with a large hemodynamically “significant” defect - elective closure at 1-3 yrs before late complications occur (RV dysfunction and dysrhythmias)
- Or closure of a mod-large defect when the child is 4-6 y/o (defects >8 mm unlikely to close on their own)
- Adults: surgery in cases of RVE, paradoxical embolism, R-to-L shunt
hole in the septum dividing the two lower chambers of the heart (ventricles)
ventricular septal defect (VSD)
VSD - More blood pumped into the lung and pulmonary artery, causing what conditions
- Heart failure
- Pulmonary HTN
- Arrhythmias
- Stroke
2 main VSD types
- Membranous - upper septum (most common)
- Muscular - lower septum
- Inlet - in the posterior portion of the V septum beneath the TV
Most common congenital heart disease, accounts of 25% of CHD
VSD
sizes of VSD
- Small - moderate VSD : 3-6mm; asx and 50% will close spontaneously by age 2yrs.
- Moderate – large VSD, almost always have sx and will require surgical repair.
s/s VSD
- asx
- At birth: Holosystolic murmur (loud, high-pitched) located at LLSB
- Size of defect
- Small: asx, murmur
- mod-large: sweating, poor feeding/ failure to thrive, rsp infections. Murmur + thrill, and diastolic rumble in mitral area
- CHF - dyspnea, persistent cough, pulmonary vascular resistance
- Eisenmenger’s syndrome
tx VSD
- MC close on their own
- Rx for sx pts:
- Anticongestives
- Diuretics (reduce system overload)
- Higher calorie feeds (calories for Heart and to Grow) - surgery
- Repair larger shunts by age 2 (prevent pulm HTN)
- Patch closure over VSD (preferred tx)
- Transcatheter closure: Mesh to close VSD (higher risk)
indications for surgical closure VSD
- Large VSD w/ medically uncontrolled symptomatology & continued FTT.
- Pulmonary HTN
- Aortic insufficiency
- LA/LV dilation
Persistence of the normal fetal vessel that joins the PA to the Aorta.
patent ductus arteriosus (PDA)
PDa nornally closes when?
1st wk of life
PDA is MC in which sex?
female > male (2:1)