Congenital heart defects

Question 1

What types of congenital defects are there

Answer 1

Acynotic and cyanotic

Question 2

What are the acyanotic conditions

Answer 2

VSD
ASD
Coarctation of the aorta
Aortic valve stenosis

Question 3

What is more common in adults ASD or VSD

Answer 3

ASD as it is more likely to present later in life

Question 4

What are the cyanotic conditions

Answer 4

tetralogy of Fallot
transposition of the great arteries (TGA)
tricuspid atresia

Question 5

What conditions are VSDs associated with

Answer 5

Downs syndrome
Edward syndrome
Patau syndrome
cri du chat syndrome

Question 6

When are VSDs detected

Answer 6

detected in utero during the routine 20 week scan. Post-natal presentations include:

Question 7

What are the post natal presentations of VSDS

Answer 7

failure to thrive
features of heart failure
hepatomegaly
tachypnoea
tachycardia
pallor
classically a pan-systolic murmur which is louder in smaller defects

Question 8

What is the treatment of small VSD

Answer 8

small VSDs which are asymptomatic often close spontaneously are simply require monitoring

Question 9

What happens in moderate to large VSDs

Answer 9

result in a degree of heart failure in the first few months
nutritional support
medication for heart failure e.g. diuretics
surgical closure of the defect

Question 10

What are the complications of VSD

Answer 10

Aortic regurgitation
Infective endocarditis
Eisenmenger’s complex
Right heart failure
pulmonary hypertension

Question 11

Why does aortic regurgitation occur in VSD

Answer 11

aortic regurgitation is due to a poorly supported right coronary cusp resulting in cusp prolapse

Question 12

What is eisenmengers complex

Answer 12

reversal of a left-to-right shunt in a congenital heart defect due to pulmonary hypertension. This occurs when an uncorrected left-to-right leads to remodeling of the pulmonary microvasculature, eventually causing obstruction to pulmonary blood and pulmonary hypertension.

Question 13

why does VSD cause Eisenmengers

Answer 13

due to prolonged pulmonary hypertension from the left-to-right shunt
results in right ventricular hypertrophy and increased right ventricular pressure. This eventually exceeds the left centricular pressure resulting in reversal of blood flow
this is turn results in cyanosis and clubbing
Eisenmenger’s complex is an indication for a heart-lung transplant

Question 14

What is the presentation of an atrial septal defect

Answer 14

Ejection systolic murmur
embolism may pass from venous system to left side of heart causing a stroke
Osmium secundum makes up 70% of ASDs

Question 15

What. is ostium secondum

Answer 15

An ostium secundum ASD is a hole in the center of the atrial septum. Normally, the right side of the heart pumps oxygen-poor blood to the lungs, while the left side pumps oxygen-rich blood to the body. An ASD allows blood from both sides to mix, causing the heart to work less efficiently

Question 16

How does ostium secundum show on ECG

Answer 16

RBBB with RAD

Question 17

What syndrome is associated with ostium secundum

Answer 17

Holt-Oram syndrome

Question 18

What is partial ASVD

Answer 18

inter-Atrial communication between bottom end of Atrial Septum and AV valves, with Abnormal AV valves, Tricuspid Mitral Valve with leaky tendency

Question 19

What are the clinical features of ASD

Answer 19

Asymptomatic, Recurrent Chest Infection and Wheeze, Arrhythmia for fourth decade onwards; Signs: ESM on Upper Left Sternal Edge due to increased flow across pulmonary valve from the L to R shunt, Fixed and widely split S2 (Often difficult to hear)
o Partial AVSD – Apical Pansystolic Murmur from AV regurgitation

Question 20

How to diagnose atrial septal defect

Answer 20

CXR
ecg
echo

Question 21

What will CXR show

Answer 21

Cardiomegaly, Enlarged Pulmonary Arteries, Increased Pulmonary Vascular Markings