Congenital heart defects

Question 1

Ventricular Septal Defect (VSD) risk factors

Answer 1

Premature birth, Trisomies (21, 18 and 13)

Question 2

VSD pathophysiology

Answer 2

A gap in the septum between the 2 ventricles of the heart.

Causes hypertrophy of atria and ventricles leading to pulmonary HTN and congestive heart failure.

Question 3

Clinical presentation of Ventricular septal defect (VSD)

Answer 3

Pan-systolic murmur at the lower left sternal border

Poor feeding

Failure to thrive

X-ray may show cardiomegaly “boot shaped heart”

Question 4

Complications of VSD

Answer 4

Eisenmengers, Endocarditis and Heart failure

Question 5

What is an atrial septal defect? (ASD)

Answer 5

Defect in the septum between the 2 atria causing a left to right shunt due to the higher pressure in the left atria

Question 6

Risk factors for ASD

Answer 6

• Maternal smoking in trimester 1
• Family hx of CHD
• Maternal diabetes
• Maternal rubella

Question 7

What type of mumur is heard in ASD?

Answer 7

Soft, systolic ejection murmur heard in 2nd ICS
Wide, fixed split S2

Question 8

Management of ASD

Answer 8

If small, can be managed conservatively and will close within 12 months of birth

Surgical closure, usually if ASD >1cm

Question 9

What are the 4 features of Tetralogy of Fallot?

Answer 9

• Overriding aorta
• Large VSD
• Pulmonary stenosis
• Right ventricular hypertrophy

Question 10

Risk factors for TOF

Answer 10

• more common in males
• rubella
• increased maternal age (over 40)

Question 11

What can be heard on auscultation in TOF?

Answer 11

Ejection systolic murmur in pulmonary region (caused by pulmonary stenosis)

Question 12

Management of TOF

Answer 12

Prostaglandin infusion PGE1 to maintain ductus arteriosus, beta blockers and morphine.

Surgical: repair under bypass age 3 months - 4 years. ICU post operatively

Question 13

What is Transposition of the great arteries?

Answer 13

Aorta rises from right ventricle and the pulmonary artery rises from the left ventricle

Question 14

Epidemiology/RFs for TGA

Answer 14

• More common in males
• Mum >40
• Rubella
• Maternal diabetes
• Alcohol consumption

Question 15

CXR finding of TGA

Answer 15

‘egg on a string’ due to narrowed mediastinum and cardiomegaly

Question 16

Clinical presentation of TGA

Answer 16

• cyanosis in first 24 hours of life
• Right ventricular heave (parasternal)
• Loud S2

Question 17

Patent ductus arteriosus (PDA)

Answer 17

Persistent connection between the aorta and pulmonary artery
Normal in utero but usually closes within first 10-15 minutes of life
Causes a left to right shunt

Question 18

What does a continuous machinery murmur at the left sternal edge usually indicate?

Answer 18

PDA

Question 19

Management of PDA

Answer 19

Cardiac catheterisation to close around 1 years old or sooner in more severe cases
Premature infants: Indomethacin or Ibuprofen inhibits prostaglandin and stimulates closure