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Cardiovascular System > Congenital heart defects > Flashcards

Congenital heart defects Flashcards

1
Q

What are the groups of causes of CHDs?

A

Genetic

Environmental

Maternal infections

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2
Q

What are three genetic conditions that give CHDs? Which CHDs do they each give?

A

Down’s syndrome - atrioventriclar septal defect

Turner’s syndrome - coarctation of aorta

DiGeorge syndrome - tetralogy of fallot

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3
Q

What are the environmental causes of CHDs?

A

Teratogens e.g. drugs, alcohol

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4
Q

What are two examples of maternal infections that cause CHDs?

A

Rubella

Toxoplasmosis

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5
Q

What are the categories of CHDs?

A

Acyanotic

Cyanotic

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6
Q

What are the defects involved in acyanotic CHDs?

A

Stenosis, obstruction

Or opening

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7
Q

What is the direction of blood flow across openings in acyanotic CHDs?

A

Left-to-right shunts

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8
Q

How are left-to-right shunts acyanotic?

A

Oxygenated blood from lungs is travelling back to the lungs

no deoxygenated blood travelling to body

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9
Q

Why does blood move from the left side of the heart to the right side of the heart in left-to-right shunts?

A

Left side of heart is at higher pressure than right side

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10
Q

What are seven examples of acyanotic CHDs?

A

Atrial septal defect

Ventricular septal defect

Patent ductus arteriosus

Aortic stenosis

Coarctation of aorta

Mitral stenosis

Pulmonary stenosis

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11
Q

What is an atrial septal defect (ASD)?

A

Persistent opening in interatrial septum after birth

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12
Q

What is the most common site of an ASD?

A

Foreamen ovale

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13
Q

What are ASDs caused by?

A

Septum primum being resorbed too much
or
Septumum secundum being too short

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14
Q

What does the amount of blood moving through an ASD depend on?

A

Size of opening

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15
Q

What does the RV experience with ASDs? Why?

A

Volume overload

due to extra blood entering RA from LA, then RV

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16
Q

How does the RV respond to volume overload?

A

Dilates

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17
Q

What can dilation of the RV lead to?

A

Right-sided heart failure

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18
Q

What happens to blood flow in the pulmonary circulation with an ASD?

A

Increased blood flow through pulmonary circulation

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19
Q

What can increased pulmonary blood flow in an ASD lead to?

A

Pulmonary hypertension

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20
Q

What are VSDs?

A

Abnormal opening in ventricular septum

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21
Q

Where are VSDs most common?

A

Membranous portion of ventricular septum

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22
Q

How does the LV respond to volume overload?

A

Dilates

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23
Q

What does dilation of the LV lead to?

A

Left sided heart failure

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24
Q

What does the LV experience with VSDs? Why?

A

Volume overload

increased blood flow in RV, pulmonary circulation, LA, then LV

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25
Q

What may increased blood flow through the pulmonary circulation with a VSD lead to?

A

Pulmonary hypertension

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26
Q

What is a patent ductus arteriosus (PDA)?

A

Ductus arteriosus fails to close after birth

persistent communication between pulmonary artery and descending aorta

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27
Q

What does the pulmonary circulation experience with PDA?

A

Volume overload

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28
Q

What may volume overload in the pulmonary circulaton with PDA lead to?

A

Pulmonary hypertension

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29
Q

What is the cause of congenital aortic valve stenosis?

A

Bicuspid form of valve instead of tricuspid

narrower opening

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30
Q

How does congenital aortic stenosis affect blood flow?

A

Increases resistance to blood flow out of the LV

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31
Q

In what direction does blood shunt in PDA? Why?

A

From aorta to pulmonary artery

aorta is at higher pressure than pulmonary artery

31
Q

What do the LA and LV experience with PDA?

A

Volume overload

33
Q

How does pulmonic stenosis affect blood flow?

A

Increases resistance to blood flow out of RV

34
Q

What happens to the RV with pulmonic stenosis? Why?

A

RV has to contract harder to generate higher pressure to push blood through pulmonic stenosis
RV hypertrophies

35
Q

What is coarctation of the aorta?

A

Narrowing of aortic lumen

36
Q

What are the causes of pulmonic stenosis?

A

Pulmonary valve stenosis

Pulmonary artery narrowing

37
Q

What happens to the LV with coarctation of aorta? Why?

A

LV has to contract harder to generate higher pressures to pump blood into aorta
LV hypertrophies

38
Q

What forms around the aorta with coarctation of aorta? Why?

A

Collateral arteries

to bypass the narrowing

39
Q

What type of shunt do cyanotic CHDs involve?

A

Right-to-left shunts

40
Q

What do right-to-left shunts require? Why?

A

Opening - for blood to pass through from right side of heart to left side

Distal obstruction - to give increased resistance to blood flow out of RV, so blood moves from RV to LV instead

41
Q

Why are right-to-left shunts cyanotic?

A

Deoxygenated blood from body is entering systemic circulation
instead of to the lungs

42
Q

What is cyanosis?

A

Blue-purple discolouration of skin and mucous membranes

43
Q

What is the cause of cyanosis?

A

High levels of deoxygenated Hb in the blood

44
Q

What are five examples of cyanotic CHDs?

A

Tetralogy of Fallot

Transposition of great arteries

Tricuspid atresia

Pulmonary atresia

Hypoplastic left heart syndrome

45
Q

What are the four defects in Tetralogy of Fallot?

A

VSD
Over-riding aorta
Pulmonic stenosis
RV hypertrophy

46
Q

What is the effect of the over-riding aorta in tetralogy of fallot?

A

Deoxygenated blood from RV enters aorta

enters systemic circulation

47
Q

What is the effect of pulmonic stenosis in tetralogy of fallot?

A

Increased resistance to blood flow out of RV

48
Q

What causes RV hypertrophy in tetralogy of fallot?

A

RV has to contract harder to generate higher pressuers to pump blood through pulmonic stenosis

49
Q

What does the amount of blood shunting from the RV to the LV depend on in tetralogy of fallot?

A

The size of the VSD

The extent of the pulmonic stenosis

50
Q

What is transposition of the great arteries?

A

Aorta arises from RV

Pulmonary artery arises from LV

51
Q

How does transposition of the great arteries affect blood flow?

A

Have two separate circuits of blood flow

rather than two circuits in series

52
Q

What the two separate circuits of blood flow with transposition of the great arteries?

A 
LA - oxygenated blood 
LV - oxygenated blood
Pulmonary artery - oxygenated blood
Pulmonary veins - oxygenated blood
LA - oxygenated blood
RA - deoxygenated blood
RV - deoxygenated blood
Aorta - deoxygenated blood
Vena cavae - deoxygenated blood
RA - deoxygenated blood
53
Q

Why does a foetus with transposition of the great arteries survive till birth?

A

Due to the shunts in foetal circulation

  • foramen ovale
  • ductus arteriosus

Form communication between the two circuits of blood flow

54
Q

Why is transposition of the great arteries problematic after birth?

A

Shunts close

loss of communication between two circuits of blood flow

55
Q

When might transposition of the great arteries not be as much of a problem after birth?

A

Shunts remain open
e.g. patent foramen ovale
PDA

56
Q

What is tricuspid atresia?

A

Complete absence of tricuspid valve

57
Q

How does tricuspid atresia affect blood flow?

A

No blood flow into RV

58
Q

How does tricuspid atresia affect the RV? Why?

A

RV is hypoplastic - underdeveloped or absent

because it didn’t have any blood to contract against

59
Q

What is required for a foetus with tricuspid atresia to survive? Why?

A

ASD
allows blood flow from RA to LA

VSD
allows blood flow from LV to RV to pulmonary artery to lungs to be oxygenated

60
Q

Why does blood flow from RA to LA with tricuspid atresia?

A

Blood cannot flow into RV

only route for blood flow is into LA

61
Q

Why does blood flow from the LV to RV with tricuspid atresia?

A

RV isn’t receiving any blood from RA

LV is at higher pressure than RV

62
Q

What is an alternative to the VSD with tricuspid atresia?

A

PDA

63
Q

How is tricuspid atresia cyanotic?

A

Deoxygenated blood moves from RA to LA
to LV
to aorta and systemic circulation, some of it

64
Q

What is pulmonary atresia?

A

Sealed pulmonary valve

65
Q

How does pulmonary atresia affect blood flow?

A

No blood flow into pulmonary trunk

66
Q

What is required for a foetus with pulonary atresia to survive? Why?

A

ASD
Allows blood flow from RA to LA

PDA
Allows blood flow from aorta to pulmonary artery

67
Q

Why does blood flow from RA to LA with pulmonary atresia?

A

Increased resistance to blood flow out of RV, into RV

Less resistance to blood flow into LA

68
Q

Why does blood shunt from the aorta to the pulmonary trunk with pulmonary atresia?

A

Because pulmonary artery isn’t recieving any blood
aorta is at higher pressure than pulmonary artery
blood flows down the pressure gradient

69
Q

Why is cyanosis seen with pulmonary atresia?

A

Because deoxygenated blood is going from RA to LA
to LV
to aorta and systemic circulation, some of it

70
Q

What is hypoplastic left heart syndrome (HLHS)?

A

LV and ascending aorta are under-developed

aortic and mitral valves are stenosed or sealed

71
Q

What is essential for a foetus with HLHS to survive?

A

ASD
allows blood flow from LA to RA

PDA
allows blood flow from pulmonary trunk to aorta

72
Q

Why does blood flow from LA to RA with HLHS?

A

Blood cannot flow into LV

only route for blood flow is into RA

73
Q

Why does blood flow from pulmonary artery into aorta with HLHS?

A

Because aorta isn’t receiving any blood

pulmonary artery is at higher pressure than aorta

74
Q

What is the role of the RV with HLHS?

A

Support systemic circulation

75
Q

Why is cyanosis seen with HLHS?

A

Mixing of oxygenated and deoxygenated blood in RA
oxygenated from LA
deoxygenated from venae cavae
enter RV, pulmonary trunk and aorta

76
Q

What happens to the LV with congenital aortic stenosis? Why?

A

LV has to contract harder to generate more pressure to push blood through stenosed valve
LV hypertrophies

76
Q

How does coarctation of the aorta affect blood flow?

A

Increases resistance to blood flow in the aorta

increases aortic pressure, afterload

Cardiovascular System (22 decks)

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