Congenital Heart Defects (The Bare Minimum) Flashcards
type of murmur in PDA?
continuous “machine like” murmur
loudest under left clavicle
other presenting features of PDA?
often asymptomatic if small and can close spontaneously
generally doesnt cause cyanosis but can do eventually if not corrected
can be asymptomatic until adulthood then cause heart failure
symptoms include:
- SOB
- difficulty feeding
- poor weight gain
- LRTI
diagnosis of PDA?
ECHO
doppler during ECHO can assess size of shunt
how is PDA managed if symptomatic?
NSAIDs can close PDA pharmacologically (eg ibuprofen or indomethacin)
if associated with another congenital heart defect amenable to surgery then prostaglandin E1 is useful to keep duct open until surgery
how is asymptomatic PDA managed?
can be monitored up to 1 year old and see if it closes on its own
if it hasnt closed by 1 year then its closed surgically
most likely congenital heart defect to be found in adulthood?
ASD
examination features in ASD?
can be asymptomatic
ejection mid-systolic murmur heart best at upper left sternal border
fixed split second heart sound (S2)
2 types of ASD?
ostium primum ostium secundum (70% of ASDs,)
ECG features of ostium primum?
RBBB with LAD
prolonged PR interval
ECG features of osttium secundum?
RBBB with RAD
presenting symptoms of ASD in children?
SOB
difficulty feeding
poor weight gain
LRTI
presnting symptoms of ASD in adults?
heart failure
dyspnoea
stroke
complications of ASD?
stroke (DVT becomes an embolus and travels to right side of heart, through ASD to left side then up to brain)
AF
atrial flutter
pulmonary hypertnesion and right sided heart failure (blood shunted from left to right causing increased pressure on right side)
eisenmenger syndrome
what is eisenmenger syndrome?
where pressure builds up so much in right side of heart that the pressure becomes higher than the left side so the shunt changes from left > right to right >left
how is ASD managed?
can watch and wait if small and asymptomatic
can be surgically corrected via transvenous catheter closure or open heart surgery
anticoagulants/antiplatelets used in adults to reduce stroke risk
what syndrome is associated with ASD?
downs
also associated with atrioventricular septal defect
most common congenital heart disease?
VSD
what syndromes are associated with VSD?
downs edwards pataus cri-du-chat turners?
other associations with VSD?
congenital infections
post-MI
how does VSD present?
often asymptomatic initially and patients can present in adulthood possible symptoms in newborns - poor feeding - dyspnoea - tahcypnoea - failure to thrive can have symptoms of heart failure
examination findings in VSD?
pan-systolic murmur heard best at left lower sternal border in 3rd/4th intercostal space
can have systolic thrill on palpation
how can VSD (or ASD) be picked up?
during 20 week antenatal scan
ECHO in childhood/adulthood when presenting with symptoms
possible complications of VSD?
aortic regurgitation eisenmengers right heart failure pulmonary hypertension endocarditis
management of VSD?
small, asymptomatic VSDs with no signs of pulmonary hypertension or heart failure can just be monitored, often close spontaneously
can be corrected surgically with TV catheter closure or open heart surgery
main heart defect associated with turners?
coarctation of aorta
examination features of coarctation of aorta?
crescendo-decrescendo systolic murmur at upper left sternal edge
weak femoral pulses
high blood pressure in limbs supplied by arteries that branch off before the narrowing and low BP in limbs supplied by branches after narrowing
systolic murmur heard best below left clavicle and below left scapula
symptoms of coarctation of aorta?
tachypnoea increased work of breathing poor feeding grey and floppy baby other signs may develop over time including left ventricular heave and underdevelopment of limbs where there is reduced blood flow
management of coarctation of aorta?
some can be left until adulthood without causing an issue
some need emergency surgery shortly after birth
management while waiting for surgery in cases of critical coarctation of aorta where there is risk of heart failure and death?
prostaglandin E used to keep ductus arteriosus open which allows some blood flow through PDA into the systemic circulation distal to the coarctation
surgery then done to correct coarctation and to ligate the PDA
4 features of tetralogy of fallot?
VSD
overriding aorta
pulmonary valve stenosis
RVH
what is overriding aorta?
entrance to aorta is further to the right than normal, above the VSD meaning that when the right ventricle contracts and sends blood upwards towards the pulmonary trunk, some of the deoxygenated blood enters the aorta
direction of blood shunt in tetralogy of fallot?
right to left
- bc of pulmonary stenosis causing increased resistance to flow and higher pressure in right side of heart
how is tetralogy of fallot diagnosed?
ECHO (doppler done during)
CXR shows “boot shaped heart” due to RVH
examination features of tetralogy of fallot?
ejection systolic murmur heard best at left sternal border (due to pulmonary stenosis)
cyanosis
may develop signs of heart failure before 1 year or older if less severe
signs and symptoms of tetralogy of fallot?
cyanosis (due to right to left shunt) clubbing poor feeding poor weight gain "tet spells"
what are tet spells?
intermittent symptomatic periods where the right to left shunt is worsened causing a cyanotic episode
can be precipitated by physical exertion, crying, waking etc
symptoms of tet spells?
child becomes irritable, cyanotic and short of breath
can lead to reduced consciousness, seizures and potentially death
management of tet spells?
older children = squat
younger children = knees to chest
can give oxygen, beta blockers, fludis, morphine, sodium bicarb or phenylephrine
management of tetralogy of fallot?
prostaglandin infusion to maintain DA allowing blood to flow into pulmonary arteries
total surgical repair via open heart surgery is definitive treatment
when does tetralogy of fallot present?
1-2 months
what can present similarly to tetralogy of fallot and how can they be differentiated?
transposition of great vessels
TGV presents in first days of life
TOF present at 1-2 months
cyanotic vs non-cyanotic congenital heart diseases?
cyanotic = tetralogy of fallot, transposition of great vessels non-cyanotic = PDA, ASD, VSD, coarctation
