Congenital heart disease Flashcards
What foramen remain open?
Foramen ovale and ductus arteriosus can remain patent beyond initial neonatal period
What is the foramen ovale?
Bypasses lungs, pulmonary vascular resistance high as alveoli closed and filled with fluid
What is the ductus arteriosus?
Connect pulmonary artery to aorta
What happens in normal closure of the foramen?
Normally when baby takes first breath O2 opens up lungs and O2 in circulation reduces prostaglandins and closes ducts
Why do some lesions not present until a few weeks of age?
In duct dependent lesions, this can assist survival
Name 4 left to right shunts
ASD
VSD
PDA
AVSD
What are the symptoms of ASD in younger children?
Asymptomatic when younger
What are the S&S of ASD in older children and adults?
Fixed and widely split S2
Ejection systolic murmur in pulmonary area
Palpitations
Why do you get palpitations in ASD?
Often due to R heart dilatation due to chronic increased blood flow on this side
What are the types of ASD?
Ostium secundum - right in middle of ASD, L-> R
Ostium primum - at bottom of septum, often associated with AVSD, often more complex
Sinus venosus ASD - top of septum
In whom do patent ductus arteriosus occur?
Usually preterm babies
What is the physiology of PDA?
Some blood goes into pulmonary arteries from aorta - increases pressure in pulmonary arteries so high pressure blood going into the lung vasculature
What are the symptoms of PDA?
Poor feeding
Failure to thrive
Tachypnoea
Active precordium
Thrill
Gallop rhythm
Easily palpable femoral pulses
Classical continuous machinery murmur pulmonary area
Hepatomegaly oedema
Why can VSD’s take a while to present?
Even large VSDs may not present symptomatically until pulmonary vascular resistance has fallen
What are the symptoms of VSD?
Poor feeding
Failure to thrive
Tachypnoea
Active precordium
Thrill
Gallop rhythm
Pan systolic murmur best heard in lower left sternal edge transmits to upper sternal edge and axillae
Hepatomegaly
Oedema
What is AVSD common in?
Trisomy 21
What is it important to do in children with Down syndrome and why?
Can lead more rapidly to pulmonary vascular disease so important to screen all children with down’s syndrome with Echo
What are the symptoms of AVSD?
Poor feeding
Failure to thrive
Tachypnoea
Active precordium
Thrill
Gallop rhythm
Hepatomegaly
Pulmonary oedema
Murmur arises from the valvular regurgitation rather than defect
Often problems with valves
May not hear any murmurs at all due to no pressure gradient between sides of heart
How do you manage left to right shunts?
Increasing calorie intake as catabolic state
NG feeds
Diuretics and ACEi
Surgical or catheter device occlusion
What are the types of stenoses?
Coarctation of aorta
Aortic stenosis
Pulmonary stenosis
What are the symptoms of coarctation of the aorta?
Weak femoral pulses- always compare to brachials
Pre and post ductal difference in sats (only if duct open)
4 limb BP - discrepancy between upper and lower limb BP
Older children murmur over back (after collaterals develop)
If duct has closed/is closing these babies present collapses and acidotic
Why is early identification important for coarctation of aorta?
Often required for survival
What are the symptoms of aortic stenosis?
Weak pulses
Thrill palpable in suprasternal region and carotid area - how well you can feel it depends on how bad the stenosis is
Ejection systolic murmur in aortic area
If critical aortic stenosis then child presents collapsed and acidotic
Can lead to RHF and then LHF
What are the symptoms of pulmonary stenosis?
Ejection systolic murmur in the left upper sternal edge
Murmur often radiates to the back especially if the pulmonary branches are also stenosed
R ventricular heave (if significant stenosis)
What are the common cyanotic heart conditions?
Transposition of great arteries
Tetralogy of Fallot’s
What do the symptoms of cyanotic heart conditions depend on?
Depending on lesion, severity, age ect
What is transposition of the great arteries?
Great arteries come off wrong side of heart - aorta comes from R side and pulmonary arteries come from L side so deoxygenated blood goes to body = cyanosis
When is patent foramen ovale helpful?
In transposition of the great arteries as keep child alive for longer
What are the symptoms of transposition of the great arteries?
Cyanosis
Acidosis
Collapse/death
What is the treatment for transposition of the great arteries?
Atrial septostomy at birth
Surgical repair within a week to prevent RV failure
What are the 4 defects in tetralogy of Fallot?
PROV
Pulmonary stenosis (right ventricular outflow obstruction)
Right ventricular hypertrophy
Overrinding aorta
VSD
What are the symptoms of tetralogy of Fallot?
Cyanosis
Collapse
Acidosis
What should you check for in tetralogy of Fallot?
22q deletion
How is tetralogy of Fallot managed?
Hypercyanotic spells - propranolol, BT shunt
Surgical repair at 6-9 months of age after child has grown more
What should you always look for in a CVS examination and why?
Dysmorphism as often associated with congenital heart conditions
What is trisomy 21 associated with?
AVSD
Tetralogy of Fallot
VSD
What is Turner’s syndrome associated with?
COA
Bicuspid aortic valve
AS
Aortic dissection later in life
What is Noonan’s syndrome associated with?
Pulmonary stenosis
LVH
Hypertrophic obstructive cardiomyopathy
What is 22q11p.2 deletion associated with?
Interrupted aortic arch
Truncus arteriosus
Tetralogy of Fallot
VSD
PDA
When medication might you give to a child with cardiac failure?
Diuretics
Beta blockers
ACEi
Ionotrophs
Paracetamol to close PDA
Antibiotics as bacterial endocarditis prophylaxis
Extra calories to keep them growing
What other causes are there of heart failure in neonates and infants?
Supraventricular tachycardia
Severe bradycardia due to complete heart block
Valvular regurgitation
Myocarditis
Hyperthyroidism
