Congenital Heart Disease Flashcards
Who gets atrioventricular septal defects?
40% of Down’s children
What is considered ‘complete AVSD’?
A single leaky 5 leaflet valve which joins the atrium to the ventricle
What are the clinical features of AVSD?
Pulmonary HTN
Cyanosis at birth/ HF in 2-3 wks
No murmur
Superior axis on ECG
What investigations do you do for AVSD?
Antenatal US- apparent
What is the management for AVSD?
Medical treatment for HF (Furosemide/ ACEi)
Surgical repair at 3-6 months
Lifelong follow up –catching AV regurge or LVOT obstruction
What is the most common form of complex congenital heart disease?
Tricuspid atresia
What are the clinical features of tricuspid atresia?
Absence of tricuspid valve
Mixing of systemic and pulmonary return in LA
Cyanosis (duct dependent)
May be well at birth
ESM at L sternal edge
What investigations would you do for tricuspid atresia?
CXR: cardiomegaly, prominent RA border (Ebstein’s abnormality)
ECG: LAD
What is the management of tricuspid atresia?
- Maintain pulmonary blood supply via BT shunt insertion or Pulmonary artery banding
- Glenn operation (SVC to pulmonary artery)
- Fontan operation (IVC to pulmonary artery)
[Complete correction not possible]
Which CHD is the most common?
VSD (80%)
What is the size of a VSD based on?
Larger or smaller than an aortic valve
What are the clinical features of a small VSD?
Asymptomatic
Loud Pan systolic murmur at LSE
Quiet pulmonary second sound
What are the features of a large VSD?
HF/ SOB poor growth chest infections tachypnoea active precordium soft pansystolic murmur apical mid diastolic murmur loud pulmonary second sound
What investigations would you do for VSD?
CXR
ECG
Echo
What findings would you get if a patient has a VSD?
Small: CXR/ECG: normal
Echo: anatomical defect
Large:
CXR: cardiomegaly, large pulm arteries, increased vassc markings, pulmonary oedema
ECG: Biventricular hypertrophy, demonstrates the anatomy of the defect and Pulm HTN
What is the management of a (A) small and (B) large VSD?
Small: Closes spontaneously
Good dental hygiene to avoid IE
Large: Diuretics (captopril) for HF, nutritional support, surgery at 4-6 mnths
What are the types of ASD?
Secundum (common 80%)
Central defect involving FO
Primum (less common)
What are the clinical features of ASD?
Asymptomatic
Recurrent chest infections
Arrhythmias
ESM, fixed widely split S2
Partial = apical pansystolic murmur
What are the investigation findings in ASD?
CXR: Cardiomegaly, Enlarged pulm arteries, increased pulm vasc markings
ECG: Superior QRS
Echo: Structural abnormality, definitive
How common is PDA?
1 in 5000
Where is the join in PDA?
Pulmonary artery to descending aorta
What are the clinical findings of PDA?
Continuous murmur below left clavicle