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Systemic Disease in Dentistry > Congenital Heart Disease > Flashcards

Congenital Heart Disease Flashcards

1
Q

What is congenital heart disease?

A

A structural abnormality of the heart or intra-thoracic great vessels that is present at birth and of functional importance

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2
Q

Describe the prevalence of CHD

A

8-9 per 1000 live births and 10-20% of still births and miscarriages

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3
Q

Describe the 4 stages at which CHD is identified

A
  1. Foetus
  2. Neonate
  3. Child
  4. Adult
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4
Q

Describe 3 ways in which CHD may present in a newborn

A
  1. Cyanosis
  2. Congestive cardiac failure
  3. Cardiac murmur
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5
Q

What are 4 associations of CHD in a newborn?

A
  1. Chromosomal defects
  2. Syndromes
  3. Extracardiac defects
  4. Teratogens
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6
Q

What is a common teratogen which may cause CHD in a newborn?

A

Sodium valproate

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7
Q

What are 3 categories of cyanotic congenital heart disease?

A
  1. Abnormal connections
  2. Right to left shunts
  3. Abnormal mixing
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8
Q

What is the most common abnormal connections which may cause cyanotic CHD?

A

Transposition of great arteries

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9
Q

Describe simple transposition of great arteries leading to cyanotic CHD

A

Aorta is connected to the right ventricle and the pulmonary artery is connected to the left ventricle meaning blood in the aorta is deoxygenated

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10
Q

Describe the treatment of transposition of the great arteries

A
  • Infants present as very cyanotic and only survive if there is mixing of blood
  • Stabilised initially using prostaglandin
  • Arterial switch repair is carried out usually within 2 weeks
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11
Q

What is a common condition which causes right to left shunts of blood in the heart?

A

Tetralogy of Fallot

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12
Q

Describe Tetralogy of Fallot

A
  • Lesion occurs between left and right ventricles
  • Narrowing of pulmonary valve
  • Aorta shifts more rightward
  • Hypertrophy of right ventricle
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13
Q

What condition can lead to abnormal mixing of blood in cyanotic CHD?

A

Univentricular heart

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14
Q

What are 3 associations with a univentricular heart?

A
  1. Pulmonary stenosis
  2. Subaortic stenosis
  3. Coarctation of aorta
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15
Q

Name 3 symptoms of heart failure in adults

A
  1. Swollen ankles
  2. Peripheral oedema
  3. Cracking in the lungs
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16
Q

Name 3 symptoms of heart failure in infants

A
  1. Tachypnoea (breathlessness)
  2. Tachycardia
  3. Hepatomegaly
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17
Q

What is hepatomegaly?

A

Increased size of liver

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18
Q

Describe 2 causes of heart failure in infancy

A
  1. Left to right shunts

2. Obstructive lesions of left heart

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19
Q

Name 4 types of left to right shunts

A
  1. Ventricular Septal Defect
  2. Atrioventricular Septal Defect
  3. Atrial Septal Defect
  4. Patent Ductus Arteriosus
20
Q

What is the most common left to right shunt in:

a) the normal population
b) children with downs syndrome

A

a) Ventricular Septal Defect

b) Atrioventricular Septal Defect

21
Q

Describe a ventricular septal defect

A

There is a defect between the ventricles, causing blood to flow to area of least resistance which causes left to right shunt

22
Q

What is the main symptom of atrial septal defects?

A

Breathlessness

23
Q

What are 2 associations with atrial septal defects?

A
  1. Mitral regurgitation (primum type)

2. Partial anomalous pulmonary venous drainage (S.V. type)

24
Q

What is coarctation of aorta?

A

A fibrous ridge of tissue encroaches into the lumen of aorta which prevents blood flow through the vessel

25
Q

Name 3 associations of coarctation of aorta

A
  1. Bicuspid aortic valve
  2. Ventricular septal defect
  3. Subaortic stenosis
26
Q

Describe the classic sign of coarctation of the aorta

A

Hypertension in the upper body and lower tension in the lower body

27
Q

Describe aortic stenosis

A

Narrowing of the aortic valve which causes hypertrophy of the left ventricle, leaving it more susceptible to arrhythmias

28
Q

What are 3 associations of aortic stenosis?

A
  1. Mitral valve abnormalities
  2. Coarctation of aorta
  3. Left ventricular hypoplasia
29
Q

What are 2 categories of asymptomatic heart murmurs in childhood?

A
  1. Innocent cardiac murmur

2. Asymptomatic CHD

30
Q

What is the definition of an innocent cardiac murmur?

A

Any murmur produced by a normal cardiovascular system under normal resting conditions

31
Q

Describe the characteristics of an innocent cardiac murmur

A
  • No symptoms
  • Normal heart sounds
  • No added sounds
  • Normal ECG / chest x-ray
32
Q

Name 4 prosthetic materials used in cardiac surgery

A
  1. Dacron (patch closure of VSD)
  2. Gortex (shunts and conduits)
  3. Prosthetic valves (aortic and mitral)
  4. Pacemaker leads
33
Q

What is the primary interventional procedure in paediatric cardiology with regards to CHD?

A

Device closure

34
Q

Name an example of a device which may be used to close atrial septal defect

A

ASD Amplatzer Device

35
Q

Describe the characteristics of infective endocarditis

A
  • Rare in childhood
  • Vast majority have underlying heart disease
  • Serious potential cause of morbidity and mortality
36
Q

Name 4 lesions in the heart which are commonly complicated by endocarditis

A
  1. Ventricular Septal Defects
  2. Aortic stenosis or incompetence
  3. Tetralogy of Fallot
  4. Patent Ductus Arteriosus
37
Q

Why does infective endocarditis tend to be more commonly seen in smaller ventricular septal defects?

A

Smaller defects cause an increased velocity of flow which causes the endothelium to become more damaged

38
Q

What are the 3 main types of microorganisms involved in infective endocarditis?

A
  1. Streptococci (viridans more than enterococci)
  2. Staphylococcus Aureus
  3. Staphylococcus Epidermis
39
Q

Describe the diagnosis of endocarditis

A
  • Isolation of infecting organism from blood culture is important
  • Two to three blood cultures over 24 hour period usually adequate
  • Echocardiography
40
Q

If blood cultures are negative during the diagnosis of potential endocarditis what may be considered?

A

Candida infection

41
Q

Describe 5 clinical features of endocarditis

A
  1. Fever
  2. General malaise
  3. Splenomegaly
  4. Heart failure
  5. Blood present in urine
42
Q

Why is echocardiography useful in the diagnosis of endocarditis?

A

It demonstrates the vegetations attached to affected valves in most cases

43
Q

Describe the treatment of endocarditis caused by Streptococcus Viridans

A

Combination of penicillin and gentamycin given intravenously

44
Q

Describe the treatment of endocarditis caused by Streptococcus Faecalis

A

Combination of amoxycillin and gentamycin is used

45
Q

Describe the treatment of endocarditis caused by staphylococcal infection

A

Flucloxacillin and gentamycin

46
Q

Describe the treatment of endocarditis caused by candida infection

A

It is difficult to treat and may require a combination of amphotericin and flucytosine

Systemic Disease in Dentistry (22 decks)

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