Congenital Heart Disease Flashcards
What is congenital heart disease?
A structural abnormality of the heart or the intra-thoracic great vessels that is present at birth and is actually or potentially of great importance
What is the prevalence of CHD?
8-9 per 1000 births, 10-20% of still births/miscarriages
What is the presentation of CHD in newborns?
Cyanosis
Congestive cardiac failure
Cardiac murmur
What associations does CHD have in newborns?
Chromosomal defects (Down’s syndrome)
Syndromes
Extra cardiac defects
Teratogens
What causes cyanotic heart disease?
Abnormal connections- transposition of great arteries
Right to left shunts- tetralogy of fallot, pulmonary atresia
Abnormal mixing- univentricular hearts
What is the incidence of univentricular heart in patients with CHD?
1%
What are the associations of univentricular heart with CHD?
Pulmonary stenosis/atresia
Subaortic stenosis
Coarctation of aorta
What are the signs of heart failure in infancy?
Tachypnoea (breathlessness)- R/R > 60 per min
Tachycardia- HR>160 bpm
Hepatomegaly (enlargement of the liver)
What are the causes of heart failure in infancy?
Left to right shunts
Obstructive lesions of left heart
What is atrial septal defect?
A birth defect in the heart in which there is a hole in the septum that divides the atria of the heart
What is the incidence of ASD?
7-10%
What associations are there with ASD?
Mitral regurgitation (primum type) Partial anomalous pulmonary venous drainage (SV type)
What is coarctation of the aorta?
Birth defect in which a part of the aorta is narrower than usual
What is the incidence of coarctation of the aorta?
5%
What are the associations of coarctation of aorta?
Bicuspid valve
Ventricular septal defect
Subaortic stenosis
What is aortic stenosis?
Narrowing of the area underneath the aortic valve that causes some degree of obstruction or blockage of blood flow through the heart
What is the incidence of aortic stenosis?
2%
What are the associations of aortic stenosis?
Mitral valve abnormalities
EFE (endocardia fibroelastosis)
Coarctation of aorta
Left ventricular hypoplasia
What are the two possible diagnoses of patients with asymptomatic murmurs in childhood?
Innocent cardiac murmur
Asymptomatic congenital heart disease
What causes asymptomatic congenital heart disease?
Small ventricular septal defect Atrial septal defect Pulmonary valve stenosis Aortic valve stenosis Coarctation of aorta
What are the characteristics of an innocent murmur?
No symptoms Normal heart sounds No added sounds No thrill Normal ECG Normal chest X-ray
What is the definition of an innocent heart murmur?
Any murmur produced by a normal cardiovascular system under normal resting conditions
What prosthetic materials are used in cardiac surgery?
Dacron- patch closure of VSD
Gortex tubes- shunts, conduits
Prosthetic valves- aortic mitral
Pacemaker leads
What is infective endocarditis?
Infection of the inner lining of the heart muscle (endocardium) caused by bacteria, fungi or germs that enter through the bloodstream
It is rare in childhood but remains a potential cause of serious morbidity and mortality
Most people effected usually have underlying structural heart disease
What organisms cause infective endocarditis?
In most series streptococci (viridans more than enterococci) are the most common causative organism with staphylococci (staphylococcus aureus and staphylococcus epidermis) being the second largest group
What lesions are most commonly complicated by infective endocarditis?
Ventricular septal defect
Aortic stenosis
Tetralogy of fallot
Patent ductus arteriosus
How is infective endocarditis diagnosed?
Isolation of the infecting organism from blood culture is crucially important in making the diagnosis and guiding appropriate antimicrobial therapy
Two or three blood cultures over a 24 hour period
Candida infection should also be considered in those with negative blood cultures
Echocardiography
What are some of the clinical features of infective endocarditis?
Fever Heart murmur (new or changing murmur) General malaise Heart failure Splenomegaly Microscopic haematuria Petechiae Osler nodes Splinter haemorrhages
What is the treatment of infective endocarditis?
Treatment is required for a minimum of 4 weeks and usually continued for 6 weeks
For streptococcus viridans the combination of penicillin and gentamicin given intravenously is effective
For streptococcus faecalis the combination of amoxicillin and gentamicin is used
Flucloxacillin and gentamicin is the first choice therapy for staphylococcal infection
Candida infection is difficult to treat and may require a combination of ampotericin and fluocytosine, it may prove impossible to eradicate
According to the NICE guidelines, what conditions put patients at risk of infective endocarditis?
Acquired valvular heart disease with stenosis/regurgitation Valve replacement Hypertrophic cardiomyopathy Structural congenital heart disease Previous infective endocarditis carditis
When not to offer antibiotic prophylaxis with IE?
Dental procedures
Non-dental procedures- upper and lower GIT, genitourinary tract, upper and lower respiratory tract
Do no offer chlorhexidine mouthwash as prophylaxis against IE to people at risk undergoing dental procedures
What important information should be given to patients with IE before undergoing dental procedures?
Benefits and risks of antibiotic prophylaxis with explanation to why its not longer routinely recommended
The importance of maintaining good oral health
Symptoms that may indicate IE
The risks of undergoing invasive procedures, including non-medical procedures
