Congenital Heart Disease Flashcards
Structural abnormalities present at birth
congenital heart disease
4 reasons for congenital heart disease
Chromosomal abnormalities
Environmental associations
Rubella
Genetic predisposition
Turner syndrome (XO) is associated with
coarctation of the aorta
Down syndrome (trisomy 21) is associated with
Atrial and ventricular septal defects
Atrioventricular valve deformities
There is an increase in __ in pregnancy at high altitudes
Patent ductus arteriosus
Rubella (german measles) is a prominent cause of CHD. Congenital rubella syndrome causes
cardiovascular malformations
Microcephaly
Common cardiac malformations associated with congenital rubella syndrome
Pulmonary artery stenosis
Patent ductus arteriosus
This is a genetic predisposition
Tetralogy of fallot
CHD can be classified according to the presence or absence of
cyanosis
Non-cyanotic CHD
left to right shunt ( patent ductus arteriosis or atrial or ventricular septal defect)
This can cause obstructive lesion like coarctation of the aorta and aortic stenosis
Non-cyanotic CHD
Transposition of the great vessels, malformations with a right to left shunt (tetralogy of fallot), left to right shunt reverses flow to right to left because of increased pulmonary pressure
Cyanotic CHD
A hole from a septum secundum or septum primum defect
Atrial septal defect (ASD)
Atrial septal defect produces a __
left to right non-cyanotic shunt
2nd most common CHD
Atrial septal defect
Smooth walled defects near the foramen ovale, NO other cardiac abnormalities
Ostium secundum ASD’s (75% of ASDs)
At lowest part of atrial septum, associated with mitral and tricuspid valve abnormalities
Ostium primum ASDs (15-20% of ASDs)
Upper part of atrial septum near superior vena cava, accompanied by anomalous drainage of the pulmonary veins into right atrium or superior vena cava
Sinus venosis (5-10% of ASDs)
Small ASDs can __ while large ASDs can __
close at birth ( or be asymptomatic throughout lifetime)
cause heart failure
Unresolved large ASDs are delayed until __ and can lead to __
4th decade of life
Right heart failure
Increased incidence of atrial arrhythmias (atrial fibrillation), can lead or paradoxical embolism
Atrial septal defect ASD
A flaplike opening between atria septa primum and secumdum at the location of the fossa ovalis that persists after age 1
Patent foramen ovale (PFO)
Little clinical significance except when it leads to paradoxical embolism or cryptogenic strokes <55 years of age
Patent foramen ovale (PFO)
Normally the __ keeps the PFO closed but transient __ can occur such as with valsalva-type manuvers
left atrial pressure
R to L blood flow
A hole within the intraventricular septum that produces a left to right non-cyanotic shunt
Ventricular septal defect (VSD)
This is the most common CHD!
Ventricular septal defect (VSD)
Larger ventricular septal defects can cause __
tachypnea, tachycardia and heart failure
In adults with untreated VSD __ is common
Left sided heart failure
With __ the shunt will reverse flow to right to left in VSD
pulmonary hypertension
Failure of closure of the fetal ductus arteriosis
Patent ductus arteriosus (PDA)
Patent ductus arteriosus produces a __
Left to Right non-cyanotic shunt
3rd most common CHD
Patent ductus arteriosis (PDA)
Can be due to premature/low birth weight, low oxygen tension, 1st trimester maternal rubella
patent ductus arteriosis (PDA)
Narrowing or constriction of the aorta - occurs near the ligamentum arteriosim just distal to the origin of the left subclavian artery
Coarctation of the aorta
Coarctation of the aorta can lead to
left ventricular outflow obstruction
The narrowing that occurs with coarctation of the aorta can be __ or __ in relation to ductus arteriosus
preductal (infantile)
Postductal (adult)
This is usually present in preductal coarctation the the aorta
patent ductus arteriosus
Symptomatic early in life, classically as cyanosis localized to the lower half of the body (without treatment infants die in neonatal)
Preductal coarctation of the aorta (with PDA)
Usually asymptomatic, sometimes well into adult life, when symptoms develop, hypertension is limited to the upper extremities and cerebral vessels with low blood pressure in the lower extremities
Postductal coarctation of the aorta (WITHOUT PDA)
The most common form of cyanotic (right to left) CHD
Tetralogy of fallot (TOF)
4 major features of tetralogy of fallot
Obstruction of the right ventricular outflow tract
Concentric right ventricular hypertrophy
Ventricular septal defect (VSD)
Dextroposition of the aorta
Obstruction of the right ventricular outflow tract can be due to what 3 things
subpulmoic stenosis
pulmonary calce stenosis
complete atresia
What is the definitive treatment for TOF
Complete surgical repair
Decreased pulmonary blood flow and increased aortic volumes are present at birth with
Tetralogy of fallot (TOF)
The second most common form of cyanotic (right to left) CHD
Transposition of the great arteries (TGA)
In transposition of the great arteries, the aorta arises from the __ and the pulmonary artery emanates from the __
right ventricle
Left ventricle
What is needed for survival of a patient with transposition of the great arteries
a concurrent compensatory anomaly (VSD) (ASD) (PDA)
