Congenital Heart disease Flashcards
Name some acyanotic defects
-ASD
-VSD
-PDA
-congenital aortic stenosis
-pulmonary stenosis
-co-arctation of the aorta
Name some cyanotic defects
-TOF
-transposition of the great arteries
Defune cyanotic defect
there is mixing/ shunting of deoxygenated blood with oxygenated blood
Define acyanotic defect
there is shunting from left to right so mixing of oxygenated blood with deoxygenated blood due to level of tissue oxygenation
What does shunting of blood mean?
divergance of blood from one system to another
-can determine o2 content of blood and the volume of blood being circulated
arterial to venous ( L-R)
venous to arterial (R-L)
What is an ASD?
communications across the atriums, left to right shunting
-missing tissue
What are three main types of ASD?
-sinus venosus (SVC defect)
-ostium secundum (Fossa ovalis defect-Not the same as a PFO)
-ostium primum-sinus venosus defect
What is the difference between a PFO and ASD?
ASD- missing tissue
PFO- Flap between septum primum and septum secundum, overtime this should close but if it doesn’t its a PFO
How do we investigate for a PFO?
-ECHO
-ECG- shows talled peak p waves due to atrial dilation
-osciltation-systolic mumur
-chest Xray
What is a VSD?
communications across the intraventricular septum
left to right shunting, can be in multiple areas in the septum
-perimembranous-high up across the septum
-muscular or trabecular septum- hole within the muscular septum
How can we investigate for a VSD?
ECHO- use doppler to see velocity and flow profile
-ECG and chest x ray could appear normal depending how big the VSD is/ how much blood is being shunted
What is a PDA/ patent ductas arteriousus )
-ductas arteriousus connects main PA to aorta, connecting pulmonary to systemic circ whilst baby is in the uterus
-when the baby has been born it should close due to the increase in oxygen saturation and a reuduction in things like prostaglandins and become the ligamentous arteriousus
What investigation do we use to find a PDA?
-osciltation identifies a machinery murmur
-chest x ray may show an enlarged heart or calcification of the ductus
-ECG may show LA hypertrophy
What is a machinery murmur?
-it is there through out systole and diastole - continuous murmur
How do we treat a PDA?
-prostaglandin inhibitors to constrict it
-surgical intervention
What is co-arctation of the aorta?
-often ossociated with a PDA
-constriction of the narrowing of the aorta usually located in the thoracic component of the ascending thoracic aorta
-significant if the pressure gradient across is about 20mm/Hg
-can be pre or post ductal
Describe the pathophysiology of the co arctation of the aorta
-obstruction increases afterload to the LV
-can cause LV hypertrophy as it compensates for the increased afterload
-decreased blood flow around the body, affects the renal system (Hypoperfused)
Give some signs of a co arcted aorta
-weak or absent pulse in lower limbs due to systemic circulation being affected higher up
-hypertension in upper limbs
Give some symptoms of a co- arcted aorta
-headaches
-leg pain
-nose bleeds
-systolic murmurs
define congenital aortic stenosis
-incomplete opening of the valvular orifice
-LVOT obstruction as it can be subvalvular, supravalvular or valvular
Describe the pathophyiology of congenital aortic stenosis
-haemodynamic effects related to degree of obstruction
-increased afterload due to LVOT obstruction
-LVH could manifest depending on severity
Give some signs and symptoms of congenital aortic stenosis
-low cardiac output
-syncope
-fatigue
-chest pain
-mitral regurgitation
-soft murmur
How do we treat congenital aortic stenosis?
mild- let the baby gain some weight and grow
severe- trans-cath balloon when the infant is older
What is pulmonary stenosis?
obstruction to blood flow by a narrowed RVOT
-can increase RV pressure, leading to RVH and tricuspid regurgitation, RA pressure rise can then cause right to left shunt through a patent fossa ovalis
