Congenital Heart Disease Flashcards
What are the causes of cyanotic heart disease?
Tetrology of fallot
Transposition of the great arteries
Tricuspid atresia
What are causes of acyanotic CHD?
VSD
ASD
Coarctation of the aorta
PDA
What are the constituents of ToF?
VSD
Pulmonary stenosis causing right ventricular outflow obstruction
Overriding aorta
Right ventricular hypertrophy
Allows passage of blood from right to left side of the heart
What are clinical features of ToF?
If not diagnosed antenatally/birth then may present at 1-2 months postpartum
Cyanosis
Failure to thrive- poor feeding/weight gain
Tet spells- acute worsening of cyanosis often precipitated by exertion/crying
Tearful
Dyspnoeic
Ejection systolic murmur loudest in pulmonary area and on inspiration
Clubbing
What are the investigations/management of ToF?
CXR- boot shaped sign
ECHO= diagnostic
Treatment
- prostaglandin infusion in neonates to maintain PDA
- Will require surgical repair
- TET spells managed with beta blockers/morphine
What are features of transposition of great arteries?
Swapping of aorta and pulmonary artery leading to circulation of deoxygenated blood
Risk factor- maternal diabetes
CXR
- egg on side appearance
Treatment
- prostaglandin infusion to maintain PDA patency
- Surgery
What are features of tricuspid atresia?
Lack of tricuspid valve preventing blood flow from right atrium to ventricle
Leads to
- hypoplastic right ventricle
- ASD- can have right to left shunt leading to variations in oxygen levels
- VSD (to allow flow)
Pulmonary stenosis- restricting blood flow, often present
Left ventricular hypertrophy- increased workload
What are clinical features of tricuspid atresia?
Presents within first few days/weeks
Cyanosis
Dyspnoea
FTT
Fatigue
O/E
-Cyanosis
- Tachypnoea
- Murmurs either holosystolic if VSD or ejection systolic if pulmonary stenosis
- Clubbing- in chronic places
What is the management of tricuspid atresia?
Prostaglandin infusion- maintain ductal patency
Surgery- including Blalock Taussig shunt, Glenn Procedure, Fontan procedure
What are features of VSD?
OPening in interventricular septum allowing blood flow between left and right ventricles
Causes
- chromosomal disorders- downs/pataus
-post-MI
What are clinical features of VSD?
FT
HF
Hepatomegaly
Tachypnoea
O/E
- harsh pan systolic murmur loudest at lower left sternal edge
What are complications of VSD?
Eisenmenger syndrome
- initial left to right shunt causes pulmonary hypertension which causes RVH with increased pressures
-At some point pressure generated by the right exceeds the left leading to right to left shunt
- symptoms cyanosis, clubbing
- requires surgical management
What are features of ASD?
Commonly identified in adulthood
SoB esp on exertion
Right heart failure
Pulmonary hypertension
Arrythmias e.g. AF
Stroke following DVT
- clot passes through defect from RA to LA and into circulation
O/E
- ejection systolic murmur
- fixed splitting of S2
Holt-oram syndrome- ASD and triphalengeal thumbs
What are classification of ASD?
Ostium Primum
- defect of septum near AV valve
- associated with Downs
Ostium Secundum
- defects of superior atrial septum
- most common form
What are features of PDA?
Incomplete closure
Risk factors- maternal rubella, prematurity
O/E
- continuous machinery type murmur
- left subclavicular thrill
- bounding collapsing pulse
Manage with indomethacin or ibuprofen to inhibit prostaglandin production
What are features of patent Foramen Ovale?
Connects the atria usually 6 months-1 year post birth
Can mean DVT/PE travel to arterial circulation and cause stroke
