Congenital heart Disease Flashcards
Stills murmur
Location
Quality
Congential Heart Dz
left midsternal border Vibratory Quality VSD Subaortic Stenosis Subpolmonic stenosis
Venous Hum
Location
Quality
Congenital Heart Dz
Neck and clavicle
Continuous loudest when sitting
PDA
Coronary AV malformation
Sinus Venosus
High in the atrial septum near the entry of the superior vena cava into the right atrium
Ostium primum ASDs
Lie adjacent to the atrioventricular valves which may be deformed/regurgitant
Common in Down syndrome; may be more complex with a common atrioventricular valve (endocardial cushion defect)
Ostium secundum ASD
Involves the fossa ovalis and is midseptal (as opposed to a patent foramen ovale)
“Probe patency” is common & trivial (functionally closed)
ASD denotes a true deficiency of the atrial septum and implies functional and anatomic patency
Magnitude of the left-to-right shunt is determined by
ASD size
Ventricular diastolic properties
Impedance in the pulmonary and systemic circulations
What is a result of a Left to right shunt created by ASD
Diastolic overloading of the right ventricle
Increased Pulmonary blood flow.
Causes Pulm HTN
ASD presentation in adults
usually asymptomatic early in life may have growth retardation and increased URI
Past 4th decade of life:
Atrial Arrhythmias
Pulm HTN
Bidirectional and then right to left shunting of blood
Right Heart failure
L to R shunting leads to progressive systemic HTN, CAD
ASD Physical Exam
prominent RV impulse and palpable pulmonary artery pulsation
1st Heart sounds is normal or split with accentuation of the tricuspid valve closure
midsystolic pulmonary outflow murmur due to increased flow across pulmonic valve
2nd heart is widely split and relatively fixed in relation to respiration
mid-diastolic rumblin murmur (4th L intercostal space) reflects increased flow across the tricuspid valve
What is a ostium primum ASD sound like
holosystolic murmur usually mitral or tricuspid regurgiatation or VSD
What happens with an ASD
increased pulmonary resistance leads to diminished L to R shunt
pulmonic component of the 2nd heart sound and a systolic ejection sound are accentuated
Cyanosis and clubbing accompany the development of right to left shunt
How do you treat ASD
patch of pericardium or of prosthestic material or percutaneous transcatheter device closure
pulmonary to systemic flow ratios 1.5-2
What is the most common of all cardiac birth defects
VSD
VSD presentation in adults
dysfunction depends on its size and on the status of the pulmonary vascular bed
Will only see small or moderate size VSD are seen in adulthood because most come to medical or surgical attention early in life
What determine clinical manifestation and feasibility of surgical repair
pulmonary vascular bed
what is Eisenmengers syndrome
large communication between the two circulations at the aortopulmonary, ventricular or atrial levels
Bi directional or predominantly right to left shunts because of high resistance and obstructive pulm HTN
Large VSD should be corrected surgically early in life when pulmonary vascular disease is still reversible or not developed
Symptoms of adults with Eisenmenger
exertional dyspnea, chest pain, syncope, and hemoptysis
R to L shunt leads to cyanosis and clubbing and erythrocytosis
VSD presentation
Asymptomatic murmur may nor be present at birth develop in the 1st few months as the VSD constricts and disappear.
Restrictive VSD holosystolic murmur with normal S2
PDA
is a vessel leading from the bifurcation of the pulmonary artery to the aorta just distal to the left subclavian artery
Normally, open in the fetus but closes immediately after birth
What is the clinical presentation of PDA
pulmonary pressure are initially normal
A gradient shunt from aorta to pulmonary artery persists throughout the cardiac cycle
characteristis thrill and
PDA clinical Pearls
machinery murmur with late systolic accentuation and upper left sternal edge
Toes but not the fingers become cyanotic and clubbed
what is the treatment of PDA
closure recommended in adults without severe pulmonary vascular disease and a R to L shunt
Transcatheter closure, Thoracoscopic surgical
What is a congenital aneurysm of an aortic sinus of Valsalva with fistula
separation or lack of fusion between the media of the aorta and the annulus of the aortic valve
Usually ruptures between 3rd or 4th decade of life
congential aortic stenosis
obstructive malformations that cause obstruction to LV outflow
One of the most common congenital heart malformations
Harsh systolic murmur
Mitral valves may develop stenosis or regurgitation
LV hypertrophy
