Congenital Heart Disease

Question 1

Acyonotic Congenital Heart Disease

Answer 1

Left to Right cardiac shunts: condition where blood from the systemic arterial circulation mixes with systemic venous blood.
Atrial Septal Defect (ASD)
Ventricular Septal Defect (VSD)
Patent Ductus Arteriosus (PDA)

Question 2

Cyanotic Congenital Heart Disease

Answer 2

Right to Left cardiac shunts: Condition where the shunt allows blood to flow from the right to the left side of the heart.
Tetralogy of Fallot
Transposition of the Great Arteries

Question 3

Obstructive Congenital Heart Disease

Answer 3

Obstruction to Right side of heart:
Pulmonic Valve Stenosis. (PVS)

Obstruction to Left side of heart:
Coarctation of the Aorta
Congenital Aortic Stenosis (AS)

Question 4

At birth two events occur:

Answer 4

Umbilical cord is clamped.

Breathing begins.

Question 5

Atrial Septal Defect

Answer 5

Opening in the atrial septum permitting blood between the two atrias.
Three major types:
Ostium Secundum (most common)
Sinus Venus (least common)
Ostium Primum

Question 6

ASD Clinical Presentation

Answer 6

Most often have no symptoms.
Rarely present with congestive heart failure
Heart is usually hyperactive with a right ventricular heave felt best at lower left sternal border.
S2 is widely split and fixed at pulmonary area
Grade II-III/VI systolic murmur

Question 7

Ventricular Septal Defect

Answer 7

An abnormal opening in the ventricular septum which allows blood to flow across the right and left ventricles.
Single most common congenital heart malformation.

Question 8

Patent Ductus Arteriosus

Answer 8

normal fetal vessel that connects the pulmonary artery to the aorta.
Accounts for 10% of all congenital heart diseases.
Twice as common in females than males.
Commonly associated with VSD and Coarctation of the aorta

Question 9

PDA diagnosis

Answer 9

Chest x-ray
Depends on size, large shunts show LV and LA enlargement along with the aorta and pulmonary artery.
EKG: May be normal or show LV hypertrophy.
Cardiac MRI and CT are the best noninvasive modalities.

Question 10

PDA treatment

Answer 10

In pre-term infants Indomethacin (a prostaglandin inhibitor) is used to close the shunt.
Cardiac catheterization
Large shunts require surgical ligation.

Question 11

TOF Congenital Heart Disease 4 Components

Answer 11

VSD
Pulmonary obstruction
Overriding aorta
RVH

Question 12

Cyanotic CHD: Tetralogy of Fallot (TOF) Clinical Presentation

Answer 12

Cyanotic.
Fatigability and dyspnea on exertion.
Single 2nd heart sound.
Grade II-IV/VI systolic ejection murmur.
Tet spells.

Question 13

Cyanotic CHD: TOF Diagnosis

Answer 13

Chest x-ray: Boot shaped heart

Question 14

Cyanotic CHD: Transposition of the Great Arteries (TGA)

Answer 14

Division of the truncus arteriosus which aorta comes off from the right ventricle and pulmonary artery comes off the left ventricle
Also known as the “blue-baby syndrome”
3:1 Male to Female ratio

Question 15

Cyanotic CHD: TGA Diagnosis

Answer 15

Chest x-ray “egg on a string” appearance

Question 16

Pulmonic valve stenosis (PVS)

Answer 16

Obstruction of blood flow from the right ventricle to the pulmonary artery
Obstruction usually caused by narrowing

Question 17

Coarctation of Aorta (COA) Diagnosis

Answer 17

Chest x-ray:
May show LV enlargement
Notching of ribs