Congenital Heart dIsease Flashcards
Cause of CHD?
- most idiopathic (85 -90%)
- teratogens:
- alcohol,
- medication (phenytoin),
- infections ( rubella) - genetics (gene/ chromosomal)
- marfan’s
- trisomy 21
- turners (45XO)
- trisomy 13
- trisomy 18
- Diabetic mother
- Fam Hx
Incidence of CHD?
1/1000 (1%)
Top 5 CHD in order?
- VSD
- PDA
- Coarctation
- TOF
- Aortic stenosis
- ASD
- pulmonary valve stenosis
Classify acyanotic CHD?
- acyanotic w/ increased pulmonary BF
- acyanotic w/ normal BF
Which acyanotic conditions allow for left to right shunting?
- PDA
- ASD
- VSD
- AVSD (or endocardium cushion defect)
How do infants w/ acyanotic (incr. pull BF) CHD present?
- excessive sweating during feeds
- interrupted feeds
- failure to thrive
- Recurrent LRTIs
- SOB
- plethora
- if significant lesion: CCF
Signs
- chest deformities: pectus carnatum, Harrison’s sulcus, precordial bulge, chest asymmetry
- signs of CCF
- plethora
Where does one hear a PDA? Characteristics?
- just below the left clavicle
- characteristics differ
- preterm: systolic murmer
- term infants: continuos (machinery) murmer
- very large w/ incr. flow: mid diastolic murmer at apex
Who gets PDAs and how do they differ with these groups?
- Pre-term: esp. Respiratory distress
- left to right shunt develops towards end of first week of life
- closes by expected term date
- closure can be accelerated w/ NSAIDs ( ibuprofen/ indomethacin) - Term:
- NSAIDs not effective
- surgical ligation required / device closure before 6-12 months (even asymptomatic)
-
How does PDA present?
- preterm: tachypnoea and systolic murmur
- term: continuos murmur, bounding/ collapsing pulses, wide pulse pressure, easily palpable dorsal is pedis
When do large VSDs present?
-large defects between 2-6 weeks of life w/ decrease in plum. Vascular resistance
Murmur of VSD?
- loud pan systolic murmur at left lower sternal border
- small defects have louder murmer because high velocity but low volume shunt - mid diastolic murmur in large defect
- loud P2 if associated plum. hypertension
What must you suspect if VSD fails to respond to anti- failure treatment?
- coexisting defect: e.g. PDA/ coarctation
Natural hx of VSDs?
- small defects: may close spontaneously in first 2 years
- medium: get smaller
- large: esp. W/ CCF will require intervention usually surgical
ASD presentation?
Symptoms:
- usually asymptomatic
- frequent LRTIs (flooded lungs)
Signs
- right ventricular hypertrophy (heave)
- murmur: pulmonary ejection systolic murmur w/ fixed splitting of S2
- tricuspid diastolic murmur
- CXR: large pulmonary artery, plethoric lungs
- ECG: RSR pattern in V1
- primum: left axis deviation
- secundum: right axis deviation
ECG changes in AVSD?
ECG: RSR pattern in V1
- primum: left axis deviation - secundum: right axis deviation
CXR changes in AVSD?
CXR: large pulmonary artery, plethoric lungs
Mx of ASD?
- secundum: surgical or device closure during childhood
- primum: only large defects need closure
Classify AVSDs (w/ description)
- complete: osmium primum ASD w/ inlet VSD w/a common atrioventricular valve.
- partial: ostium primum only
Name a common population group w/AVSDs.
- trisomy 21
Murmur of AVSD?
- pansystolic murmur at apex secondary to mitral regurgitation
- ejection systolic at pulmonary valve secondary to increased pulmonary flow
- no murmur: balanced pressures due to large defect
ECG in AVSD?
- left anterior hemiblock
- left QRS axis between 0 - minus 90 degrees
- RSR in V1 (right ventricular hypertrophy)
Top 5 cause of CHD in order?
- VSD
- PDA
- Coarctation
- TOF
- Aortic stenosis
- ASD
- pulmonary valve stenosis
Which gender predominates aortic stenosis
Males w/ 4:1 ratio
Presentation of AS?
Symptoms:
-usually asymptomatic in infancy ( develops later in a congenitally bicuspid valve)
Signs:
- Significant stenosis: palpable thrill, loud long ejection systolic murmur radiating to the neck in 2nd (right) intercostal space, ejection click (valvular)
- very severe: left heart failure, poor volume pulses, narrow pulse pressure
Investigations:
-CXR: normal or enlarged proximal aorta, cardiomegaly (very severe)
Classify AS?
- valvular
- supra valvular (rare)
- sub valvular (rare)
Is pulmonary stenosis an acyanotic or cyanotic CHD?
-primarily an acyanotic condition but if critical pressures in the right atrium can build up enough to cause a right to left shunt through a patent foramen ovale leading to mixing and cyanosis
Aetiology of rheumatic fever?
- susceptible person (HLA class II variant)
- pharyngeal infection with GAS
