Congenital Heart Disease

Question 1

Bicuspid aortic valve

Answer 1

• work well at birth and go undetected
• Many eventually devlop aortic stenosis + aortic regurg predisopsing to IE/SBE

Question 2

Atrial septal Defect definition

Answer 2

ASD is a congenital heart defect. It is an atrial septal defect with a hole in the diviging wall (atrial septum) between the 2 upper chambers of the heart.

Question 3

Problem with atrial septal defect?

Answer 3

Blood normally flows from chamber to chamber in 1 direction through the left and right sides of the heart. With an ASD, blood flows through the dect from the left atrium to the right atrium. This is called left-to-right-shunt. It causes more blood than normal to circulate through the right side of the heart. As a result, extra blood has to be pumped to the lungs. Overtime, too much blood flow to the lungs can increase the pressure in teh PA.

Question 4

Clinical features of ASD

Answer 4

Magnitude of Left-to-right shunt depends upon the size of the defect and also the relative pressures on the left and right sides of the heart

History

• asymptomatic in early life
• in adult hood- dyspnoea, fatigue and recurrent chest infections
• Increased pulmonary blood flow results in in Pulmonary HTM and eventually reverasal of the shunt and eisenmenger syndrome ( central cyanosis, high red blood cell count, syncope, fingerclubbing)

Examination

• 2nd Left ICS - fixed splitting of the 2nd heart sound
• Prominent right ventricular heave mitral regurgitation
• If pulmonary HTN disapears - pulmonary flow murmur (systolic ejection murmur) disappears and loud pulmonary compnent to second heart sound

Question 5

Investigations of ASD

Answer 5

• Echo- visulaisation of the defect, determination of flow pattern and shunt volume
• ECG- normal or tall P waves, large R waves in V1
• Chest X-ray - Normal or enalrged heart with increased pulmonary markings

Question 6

Treatement of ASD

Answer 6

in children closure is recommended before the age of 10.

In adults symptamtic- trasncatheter closure

Question 7

Ventricular septal defects definition

Answer 7

Ventricular septal defect is a whole in the wall that separates the right and left ventricles

Question 8

Problem with ventricular septal defect

Answer 8

Blood normally flows from chamber to chamber in 1 direction through the left and right sides of the heart. WIth a VSD, blood flows through the defect from the left ventricle to the right ventricle. This is called left to right shunt. It causes more blood than normal to pass through the right side of the heart. It causes the left side of the heart to vecome dilated or enlarged. More blood than normal has to be pumped to the lungs. With a large VSD, the lungs can become filled with extra blood and fluid- when this happens you have developed congestive heart failure.