Congenital heart disease Flashcards
what are the 3 types of shunts that congenital heart disease cause?
- left to righ
- right to left
- obstruction (like coarctation of the aorta)
a left to right heart shunt is considered what?
what will a left to right shunt cause?
what complications can be seen with left to right shunt?
acyanotic
vauses volume overload in the rught side of the heart
pulmonary HTN, right ventricular hypertrophy, Eisenmenger’s complex (when right ventricular pressure overrides left ventricular pressure)
in a left to right shunt with eisenmenger’s complex, the patient will develop what?
cyanosis tardive = pt will develop cyanosis because the shunt eventually reverses
what are the 3 left to right shunts?
which is the most common congenital disease?
which is the most common diagnosed in adult life?
VSD, ASD, PDA
VSD is the most common congenital disease
ASD is the most common to be diagnosed in adult life
VSD is associated with what other diseases?
most of the defect occurs where?
what are the small clinical findings for VSD?
what are the large clinical findings for VSD?
Cri Du Chat (ch. 4), trisomies 13 adn 18
in the membranous portion of the IVS
small = spontaneous closure
large = fulminant cardiac heart failure to late cyanosis
ASD will most commonly be caused by: ostium primum or secundum?
ASD can also be associated with what syndrome?
secundum is most common
Fetal Alcohol syndrome
PDA can be associated with what?
congenital rubella and Resp. Distress Syndrome,
what is a PDA?
duct that remains open connecting the aorta to the pulmonary artery
What are the clinical findings of PDA?
pink in upper extremities
cyanotic lower extremities
heart murmur- heard in diastole and systole
how do you treat PDA?
use indomethacin
What do you call right to left heart shunt?
cyanotic
what happens in a right to left heart shunt?
blood from unoxygenated (right) part of heart goes into the left side of the heart
what are the complications that can be developed from a right side to left side shunt?
2ry polycythemia
septicemia
increased incidence of infective endocarditis
fingers and toes clubbing
wahtare the 5 T’s of right to left heart shunts?
- Tetralogy of Fallot
- Transposition fo the Great Vessels
- Truncus Arteriosus
- Tricuspid Atresia
- Total anomalous Pulmonary Venous return
what is the most common cyanotic congenital heart disease?
Tetralogy of Fallot
what are the 4 (tetra) defects of Tetralogy of Fallot?
- VSD
- Pulmonary Stenosis with Right Ventricular outflow obstruction
- Overriding the Aorta
- Right Ventricular Hypertrophy
Cyanosis caused by Tetralogy of Fallot depends on what?
the degree of pulmonary valve stenosis
What is pink tetralogy?
how will newborns look?
the amount of pulmonary valve stenosis is minimal
newborns are acyanotic at birth
What is classic tetralogy?
how will newborns look?
when the degree of pulmonary valve stenosis is severe
newborns will be cyanotic at birth (most of the unoxygenated blood is passing into the left ventricle)
what are the clinical features found in tetralogy of fallot?
- cyanosis in lips and mouth
- cyanotic spells (usually after feeding, crying or straining)
-
patient squats to improve symptoms of cyanosis
- compression of femoral artery will increase pressure while decreasing the right to left shunt
what can allow this patients to live without needing an intervention?
presence of ASD or PDA - a left to right shunt
what is a transposition of the great vessels?
what part of the heart remains normla?
aorta arises from right ventricule and the pulmonary artery arises from the left ventricle
the atria
patients with transposition of the great vessels can live if there is presence of what?
a left to right shunt (ASD or VSD or PDA)
What happens in truncus arteriosus?
aorta and pulmonary artery share a common trunk causing intermixture of blood
what happens in tricuspid atresia?
patients have a atrial septal defect with right to left shunt
what happens in anomalous pulmonary venous return?
the pulmonary vein empties into the right atrium
What is coarctation of the aorta?
what are the 2 types of coarctation of the aorta?
whare are the differences?
a segemental narrowing or constriction of the aorta
- pre-ductal coarctation
- happens in infants
- less common
- happens before the ductus arteriosus
- post-ductal coarctation
- happens in adults
- more common
- happens after the ductus arteriosus
what happnes in preductal coarctation of the aorta?
there is a constriction of the aorta between the subclavian artery and ductus arteriosus causing a decrese in blood supply of the lower part of the body
pre-ductal coarcatation of the aorta is associated with what other disease?
Turner’s Syndrome
Is post-ductal coarctation of the aorta symptomatic always?
no, it is asymptomatic in early life but symptoms appear in adolescence and adult life
in post-ductal coarctation of the aorta, the constriction of the aorta will occur where?
distal to the ligamentum arteriosum (remnant of ductus arteriosus)
in a post-ductal coarctation of the aorta, with a proximal aortic constriction, what is happening?
what symptoms will you
more blood flows into close branches so blood pressure increases in upper extremities while the proximal aorta dilates
