Congenital Heart Disease Flashcards
Cyanotic CHDs (6)
H+5Ts:
- hypoplastic L heart syndrome
- tetralogy of fallot
- transposition of the great arteries
- tricuspid and pulmonary atresia
- total anomalous pulmonary venous connection
- truncus arteriosus
Acyanotic CHD (6)
VC PAPA:
- VSD
- coarctation of the aorta
- PDA
- ASD
- pulmonary stenosis
- aortic stenosis
general presentation of CHD (3)
often sweaty
breathlessness often during feeds
fail to thrive due to high metabolic demand
Features of osteum secundum ASD (4)
higher in atrium
often asymptomatic till adulthood
3 times more common in girls
ECG shows RBBB w. RAD
Features of osteum primum ASD (4)
lower in atrium
also affects AV valves>valve incompetence
common in Down’s
ECG shows RBBB w. LAD
Features of severe osteum primum defect (4)
breathlessness
recurrent chest infections
pulmonary HTN
heart failure
signs of ASD (3)
ejection systolic murmur loudest in pulmonary region
fixed, widely split s2
partial AVSD>pansystolic murmur at apex
complications of ASD (2)
Eisenmenger’s
paradoxical emboli
Ix in ASD (3)
CXR: enlarged right side, enlarged pulmonary vessels (pulmonary plethora)
ECG: RBBB+LAD(primum)/RAD (secundum)
Echo is diagnostic
Mx of primum and secundum defects (2)
secundum: insert device via cardiac catheter
primum: surgical closure by 3yrs.
Sx, signs, Ix and Rx of small VSDs (6)
asymptomatic signs: loud pansystolic murmur in tricuspid region, quiet p2 CXR and ECG normal Echo is diagnostic should close spontaneously
symptoms and signs of large VSDs (5)
heart failure+SOB in first wk of life recurrent chest infections quiet/absent pansystolic murmur loud p2 pulmonary HTN
Ix findings in large VSDs (6)
CXR: -Cardiomegaly -engorged pulmonary arteries -increased pulmonary vascular markings -pulmonary oedema ECG shows biventricular hypertrophy echo is diagnostic
Mx of large VSDs (2)
diuretics for HF; most close spontaneously by 1yr
surgical closure if large or not controlled with diuretics by 3mo due to risk of Eisenmenger’s
features of PDA (3)
ductus open 12mo after due date
blood flows from aorta to pulmonary artery
in womb, ductus is maintained by low paO2 and PGE from the placenta
RFs for PDA (4)
Down’s
altitude
prematurity
rubella
Features of PDA (5)
continuous machinery murmur below left clavicle
raised pulse pressure
collapsing/bounding pulse
pulmonary HTN
may need ventilator support at birth which can be difficult to wean off
Ix for PDA (4)
usually normal ECG and CXR if severe, same as large VSD: -CXR: cardiomegaly, pulmonary plethora etc -ECG: biventricular hypertrophy -echo is diagnostic
Rx of PDA (5)
most close spontaneously so don’t Rx unless 1yr (3mo for prem) or symptomatic.
Dexamethasone for prematurity
Indomethacin to close PDA in first 14d of life
diuretics to reduce preload
coil via cardiac cath/surgical closure
coarctation of the aorta-common site, epidemiology and associations (4)
distal to left subclavian at the ductus
M>F
assoc. w. turner’s, bicuspid aortic valve, berry aneurysms and NF
Features of pre-ductal coarctation (3)
symptomatic: sick infant w. absent femorals
arms pink and legs blue
right ventricle compensates and provides for systemic circulation via ductus> heart failure when it closes
Mx of pre-ductal coarctation
give PGE infusion at Dx and transfer to cardiac centre
Features of post-ductal coarctation (5)
asymptomatic infant HTN in arm weak/absent femorals mottled appearance of lower limb left ventricular hypertrophy
Mx of post-ductal coarctation
surgical resection: balloon dilatation or resection of segment
Signs of coarctation
ejection systolic murmur; can heard between scapulae
Ix for coarctation (4)
CXR: bilateral rib notching
ECG: RVH+RBBB in neonates and LVH in older kids
CT angiogram
complications of coarctation (3)
LVH
aortic rupture
intracranial haemorrhage
Rx of coarctation (2)
Furosemide
balloon dilatation, stenting and patching
Causes of blue baby (4)
heart disease
lung disease
infection
polycythaemia
how to differentiate between cardiac and pulmonary disease in blue baby
nitrogen washout test:
failure of PaO2 to rise above 15 in right radial artery after 10 mins on 100% O2.
Mx of a blue baby and SEs (3)
start PGE infusion to maintain ductus
SEs: temperature, NEC and apnoea
may need Abx until sepsis is ruled out
Tetralogy of Fallot (4)
overriding aorta
pulmonary stenosis
RVH
large VSD
Associated condition of ToF
DiGeorge syndrome (absent thymus, cleft palate)
presentation of ToF (6)
presents around 6mo
cyanosis
paroxysmal hypercyanotic spells: increasing cyanosis>white and floppy
clubbing
squatting after exercise
harsh ejection systolic murmur at left sternal edge
Severity of ToF based on…
degree of pulmonary stenosis
Ix for ToF (5)
CXR: boot shaped heart, decreased pulmonary vascular markings, RVH
ECG: RVH
echo shows cardinal features.
Mx of ToF
initially a PGE infusion and Blalock-Taussig shunt to maintain ductus for hypercyanotic spells: -sedation and analgesisa (morphine) -propranolol -bicarbonate to correct acidosis
will then require surgical correction at 6mo:
- closure of VSD
- pulmonary valve patching
Features of TGA (2)
2 parallel circulations
not compatible w. life unless there’s also an ASD, VSD or PDA
Presentation of TGA (2)
normally on 2nd day of life when ductus closes
cyanosis
Ix for TGA
CXR shows egg-shaped heart
Mx of TGA (3)
PGE infusion
balloon atrial septostomy to maintain foramen ovale
definitive surgery w/i 2wks of life.
Features of complete AVSD (3)
most common CHD in down’s
cyanotic
presents w. SOB+cyanosis and signs of HF in first day of life
when to Rx complete AVSD
at 3 months
Features of tricuspid atresia (3)
no connection between RA and RV
venous blood flows through foramen ovale
pulmonary circulation dependant on the ductus
Mx of tricuspid atresia (3)
PGE infusion
Blalock-Taussig shunt (pulm art>subclavian)
pulmonary artery banding
