Congenital Heart Disease

Question 1

Definition

Answer 1

• Abnormality found in the Heart/GV found at birth.
• Fault in Embryogenesis (gestational week 3-8)
• 90% of time cause is unknown (genetic + environmental factors play a part)

Question 2

Subdivision of Congenital Heart Disease

Answer 2

1) L->R Shunt: - thus the lower Pulmonary circulation is exposed to the high pressure of systemic circulation caused R.S Hypertrophy + R.S HF
2) R->L Shunt: -Blue Babies: Cyanosis develops due to Pulmonary circulation being bypassed - so hypoxic blood enters the circulation.

3)Obstructions

Question 3

L->R Shunt overview

Answer 3

Shunt causes R.S overload –> RS Hypertrophy –> overload in Pressure +Volume in Pulmonary Circulation (pul.oedema)

Long Standing: Intimal Fibrosis –> increased resistance of the Lungs –> EISENMENGER SYNDROME (R–>L Shunt) –> Death

Question 4

Causes of L->R Shunting

Answer 4

1) Osteum Secundum

2) Osteum Primum

*if hole is less than 1cm = Tolerated

• *3) VSD:
• Hole in membranous Part =Rogers Disease**
• Increase risk for Superimposed Infective E.C (jet lesions)

4) Patent Ductus Arterious:

-Normally moves blood from PT –> Aorta (as resistance of lung is high + oxy is low)
-After birth constricts due to … and becomes Ligamentum Arteriosum
> incr Oxy
> decr. pul resist
> decr. local levels of PGE2
-Doesn’t Close if: IRDS/

Question 5

Compensatory methods for R->L Shunts

Answer 5

1. Polycythemia (incr. risk for Venous Thrombosis)
2. Hypertrophic Osteoanthropy
3. Paradox Embolism

Question 6

Causes of R–>L Shunting

Answer 6

• *1. Tetralogy of Fallot:**
• PT Stenosis
• VSD (Memb)
• Dextraposition of Aorta
• Hypertrophy of RV

*if mild PT Stenosi -> Pink Tetralogy (L->R shunt)
**if intermediate –> Bilateral shunting

***as child grows the condition gets worse

2. Transposition of GA:

• Incompatible with life (unless shunt develops)
• PT from LV/ Aorta from RV

3. Truncus Arteriosus:

• failure to split –> so patient has common trunk for both sides of the heart

Question 7

Obstruction

Answer 7

• occurs at the level of the valves/Great vessel

1. Pulmonary/Aortic Stenosis

2. Atresia

3. Aortic Coarticion:

>Infantile Type:

• *-** Aortic Arch narrow up until the point of Branching
• Hypoxia to Upper + Lower parts of the Body
• *>Adult Type:
• **infolding at the area of the Lig.Arteriosum.
• LV HPT –> BP high in Upper/ Low in Lower

Risk:
1. Brain hemorrhage

2. HF (due to Ischemia)
3. Aortic Dissection