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Clin Med - Cardiology > Congenital Heart Disease > Flashcards

Congenital Heart Disease Flashcards

1
Q

What is the most common congential heart defect?

A

VSD

(also believed 1/2 of these repair themselves and never come to medical attention)

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2
Q

What is an atrial septal defect?

A

persistent opening in the interatrial septum after birth that allows for direct communication between the l. and r. atria

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3
Q

What is the prevalence of ASD?

A

1:1500 live births

10% of all congenital heart disease

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4
Q

What is the consequence of an ASD?

A

blood ordinary shunted from left–>right

volume overload in right atrium

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5
Q

What is Einsemenger Syndrome?

A

When a shunt that was formerly left-to-right becomes right-to-left

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6
Q

What is the common presentation for ASD?

A
  • May be asymptomatic
  • DOE
  • Fatigue
  • Recurrent lower respiratory tract infections
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7
Q

What are the exam/test findings with ASD?

A

RV heave along LSB

S2 wide, fixed splitting

murmur is mid-systolic left USB

cardiac cath - measures higher O2 in right atria

echo - shows shunt on doppler

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8
Q

Rx for ASD?

A

Surgical-

  • direct suture closure
  • pericardial or synth patch
  • percutaneous apporahc with septal occluder device
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9
Q

How prevalent is VSD?

A

1.5-3.5:1000 live births

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10
Q

How do you diagnose VSD?

A

echocardiography

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11
Q

What are the symptoms and signs of VSD?

A
  • depends upon the size of the defect ranges from no symp. to heart failure
  • harsh, holosystolic murmur along LSB
  • systolic thrill
  • if reversed shunt, cyanosis and dyspnea
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12
Q

What is the Rx for VSD?

A
  • 1/2 close spontaneously by age 2
  • closure indicated with s/sx of CHF or pulmonary vascular disease
  • same as ASD methods for closure
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13
Q

What is the tetraology of Fallot?

A

4 Defects:

  1. VSD
  2. pulmonic stenosis
  3. overridng aorta (communicates with right ventricle through VSD)
  4. RVH
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14
Q

How common is tetralogy of Fallot?

A

Pretty rare: 5:10k live births

but most common cyanotic heart disease in childhood

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15
Q

What are the s/sx of tetralogy of Fallot?

A
  • “Tet” Spells - hyperventilation, cyanosis, syncope and squatting after exertion, feeding, crying
  • dyspnea on exertion
  • mild cyanosis and clubbing
  • RV heave
  • systolic ejection murmur at left USB
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16
Q

What is the Rx for tetralogy of Fallot?

A

surgery-close VSD and increase pulmonary artery width

*if necessary, temporarily create connection between aorta and pulmonary artery to reduce hypertension

17
Q

What is transposition of the great vessels?

A

aorta arises from the RV

pulmonary artery arises from the LV

so, aorta pumps deoxygenated blood and the pulmonary artery carries oxygenated blood to the heart

18
Q

What is the prevelence of transposition of the great vessels?

A

40:100k births (7% congenital)

most common neonatal cyanosis

19
Q

What are the s/sx of transposition of the great vessels?

A

blue baby - extremely hypoxic and cyanotic

20
Q

How do you diagnose transposition of the great vessels?

A

echocardiogram

21
Q

What is the Rx for transposition of the great vessels?

A

arterial switch surgery is definitive

until that can occur, use prostaglandins to keep ductus arteriosis open (only way to get some oxygenated blood circulating)

22
Q

Who still gets pre-dental/surgical antibiotic prophylaxis with congenital heart disease?

A

unreparid cyanotic heart disease

post-repair for six months

post-repair with residual defects

23
Q

What is coarctation of the aorta?

A

narrowing of the aortic lumen

(can be postductal -98% or preductal - 2% for the DA)

24
Q

how common is coarctation of the aorta?

A

1:6k live births

25
Q

What are the s/sx of coarctation of the aorta?

A
  • most asymptomatic, but severe will be evident in a newborn
  • preductal has cyanosis in LE
  • femoral pulses weak and delayed
  • midsystolic murmur
  • elevated UE BP
26
Q

How do you diagnose coarctation of the aorta?

A
  • x-ray may show indented aorta and notches on inferior part of the ribs
  • echo confirms
27
Q

What is the treatment for coarctation?

A

severe - prostaglandin to keep DA open

definitive - excision and reanastamosis (balloon +/- stenting)

28
Q

What is patent ductus arteriosus (PDA)

A

when embryological anastamosis between aorta and pulmonary artery fails to close after birth

29
Q

What is the prevalence of PDA?

A

1:2500-5000 live births

30
Q

What are the s/sx of PDA?

A

small are asymptomatic

moderate - fatigue, dyspnea, palpitation

large - left-to-right shunt HF

Afib can develop if left atria dilates

“machine” like murmur

31
Q

How do you diagnose PDA?

A

echo

32
Q

What’s the treatment for PDA?

A
  • prostaglandin synthesis inhibitor - indomethacin
  • surgical ligation or division
  • transcather coiling
33
Q

What is congenital aortic stenosis?

A

Abnormal development of the aortic valve with resulting obstruction of flow. Usually bicuspid leaflet or unicuspid (more severe)

34
Q

What are the s/sx of aortic stenosis?

A

most are symptomatic, but when symptoms occur, looks like AS in grown-ups.

35
Q

What is pulmonic stenosis and what is its prevalence?

A

obstruction across the pulmonic valve due to abnormal development of the valve, outflow tract, or artery.

It’s very rare

36
Q

What are the signs and symptoms of pulmonic stenosis?

A

usually asymp.

when there are symptoms, DOE, exercise intolerance, right-sided HF

  • On exam:
    • prominent jugular venous a wave
    • RV heave and thrill
    • widely split S2 and soft P2
    • loud, late-peaking, crescendo-decrescendo systolic murmur at upper LSB
37
Q

How do you dx and grade pulmonic stenosis?

A

echo to confirm and assess pressure gradient

Mild <50 mmHg

Moderate 50-80 mmHg

Severe >80 mmHg

38
Q

What’s the Rx for pulmonic stenosis?

A

moderate or severe cases treated - transcatheter balloon valvuloplasty

RV hypertrophy usually regresses!

Clin Med - Cardiology (17 decks)

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