congenital heart disease Flashcards
1
Q
what is congenital heart disease?
A
- abnormality of the structure of the heart which is present at birth
2
Q
what is mild CHD?
A
- asymptomatic, may resolve spontaneously
- may progress to moderate or severe in adulthood in some specific conditions
3
Q
what is moderate CHD?
A
- require specialist intervention and monitoring in a cardiac centre
4
Q
what is severe CHD?
A
- present severely ill / die in newborn period or early in infancy
5
Q
what is major CHD?
A
- requires surgery within the first year of life
6
Q
how does CHD present?
A
- screening = antenatal, newborn baby check
- well baby with clinical signs
- unwell baby = cyanosis, shock, cardiac failure
7
Q
when does CHD present?
A
- antenatally
- soon after birth
- day 1-2 baby check = murmurs, abnormal pulse, cyanosis
- day 3-7 = sudden circulatory collapse, shock, cyanosis, sudden death
- day 4-6 = signs of cardiac failure - reduced feeding, failure to thrive, breathlessness, sweatiness
- 6-8 week GP check, incidental finding of murmurs at other clinical contacts
8
Q
what is antenatal screening?
A
- ultrasound at 18-22 weeks gestation
- 4 chamber heart view and outlfow tract view
- sesitivity very variable
- large centres in some countries achieve 80% detection rates
9
Q
how is antenatally diangosed CHD managed?
A
- depends of the disease
- expert team avalibale and plans in place
- may decide to delivery in cardiac surgical centre
- prostaglandin infusion if duct dependent lesion
10
Q
what are the differential diagnosis’ of cyanosis in newborns?
A
- cardiac disease
- resp disease
- persistent pulmonary hypertension of newborn
11
Q
what are small muscular VSDs?
A
- can present as a murmur in early life
- Smaller VSDs make louder noises than larger ones = think hose pipe
- No haemodynamic consequences
- Many close spontaneously
12
Q
how is collapse of duct closure treated?
A
- ABC = support airway and breathing as necessary
- prostaglandin E2 to open duct
- multisystem supportive treatment
- transfer to cardiac surgical centre for definitive management
13
Q
give exmaples of duct depenedent conditions?
A
- duct dependent systemic circulation
= hypoplastic left heart, critical aortic stenosis, interupted aortic arch, critical coarctation of aorta - duct dependent pulmonary circulation = tricuspid atresia, pulmonary atresia
14
Q
presentation with cardiac failure
A
Failure to thrive Slow/reduced feeling Breathlessness Sweatiness Hepatomegaly Crepitations
15
Q
what are clinical signs of failure in babies?
A
- failure to thrive
- slow / reduced feeding
- breathlessness esp when feeding
- sweatiness
- hapatomegaly
- crepitations
16
Q
what is moderate / large VSD?
A
- big defect - less gradient
- often no mrmur at baby check
- murmur develops as pulmonary pressures drop over first weeks
- increased pulmonary circulation, congestive cardiac failure
17
Q
what is the long term managemet of major congenital heart disease?
A
- surgical management
- developmential probelms eg hypoxia, bypass time
- need for further surgery eg valves, senosis, transpolan
- emotional / social issues
18
Q
what is patent ductus ateriosus repair?
A
- catheter procedure
- couple of follow upappointments
- discharged
19
Q
what is VSD repair?
A
- follow up during child hood / adolsecence
- rhyth probelms or valve probel,s
- generally expect to go on to normal life
20
Q
what is HLHS?
A
- 3 stage complex surgery
- significan mortaity at each stage and between
- ends with RV supplying systmic circulation
- will fail over time
- transplant
