Congenital Heart Disease

Question 1

Pathophysiology

Answer 1

Shunts & regurgitation - abnormal communication between heart chamber with direction determined by blood vessel pressure.

Obstruction (stenosis/ great vessel narrowing)

1- overloading 
2- increased resistance 
3- increased workload
4- hypertrophy 
5- muscle failure

Question 2

Clinical symptoms

Answer 2

Tachypnoea
Cyanosis
Clubbing
Pulm hypertension 
Infective endocarditis

Question 3

Left-to-right pathophysiology

Answer 3

Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus

Question 4

Right-to-left pathology

Causes

Answer 4

Tetralogy of Fallot
Pulmonary stenosis with VSD
Persistent truncus arteriosus
Tricuspid atresia

Question 5

Tetralogy of Fallot

Pathophysiology

Answer 5

VSD -> aorta overriding VSD -> Obstruction of RV outflow -> RV hypertrophy

Pulm stenosis protects lungs from increased pressure -> prolonged survival

Question 6

VSD late cyanosis

Pathophysiology

Answer 6

Larger defect = sooner symptom development

Signs: Loud murmur + thrill

Roger’s disease (small VSD’s)

Result: Hyperkinetic Pulm HPT -> Reversal of shunt -> cyanosis ( Eisenmenger complex)

Fix: Surgery

Complications: Bacterial endocarditis predisposition

Question 7

ASD

Pathophysiology

Answer 7

Raised right-side pressure

Sign: Cardiac Murmur

Results: Hyperkinetic pulm HPT -> Reversal of Shunt -> cyanosis or Right heart failure

Fix: surgery prior to school in children

Question 8

PDA

Answer 8

Cause: Ductus arteriosus doesn’t close after birth and creates a shunt from aorta to pulm artery.

Causes: Maternal Rubella, Prematurity, Respiratory distress syndrome

Results: Hyperkinetic pulm HPT -> shunt Reversal
Clinic: Machinary murmur

Fix: Medical therapy or surgical ligature

Question 9

Eisenmenger Complex

Description

Answer 9

Eisenmenger syndromerefers to any untreated congenital cardiac defect with intracardiac communication that leads to pulmonary hypertension, reversal of flow, and cyanosis.

Question 10

Obstruction

Causes

Answer 10

Coarctation of Aorta
Tubular hypoplasia of the aortic isthmus
Aortic valve stenosis or atresia

Question 11

Cardiac Murmurs

Answer 11

Abnormal shunting of blood through narrowed/ abnormal vessel/ valve or septal defect.

VSD
PDA
ASD in children

Question 12

Coarctation of Aorta

Answer 12

Associated with PDA, ASD, VSD & aortic valve.

Proximal compartment HTP

Radio-femoral delay

Question 13

Tubular hypoplasia of aortic isthmus

Answer 13

Associated: Turner’s Syndrome & large post-nuchal cystic hygroma

Die in utero of Cardiac failure