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Cardio > Congenital Heart Disease > Flashcards

Congenital Heart Disease Flashcards

1
Q

What is congenital heart disease?

A

Abnormality of the structure of the heart
Present at birth
‘Gross abnormality of the heart or intrathoracic great vessels that is actually or potentially of functional significance

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2
Q

Spectrum of severity for congenital heart disease?

A

Mild
Moderate
Severe
Major

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3
Q

Describe mild congenital heart disease?

A

Asymptomatic
May resolve spontaneously
(can progress to moderate or severe in specific conditions at adulthood)

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4
Q

Describe moderate congenital heart disease?

A

Require specialist intervention

Monitoring in cardiac center

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5
Q

Describe severe congenital heart disease?

A

Present severely ill/Die in newborn period or early infancy

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6
Q

Describe major congenital heart disease?

A

Requires surgery within the first year of life

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7
Q

How is congenital heart disease picked up?

A

Screening- antenatal, newborn baby check
Well baby with clinical signs
Unwell baby - cyanosis, shock, cardiac failure

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8
Q

When congenital heart disease can present?

A

Antenatally
Soon after birth- cyanosis
Day 1-2 baby check= murmurs, abnormal pulses, cyanosis
Day 3-7 = Sudden circulatory collapse, shock, cyanosis, sudden death
4-6 weeks = Signs of cardiac failure- reduced feeding, failure to thrive, breathlessness, sweaty
6-8 week GP check= Finding murmurs incidentally

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9
Q

What is involved in antenatal screening?

A

Ultrasound at 18-22 weeks

4 chamber heart view and outflow tract

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10
Q

Management of antenatally diagnosed congenital heart disease?

A

Plans in place with expert team available
May decide to deliver in cardiac surgical centre
Prostaglandin infusion duct dependant lesion

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11
Q

What is newborn screening?

A

Clinical examination at around 24 hours of age

Femoral Pulses, heart sounds, presence of murmurs

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12
Q

Murmur in new born health check?

A

Small muscular VSD
Murmur early in life
No haemodynamic consequences
May close spontaneously

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13
Q

What is cyanosis?

A
  • Any condition causing deoxygenated blood to bypass the lungs and enter the systemic circulation
  • Any condition where mixed oxygenated and deoxygenated blood enters the systemic circulation from the heart
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14
Q

What does cyanosis do clinically?

A

Blueish discoloration

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15
Q

Differential diagnosis of cyanosis in newborn baby?

A
  • Cardiac disease
  • Respiratory disease
  • Persistent pulmonary hypertension of the newborn
  • Pre-post ductal differential - cardiac babies tend to be blue with little to no respiratory distress
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16
Q

Clinical sign of collapse at time of duct closure?

A 
Pallor 
Prolonged CRT 
Poor or absent pulses 
Hepatomegaly 
Crepitations 
Increased work of breathing
17
Q

Differential Diagnosis for collapse at time of duct closure?

A

Sepsis

Metabolic conditions

18
Q

When do babies often collapse due to duct closure?

A

2-7 days after birth

19
Q

Treatment of babies who collapse on duct closure?

A

ABC- support airway and breathing as necessary
Prostaglandin E2 to open duct
Multisystem supportive treatment
Transfer to cardiac surgical centre for definitive management

20
Q

Examples of duct dependent systemic circulation conditions?

A

Hypoplastic left heart
Critical aortic stenosis
Interrupted aortic arch
Critical coarctation of aorta

21
Q

Examples of duct dependant conditions in relation to pulmonary circulation?

A

Tricuspid atresia

Pulmonary atresia

22
Q

Clinical signs of cardiac failure in babies?

A
  • Failure to thrive
  • Slow/reduced feeding
  • Breathlessness (especially when feeding)
  • Sweatiness
  • Hepatomegaly (enlargement of the liver)
  • Crepitations
23
Q

Events in a moderate ventricular septal defect?

A

Big defect
Often no murmur at baby check
Murmur develops as pulmonary pressures drop over first weeks

24
Q

Effects of VSD? Ventricular septal defect

A

Increased pulmonary circulation

Congestive cardiac failure

25
Q

Longer term management of major congenital heart disease?

A

Surgical management
Developmental problems - hypoxia, bypass time
Need for further surgery- valve, stenosis, transplant
Emotional/social support

26
Q

Patent ductus arteriosus repair?

A

Catheter procedure
Follow up appointments- ensure flow stopped, device in correct position
Discharge patient

27
Q

Ventricular septal defect repair?

A
  • Follow up during childhood/adolescence
  • Rhythm problems or valve problems
  • Generally expected to go onto normal life
28
Q

Hypoplastic left heart syndrome repair?

A

3 stage complex surgery
Significant mortality at each stage and between
Ends with RV supplying systemic circulation
Will fail over time- transplant

29
Q

What is one of the most common congenital abnormalities?

A

Congenital heart disease

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