Congenital Heart Disease Flashcards
When are defects detected?
20 week anomaly scan
Fetal echocardiography due to FH and other indications (e.g. DM, monochorionic twins)
When can symptoms present?
Hours to days postnatally to adulthood - depends on defect
What is the Tetralogy of Fallot?
Mnemonic ROVeR
Right Ventricular outflow tract obstruction - pulmonary stenosis
Overriding aorta: sits above VSD and connects both ventricles
VSD
RVH
What defects would cause symptoms to appear in early life?
What defects would cause symptoms to appear in adulthood?
Hypoplastic left heart
Transposition of the great arteries (TGA)
Shunt dependent circulations
Artrial septal defect (ASD)
Ventricular septal defect (VSD)
Coarctation (COA)
What is the only defect that will cause cyanosis?
Right-to-left shunts - can be reversed to left-to-right shunts due to increased pulmonary resistance
The rest still cause decompensation and HF
How would you know if there is acute decompensation or heart failure?
Poor feeding Dyspnoea Tachycardia Hepatomegaly Cool peripheries Acidosis on ABG Pulmonary venous congestion on CXR
Investigations:
Bedside
Bloods
Imaging
PaO2, ECG
FBC
CXR, echocardiogram +/- cardiac catheter
Management - Conservative and Medical
Sit-up right
O2
Calories via NG feed
Diuretics - furosemide +/- spironolactone
VSD:
- Sym
- Signs
- ECG
- CXR
- M - 2
- Complications
usually mild
harsh loud pansystolic blowing murmur +/- thrill Parasternal heave Tachycardia SOB Hepatomegaly
Ventricular hypertrophy and strain
Pulmonary engorgement
Cardiomegaly
Small or muscular defects close spontaneously - diuretics for HF and ACEi to reduce afterload
Surgery if large and not resolving
Aortic regurg
Infective endocarditis
Eisenmenger’s (shunt reversal and cyanosis)
ASD
- Sym
- Signs
- ECG
- CXR
- M
Usually none - SOB, cyanosis, haemoptysis, chest pain
Widely split fixed S2
Systolic (pulmonary flow) murmur in pulmonary area
Raised JVP
AF
RVH +/- partial RBBB
Right acis deviation
Cardiomegaly
Prominent pulmonary artery
Surgical closure
Pulmonary Stenosis
- Sym
- Signs
Usually assymptomatic
ESM ULSE
Thrill
Soft S2
Patent ductus arteriosus (PDA)
- Sym
- Signs
- ECG
- CXR
- What should be ensured?
- What does closure avoid?
- M - preterm and term
- Complications
Usually assymptomatic unless large causing CCF and pulmonary HTN
Continuous machine murmur below left clavicle
Thrill
Collapsing pulse
Displaced heaving apex
Usually normal
Large pulmonary arteries and large left heart
No duct dependent circulation by echocardiogram
Spontaneous bacterial endocarditis and circulatory overload
PT - treat if symptomatic, IV NSAIDS or surgical ligation
T - Wait until large enough / old enough for endovascular surgery - Digoxin + furosemide or surgical ligation
CHF
Eisenmenger’s syndrome
Coarctation
- Sym
- When?
- Signs
- ECG
- CXR
- M
- Complications
- What can be used to maintain a patent ductus arteriosus so they have adequate circulation before surgery?
Usually none unless severe or interrupted arch type and so duct dependent and symptomatic
Day 3-10
HTN
Radio-femoral delay and/or weak femoral pulse
Murmur at ULSE
LVH/RVH and strain
Rib notching
Stent or surgery by 5 years to avoid pulmonary HTN and end organ damage.
Infective endocarditis
IV prostoglandins - IV NSAIDs used to close it - (think - they are the opposite of each other)
TGA
- Sym
- When?
- M
Cyanosis
Day 1-2
Maintain PDA
Balloon catheter atrial spetal perforation
Surgery with arterial switch first in the first few days of life
Tetralogy of Fallot - when is it diag? - 2
Sym and Signs
M - medical and surgical
Antenatally or hearing a harsh ESM LLSE
Poor growth
SOB
Cyanosis and clubbing
Pallor due to hyposxia
Correcticve surgery at 1 yr
Earlier if severe
Until then, oxygen if symptomatic, morphine, beta-blockers
prostaglandins to keep ductus open
