Congenital Heart Disease Flashcards
what is congenital heart disease
abnormality of the structure of the heart or intra-thoracic great vessels
present at birth
severity of congenital heart diseases
mild - asymptomatic (may resolve spontaneously)
moderate - specialist intervention, monitoring in cardiac centre
severe - severely ill/die in newborn period
major - surgical intervention within first year of life
symptoms of congenital heart disease
well baby with clinical signs unwell baby; cyanosis shock cardiac failure
tests for congenital heart disease
screening;
antenatal
new born baby check
signs of congenital heart disease
murmurs abnormal pulse sudden circulatory collapse shock cardiac failure - reduced feeding, failure to thrive, breathlessness, sweatiness
death?
describe antenatal screening
ultrasound as gestation
4 chamber heart view and outflow heart tract
very sensitive
treatment of antenatally diagnosed congenital heart disease
depends on the specific disease
prostaglandin infusion if duct dependent lesion
describe cyanosis in newborn
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
differential diagnosis of cyanosis in newborn
cardiac disease - e.g. transposition of great arteries
respiratory disease
persistent pulmonary hypertension of the newborn
sepsis or metabolic conditions
signs of transposition of great arteries
severe cyanosis or pallor tachypnoea distress poor or absent pulses acidotic rapid deterioration or death
treatment of transposition of great vessels
ABC
prostaglandin E2 - open duct
multi-system supportive treatment
transfer to cardiac surgical centre for definite management
list exmaples of duct dependent conditions
duct dependent circulation; hypoplastic left heart, critical aortic stenosis, interrupted aortic arch, critical coarction of aorta duct dependent pulmonary circulation; tricsupid atresia pulmonary atresia
presentation of cardiac failure in newborns
moderate to large left to right shunts - increased pulmonary flow, increased ventricular load
pulmonary pressures drop
failure to thrive slow/reduced feeing breathlessness sweatiness hepatomegaly crepitations
describe moderate/large ventricular septal defect
big defect - less gradient
often no murmur at baby check
murmur develops as pulmonary pressures drop over first weeks
increased pulmonary circulation, congestive cardiac failure
long term management of major congenital heart diseae
surgical;
repair vs palliation
developmental problems;
hypoxia
bypass time
further surgery;
valves, stenosis
transplant
emotional/social issues
