Congenital Heart Disease Flashcards
What changes to foetal circulation happen at birth?
Increase in SVR
Decrease in pulmonary vascular resistance
This causes increase in RA pressure
Foramen ovale pushed closed
Ductus arteriosus also closes and becomes the ligament arteriosus
How is congenital heart disease usually detected?
Antenatal sanning
What are tested to detect congenital heart disease in newborns?
Femoral pulses
Heart sounds
Presence of murmurs
Pre and post ductal saturations
What factors of murmurs make them likely to be innocent?
Soft Systolic Short S1 and 2 normal Symptomless
What causes cyanosis in newborns?
If a lesion allows blood to bypass the lungs or mixed oxygenated and deoxygenated blood to enter circulation
What can cyanosis in newborns be a symptom of?
Respiratory disease
Persistent pulmonary hypertension of the newborn
When does the ductus arteriosus close?
Day 4-7
What does collapse at day 4-7 indicate?
Duct dependent lesion
What are symptoms of heart failure?
Failure to thrive Slow/reduce feeding Breathlessness Sweatiness Hepatomegaly Crepitations
When do symptoms of heart failure usually occur in newborns?
4-6 weeks
In which situation would a heart defect not cause cyanosis?
If lesion only shunts blood left to right, or no shunting
What are some heart defects that do not cause cyanosis?
Atrial septal defect Ventricular septal defect Atrioventricular septal defect Atrial stenosis Pulmonary stenosis
What are some heart defects that cause cyanosis?
Truncus arteriosus Tetralogy of Fallot Transposition of the great vessels Tricuspid atresia Total anomalous pulmonary venous connection
In a duct dependent lesion where the patient relies on a patient ductus arteriosus to maintain oxygenation, what management is done?
Prostaglandin e2infusion to keep it open until surgery
What is a buzzword for patent ductus arteriosus?
Machinery murmur
What is the management for patent ductus arteriosus?
NSAIDs or surgical repair
What is coarctation of the aorta?
Narrowing of the aorta
Where does coarctation of the aorta usually affect?
Proximal thoracic aorta
What are the clinical signs of coarctation of the aorta?
Radio-femoral delay
Strong upper body pulses
Weak lower limb pulses
Rib notching
What does coarctation of the aorta cause?
Hypertension and LV hypertrophy above the lesion and hypoperfusion below
What is in the differential for hypertension in a young person?
Coarctation of the aorta
What are all patients with congenital heart disease at an increased risk of?
Infective endocarditis
What is Eisenmenger’s syndrome?
Long standing left to right shunt causes pulmonary hypertension
The increased pressure over time causes reversal of this shunt to right to left, causing cyanosis
