Congenital Heart Disease Flashcards
What is congenital heart disease?
Abnormality of the structure of the heart present at birth
Mild congenital heart disease
Asymptomatic, may resolve spontaneously
Moderate congenital heart disease
Requires specialist intervention and monitoring in a cardiac centre
Severe congenital heart disease
Present severely ill/die in newborn period or early infancy
Major congenital heart disease
Requires surgery within first year of life
When can congenital heart disease present?
Antenatally, soon after birth, day 1-2 baby check, day 3-7, 4-6 weeks, 6-8 weeks GP check
Signs of congenital heart disease soon after birth
Cyanosis
Signs of congenital heart disease at day 1-2 baby check
Murmurs, abnormal pulses, cyanosis
Signs of congenital heart disease at day 3-7
Sudden circulatory collapse, shock, cyanosis, sudden death
Signs of congenital heart disease at 4-6 weeks
Signs of cardia failure - reduced feeding, failure to thrive, breathlessness, sweating
Signs of congenital heart disease at 6-8 weeks
Incidental finding of murmurs at other clinical contents
Management of antenatally diagnosed congenital heart disease
Depends on disease, expert team available, may decide to deliver in cardiac surgical centre, prostaglandin infusion if duct dependent lesion
What does antenatal screening show in relation to heart?
Ultrasound at 18-22 weeks will show 4 chamber heart view and outflow tract view
What does the newborn screening exam involve in relation to the heart?
Femoral pulses, heart sounds, presence of murmurs
What can a murmur at baby check indicate
Small muscular ventricular septal defect - no haemodynamic consequences and many close spontaneously
What can cause cyanosis in a baby?
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
Example of congenital heart condition that can cause cyanosis of the newborn
Transpositon of the great arteries
Differential diagnosis of cyanosis in a newborn
Cardiac disease, respiratory disease, persistent pulmonary hypertension of the newborn
Signs of collapse at time of duct closure
Severe cyanosis or pallor, tachycardia, distress, rapid deterioration to death, prolonged capillary refill time, poor or absent pulses, hepatomegaly, crepitations
Treatment for collapse at time of duct closure
ABC, Prostaglandin E2, multisystem supportive treatment
Examples of duct dependent conditions - duct dependent systemic circulation
Hypoplastic left heart, critical aortic stenosis, interrupted aortic arch, critical coarctation of the aorta
Examples of duct dependent conditions - duct dependent pulmonary circulation
Tricuspid atresia, pulmonary atresia
Clinical signs of cardiac failure in babies
Failure to thrive, slow/reduced feeding, breathlessness, sweating, hepatomegaly, crepitations
Patent ductus arteriosus repair
Closure by device, catheter procedure, couple of follow up appointments to ensure the flow is stopped and the device is in the correct position
Ventricular septal defect repair
Closure by patch, follow up during childhood/adolescence. Rhythm problems or valve problems may occur, but generally expected to go on to live a normal life
Hypoplastic left heart surgery
3 stage complex surgery with significant mortality at each stage and between. Ends with RV supplying circulatory system but will fail over time so a transplant will be needed
