Congenital Heart Disease

Question 1

What are the different types of congenital heart defects

Answer 1

Atrial septal defects
Ventricular septal defects
Patent ductus arteriosus
Great vessel malformations

Question 2

Describe finger clubbing

Answer 2

Swelling of the terminal digits of the hands

Changes in the nail bed angle to the finger, flattening the normal dip between the finger tissue and the nail bed

Question 3

Which diseases can lead to finger clubbing

Answer 3

Cardiac diseases
Lung diseases
Inflammatory bowel diseases
Liver cirrhosis

Question 4

What is cyanosis

Answer 4

An increase in deoxygenated haemoglobin in the blood

Exists when there is 5g/dl or more of deoxygenated Hb in the blood

Question 5

What are the different types of cyanosis and what are their causes

Answer 5

Central - congenital heart disease

Peripheral - cold environment

Question 6

What causes central cyanosis

Answer 6

Poor oxygenation of the blood
Either poor flow of blood through the lungs to the tissues or oxygenated and deoxygenated blood mixing after the lungs leading to a CO with a reduced oxygenated level

Question 7

How does central cyanosis present

Answer 7

Warm body tissues but still blue
Tongue and lips easiest to see
Peripheral tissues also look blue

Question 8

How does peripheral cyanosis present

Answer 8

Affects particular tissues
Cold extremities
Vascular spasm such as Raynaud’s disease

Question 9

Describe Raynaud’s disease

Answer 9

Spasm of the blood vessels to the peripheral tissues in cold circumstances, restricting blood flow to the end of the fingertips causing them to have slow circulation and more deoxygenated blood

Question 10

What investigations can be carried out in patients for congenital heart defects and why

Answer 10

Doppler ultrasound scan
Possible to see blood flow through the valves and detects any defects in the cardiac wall
Defects will show that there is blood where there shouldn’t be and which direction the blood is flowing

Question 11

Where do atrial septal defects occur

Answer 11

Between the left and right atria

Question 12

What percentage of all septal defects are atrial septal defects

Answer 12

20-40%

Question 13

Describe an atrial septal defect

Answer 13

Pressure within the left atria is higher than in the right so the blood flow will be from the left side to the right meaning that oxygenated blood is being passed to be mixed with deoxygenated blood in the right side then being passed to the lungs to be oxygenated again

Question 14

Do patients with atrial septal defects show cyanosis

Answer 14

Blood that reaches aorta will be oxygenated so the patient will not show cyanosis

Question 15

Why do atrial septal defects increase the workload of the heart

Answer 15

Part of the CO is recirculating through the lungs and can lead to heart failure because of the increased strain on the heart

Question 16

What does an atrial septal defect look like on an x-ray

Answer 16

Bulge in the right side of the heart due to atrial hypertrophy

Question 17

Describe a ventricular septal defect

Answer 17

Blood is forced into the right side as well as up the aorta
As pressure is greater, the amount of blood forced back into the right ventricle will be treated and the volume of blood recirculating through the lungs will be higher

Question 18

What is the endocarditis risk of patients with septal defects

Answer 18

Low in patients with atrial septal defects

Higher in patients with ventricular septal defects as there is more turbulent blood flow

Question 19

What is the risk of heart failure in septal defects

Answer 19

Higher in ventricular septal defects but still existing in atrial septal defects

Question 20

How can septal defects be closed

Answer 20

Some shrink naturally with time and require no intervention
Open heart surgery and directly close the defect
Insertion of a mesh on each side of the defect by arterial access

Question 21

What is coarctation of the aorta

Answer 21

Narrowing of the aorta just after the left carotid artery

Question 22

What causes coarctation of the aorta

Answer 22

Ductus arteriosus in the foetus carrying blood from the pulmonary artery into the aorta has constricted, continuing around more of the aorta than it should do, creating a narrowing that restricts blood flow to the systemic arteries of the lower parts of the body

Question 23

What is unaffected by coarctation of the aorta

Answer 23

Brain, head, neck and right arm are unaffected

Question 24

What is affected by coarctation of the aorta

Answer 24

Left arm and lower limbs will have reduced blood flow

Question 25

What is patent ductus arteriosus

Answer 25

When the ductus fails to close

Question 26

What is the outcome of patent ductus arteriosus

Answer 26

There is greater pressure in the aorta than the ductus, blood will start to flow in the wrong direction in the ductus, back to the lungs

Question 27

Is coarctation of the aorta an endocarditis risk

Answer 27

No

Question 28

Is patent ductus arteriosus an endocarditis risk

Answer 28

Yes