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cardiovascular > congenital heart disease - atrial septal defect, ventricular septal defecft > Flashcards

congenital heart disease - atrial septal defect, ventricular septal defecft Flashcards

1
Q

how often do they occur

A

in about 1% of all live births

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2
Q

who is more likely to get it women or men

A

men

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3
Q

which diseases are more common in females

A
  • atrial septal defect

- persistent ductus arteriosus

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4
Q

how is oxygen and nutrients supplied to the foetus

A

via the placenta and umbilical vein

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5
Q

where does the blood go

A

half to the fetal ductus venous and carried to the IVC

other half enters the liver

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6
Q

where does the blood move after the IVC

A

the right atrium

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7
Q

what is significant about foetal heart

A

there is an opening between right and left atrium

so blood flows from the right to left

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8
Q

what happens to blood in left ventricle

A

pumped through the aorta through the internal iliac arteries and re-enters the placenta

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9
Q

where does carbon dioxide go

A

taken up and enters the mothers circulation

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10
Q

where does the blood form the right atrium go that doesn’t go into the left atrium

A

enters the right ventricle and is pumped into the pulmonary artery

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11
Q

what is the ductus arterioles

A

connection between the pulmonary artery and the aorta

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12
Q

how does the foramen ovale close

A

due to increase in left atrial pressure

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13
Q

when does the ductus arteriosus usually close off

A

1-2 days after birth

this completely separates left and right systems

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14
Q

when does the umbilical vein and ductus venous close off

A

within 2-5 days of birth

leaving behind the ligaementum teres and the ligamentum venosus of the liver

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15
Q

what are some causes

A
  • maternal prenatal rubella infection
  • maternal alcohol misuse
  • maternal drug treatment and radiation
  • genetic abnormalities
  • chromosomal abnormalities
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16
Q

what does alcohol misuse cause

A

septal defects

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17
Q

what is Turner syndrome associated with

A

coarctation of aorta

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18
Q

what is Down syndrome associated with

A
  • septal defects

- mitral and tricuspid valve defects

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19
Q

common symptoms

A
  • central cyanosis
  • pulmonary hypertension
  • finger clubbing
  • paradoxical embolism
  • polycythaemia
  • growth retardation
  • syncope
  • squatting
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20
Q

why does cyanosis occur

A

because of right to left shunting of blood

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21
Q

what disease occurs with cyanosis

A

Fallots tetraology

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22
Q

why does hypertension occur

A

large left to right shunt

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23
Q

what tis pulmonary hypertension known as

A

Eisenmengers reaction

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24
Q

what is finger clubbing associated with

A

prolonged cyanosis

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25
Q

what can polycythaemia develop secondary to

A

chronic hyperaemia

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26
Q

what does polycythaemia increase risk of

A

stroke

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27
Q

when is syncope common

A

when severe right of left ventricular outflow tract is obstructed

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28
Q

when does syncope occur

A

in Fallots tetralogy associated with cyanosis

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29
Q

when does squatting occur

A

Fallots tetraology

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30
Q

what is most common congenital cardiac abnormalities

A

ventricular septal defect

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31
Q

when left ventricular pressure is higher than right where does blood move

A

from the left to the right

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32
Q

if large defect what does it lead to

A
  • pulmonary hypertension

- Eisenmengers complex

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33
Q

what happens when blood starts to move from right to left

A

cyanosis

34
Q

what is in small restrictive VSD

A

pan systolic murmur

35
Q

does small VSD produce abnormal CXR or ECG

A

no

36
Q

what is seen on CXR of larger defects

A

prominent pulmonary arteries causing increased blood flow

37
Q

when there is cardiomegaly what is seen on ECG

A

left and right ventricular hypertrophy

38
Q

what does echo do

A

assess the size and location of the VSD

39
Q

treatment for VSD

A
  • surgical patch repair

- device closure

40
Q

what are the indications for treatment in VSD

A

left atrial and ventricular enlargement

41
Q

when is atrial septal defect usually diagnosed

A

adulthood

42
Q

who’s more likely to get atrial septal defect men or women

A

women

43
Q

what are the 3 types of atrial septal defect

A
  • sinus venous defects
  • ostium secundum defect t
  • ostium primum defects
44
Q

where is sinus venous located

A

in superior part of the septum near superior vena cava or IVC

45
Q

where is ostium secundum

A

located in mid septum

46
Q

where is ostium premium located

A

in lower part of atrial septum

47
Q

what can be felt in atrial septal defect

A

right ventricular heave

48
Q

what is done for investigating atrial septal defect

A
  • CXR
  • ECG
  • echo
49
Q

what is seen on CXR for ASD

A

prominent pulmonary arteries with pulmonary plerotha

50
Q

what is seen on ECG for ASD

A

right bundle branch block and right axis deviation

51
Q

what is seen on echo for ASD

A

hypertrophy and dilatation or right heart and pulmonary arteries

52
Q

what allows calculation of the left to right shunt for ASD

A

Doppler

53
Q

what are indications for treatment in ASD

A
  • ASD with signifiant left to right shunting
  • thromboembolic events
  • patent foramen ovale
54
Q

what are the treatment options in ASD

A
  • device closure using transcatheter clamshell device

- surgical closure

55
Q

what keeps patent ductus arteriosus open

A

prostaglandin E

56
Q

what does prostaglandin E2 require for synthesis

A

COX

57
Q

what is patent ductus arteriosus

A

persistent communication between the proximal left pulmonary artery and descending aorta

resulting in left to right shunt

58
Q

when does ductus arteriosus usually close

A

couple hours after birth

59
Q

what is given to stimulate duct closure

A

indomectacin

a prostaglandin inhibitor

60
Q

what happens if shunt is large in patent ductus arteriosus

A

results in left heart volume overload

some cases pulmonary hypertension

61
Q

signs of patent ductus arteriosus

A
  • bounding pulse
  • machinery murmur
  • thrill can be felt
62
Q

what is used for investigation of patent ductus arteriosus

A
  • CXR
  • ECG
  • echo
63
Q

what is seen on CXR of patent ductus arteriosus

A

aorta and pulmonary arterial system are prominent

64
Q

what is seen on ECG of patent ductus arteriosus

A

left atrial abnormality and left ventricular hypertrophy

65
Q

what is seen on echo of patent ductus arteriosus

A

dilated left atrium and left ventricle

66
Q

what are indications for treatment of patent ductus arteriosus

A

left ventricular dilatation and mild to moderate pulmonary arterial hypertension

67
Q

what is coarctation of aorta

A

narrowing of aorta just distal to the insertion of the ductus arteriosus

68
Q

who gets coarctation of aorta more commonly men or women

A

men

69
Q

what is coarctation of aorta associated with

A

Turners syndrome

70
Q

what is the aortic valve like in coarctation of aorta

A

bicuspid

71
Q

what does severe narrowing of aorta encourage the formation of

A

collateral arterial circulation

72
Q

signs and symptoms of coarctation of aorta

A
  • systolic murmur heard over upper precordium of the back
  • vascular bruits
  • headaches
  • nosebleeds
  • claudication
  • cold legs
  • hypertension in upper limbs
  • weak delayed pulses in legs
73
Q

investigation for coarctation of aorta

A

CXR
ECG
echo

74
Q

what is seen on CXR for coarctation of aorta

A
  • dilated aorta indented at the site of coarctation

- aorta looks like a ‘3’

75
Q

what is seen on ECG for coarctation of aorta

A

left ventricular hypertrophy

76
Q

what is treatment of coarctation of aorta in neonates

A

surgical repair

77
Q

what is treatment of coarctation of aorta in older children and young adults

A

balloon dilatation and stenting

surgery is preferred

78
Q

what is Fallot’s tetraology characterised by

A

an aorta overriding the ventricular septum and arising from the right ventricle

79
Q

symptoms and signs of Fallot’s tetraology

A
  • systolic ejection murmur
  • cyanosis
  • squatting
80
Q

what can occur with Fallot’s tetraology

A

DiGeorge syndrome

cardiovascular (36 decks)

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