congenital heart disease - atrial septal defect, ventricular septal defecft Flashcards
how often do they occur
in about 1% of all live births
who is more likely to get it women or men
men
which diseases are more common in females
- atrial septal defect
- persistent ductus arteriosus
how is oxygen and nutrients supplied to the foetus
via the placenta and umbilical vein
where does the blood go
half to the fetal ductus venous and carried to the IVC
other half enters the liver
where does the blood move after the IVC
the right atrium
what is significant about foetal heart
there is an opening between right and left atrium
so blood flows from the right to left
what happens to blood in left ventricle
pumped through the aorta through the internal iliac arteries and re-enters the placenta
where does carbon dioxide go
taken up and enters the mothers circulation
where does the blood form the right atrium go that doesn’t go into the left atrium
enters the right ventricle and is pumped into the pulmonary artery
what is the ductus arterioles
connection between the pulmonary artery and the aorta
how does the foramen ovale close
due to increase in left atrial pressure
when does the ductus arteriosus usually close off
1-2 days after birth
this completely separates left and right systems
when does the umbilical vein and ductus venous close off
within 2-5 days of birth
leaving behind the ligaementum teres and the ligamentum venosus of the liver
what are some causes
- maternal prenatal rubella infection
- maternal alcohol misuse
- maternal drug treatment and radiation
- genetic abnormalities
- chromosomal abnormalities
what does alcohol misuse cause
septal defects
what is Turner syndrome associated with
coarctation of aorta
what is Down syndrome associated with
- septal defects
- mitral and tricuspid valve defects
common symptoms
- central cyanosis
- pulmonary hypertension
- finger clubbing
- paradoxical embolism
- polycythaemia
- growth retardation
- syncope
- squatting
why does cyanosis occur
because of right to left shunting of blood
what disease occurs with cyanosis
Fallots tetraology
why does hypertension occur
large left to right shunt
what tis pulmonary hypertension known as
Eisenmengers reaction
what is finger clubbing associated with
prolonged cyanosis
what can polycythaemia develop secondary to
chronic hyperaemia
what does polycythaemia increase risk of
stroke
when is syncope common
when severe right of left ventricular outflow tract is obstructed
when does syncope occur
in Fallots tetralogy associated with cyanosis
when does squatting occur
Fallots tetraology
what is most common congenital cardiac abnormalities
ventricular septal defect
when left ventricular pressure is higher than right where does blood move
from the left to the right
if large defect what does it lead to
- pulmonary hypertension
- Eisenmengers complex
what happens when blood starts to move from right to left
cyanosis
what is in small restrictive VSD
pan systolic murmur
does small VSD produce abnormal CXR or ECG
no
what is seen on CXR of larger defects
prominent pulmonary arteries causing increased blood flow
when there is cardiomegaly what is seen on ECG
left and right ventricular hypertrophy
what does echo do
assess the size and location of the VSD
treatment for VSD
- surgical patch repair
- device closure
what are the indications for treatment in VSD
left atrial and ventricular enlargement
when is atrial septal defect usually diagnosed
adulthood
who’s more likely to get atrial septal defect men or women
women
what are the 3 types of atrial septal defect
- sinus venous defects
- ostium secundum defect t
- ostium primum defects
where is sinus venous located
in superior part of the septum near superior vena cava or IVC
where is ostium secundum
located in mid septum
where is ostium premium located
in lower part of atrial septum
what can be felt in atrial septal defect
right ventricular heave
what is done for investigating atrial septal defect
- CXR
- ECG
- echo
what is seen on CXR for ASD
prominent pulmonary arteries with pulmonary plerotha
what is seen on ECG for ASD
right bundle branch block and right axis deviation
what is seen on echo for ASD
hypertrophy and dilatation or right heart and pulmonary arteries
what allows calculation of the left to right shunt for ASD
Doppler
what are indications for treatment in ASD
- ASD with signifiant left to right shunting
- thromboembolic events
- patent foramen ovale
what are the treatment options in ASD
- device closure using transcatheter clamshell device
- surgical closure
what keeps patent ductus arteriosus open
prostaglandin E
what does prostaglandin E2 require for synthesis
COX
what is patent ductus arteriosus
persistent communication between the proximal left pulmonary artery and descending aorta
resulting in left to right shunt
when does ductus arteriosus usually close
couple hours after birth
what is given to stimulate duct closure
indomectacin
a prostaglandin inhibitor
what happens if shunt is large in patent ductus arteriosus
results in left heart volume overload
some cases pulmonary hypertension
signs of patent ductus arteriosus
- bounding pulse
- machinery murmur
- thrill can be felt
what is used for investigation of patent ductus arteriosus
- CXR
- ECG
- echo
what is seen on CXR of patent ductus arteriosus
aorta and pulmonary arterial system are prominent
what is seen on ECG of patent ductus arteriosus
left atrial abnormality and left ventricular hypertrophy
what is seen on echo of patent ductus arteriosus
dilated left atrium and left ventricle
what are indications for treatment of patent ductus arteriosus
left ventricular dilatation and mild to moderate pulmonary arterial hypertension
what is coarctation of aorta
narrowing of aorta just distal to the insertion of the ductus arteriosus
who gets coarctation of aorta more commonly men or women
men
what is coarctation of aorta associated with
Turners syndrome
what is the aortic valve like in coarctation of aorta
bicuspid
what does severe narrowing of aorta encourage the formation of
collateral arterial circulation
signs and symptoms of coarctation of aorta
- 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
investigation for coarctation of aorta
CXR
ECG
echo
what is seen on CXR for coarctation of aorta
- dilated aorta indented at the site of coarctation
- aorta looks like a ‘3’
what is seen on ECG for coarctation of aorta
left ventricular hypertrophy
what is treatment of coarctation of aorta in neonates
surgical repair
what is treatment of coarctation of aorta in older children and young adults
balloon dilatation and stenting
surgery is preferred
what is Fallot’s tetraology characterised by
an aorta overriding the ventricular septum and arising from the right ventricle
symptoms and signs of Fallot’s tetraology
- systolic ejection murmur
- cyanosis
- squatting
what can occur with Fallot’s tetraology
DiGeorge syndrome
