Congenital Heart Diseases Flashcards
what is the most common congenital heart disease
biscupid aortic valve
what can you develop from bicuspid aortic valve
aortic stenosis +- aortic regurg predisposing to IE/SBE +- aortic dilatation/dissection
what may accelerate complications in biscuspid aortic valve
intense exercise
can bicuspid valves go undetected at birth
yes, can work well at birth
what is atrial septal defect
a hole connects the atria
what are the most common defects for ASD
ostium secundum- high in the septum
what defects are associated with AV abnomalies (ASD)
ostium primum (opposing endocardial cushions- where the atrial and ventricular septi meet, and the mitral and ventricular valves meet)
which defect presents early out of ostium primum and secundum
primum presents early, secundum can be asymptomatic until adulthood. L-R shunt depends on compliance R and L ventricles. left ventricle decr with age
associated symptoms with ASD
pulm hypertension, cyanosis, arrhythmia, haemoptysis, chest pain
signs ASD
incr JVP, AF, split S2, pulm ejection systolic murmur. pulm or tricusp regurg from pulm hypertension.
complications ASD
reversal L-R shunt- Eisenmengers complex- pulm hypertension reverses the shunt leading to cyanosis. paradoxical emboli- vein-artery via ASD rare
ECG for ASD ostium primum
RBBB with left axis deviaton and prolonged PR interval.
how is left axis deviation diagnosed on ECG
+ve on lead I and aVL. -ve on lead II and aVF.
how is right axis deviation diagnosed on ECG
+ve on leads III and aVF. -ve on leads I and aVL.
ECG for ASD secundum
RBBB with right axis deviation
what is the treatment for ASD
in children closure recommended before 10 years old. in adults if symptomatic or if pulm to systemic blood flow ratios >1.5:1. transcatheter closure more common than surgery now
which is more common atrial or ventricular septal defect
atrial
what is ventricular septal defect
hole connects ventricles
causes of VSD
congenital, acquired- post MI
symptoms of VSD
severe heart failure in infancy, or asymptomatic and detected incidentally in later life
signs of VSD
smaller holes give louder murmurs. harsh pansystolic murmur, systolic thrill +- left parasternal heave. larger holes associated with signs pulmonary hypertension
complications VSD
AR, infundibular stenosis, IE/SBE (subacute bacterial endocarditis, pulmonary hypertension, Eisenmengers complex
what is the ECG like in small VSD
normal
ECG in moderate VSD
LAD + LVH
ECG in large VSD
LVH + RVH
what is the CXR like in large VSD
cardiomegaly, large pulmonary arteries, marked pulmonary plethora (enlargement of the pulmonary arteries)
treatment of VSD
medical at first as may close spontaneously. indications for surgical closure- failed medical therapy, symptomatic VSD, shunt >3:1, SBE/IE. endovascular closure possible
what is coarctation of the aorta
congenital narrowing of descending aorta, usually just distal to origin of left subclavian artery.
is coarctation of aorta more common in boys or girls
boys
associations of aortic coarctation
bicuspid aortic valve, Turners syndrome (in females)
signs of aortic coarcation
radiofemoral delay (fem later), weak femoral pulse, incr BP, scapular bruit, systolic murmur
complications aortic coarctation
heart failure, infective endocarditis
tests for coarctation
CXR shows rib notching
treatment of coarctation
surgery, balloon dilatation +- stenting
pulmonary stenosis can occur when
alone or with other lesions
what is Fallots tetralogy
- VSD. 2. pulmonary stenosis. 3. RVH. 4. aorta overriding VSD
what is the most common cyanotic congenital heart disorder
tetralogy of fallot
occasionally there can be a pentad of Fallot what is the additional condition
ASD
presentation of Fallots tetralogy children
depends on degree of pulmonary stenosis.when hypoxic toddler may become restless agitated cry. may squat- increases peripheral vascular resistance decreases degree R to L shunt. failure to thrive clubbing
presentation fallots adults
often asymptomatic. cyanosis common. late symptoms- dyspnoea, palps, RV failure, syncope, sudden death
what does ECG show with fallots
RVH and RBBB
what is the classic hallmark of fallots on CXR
classic boot shaped heart
management fallots
give O2. child in knee chest position. morphine for sedation, long term B blockers, endocarditis prophylaxis, surgery
