Congenital heart diseases Flashcards
What are three kinds of atrial septal defects and location in the septum for each?
Ostium secundum (80%)-central interatrial septum Ostium primum - low septum Sinus venosus defect - high septum
What is the pathophysiology of ASD
Blood from LA to RA, increasing right heart output- RA/RV dilation occurs with big shunts with pulmonary to systemic flow ratio > 1.5:1.0
When do symptoms in a patient’s lifetime occur for ASD
After 40 - exercise intolerance, dyspnea on exertion, fatigue
What do you see on physical exam in ASD
Wide, fixed splitting of S2 due to increased pulmonary flow
What three diagnostic modalities can be used to diagnose ASD
- ) TEE - best (use bubble study contrast for better results)
- ) CXR - large pulmonary arteries
- ) ECG - RBBB, right axis deviation, Afib/flutter
What are five main complications of ASD
- ) Pulmonary HTN - common after age 40
- ) Eisenmanger - irreversible pulmonary HTN, causing reversed right to left shunt, resulting in heart failure and cyanosis
- ) RVF
- ) Afib
- ) Stroke from paradoxal emboli - important
What should you do for treatment of ASD
Only surgery if very large or if pulmonary to systemic blood flow greater than 2:1
What is the pathophysiology of ventricular septal defect
Blood flow from LV into RV, but small defects are asymptomatic, only large ones can cause eisenmangers syndrome
What are the symptoms of VSD for small shunts, large shunts without increased pulmonary resistance, and large shunts with increased pulmonary resistance
Small shunt - asymptomatic
Large shunt without PR - CHF, growth failure, recurrent lower respiratory infections
Large shunt with PR - SOB, dyspnea on exertion, chest pain, syncope, cyanosis
What are the clinical exam signs of VSD and the effects of valsalva and handgrip
Blowing holosystolic murmur with thrill
Valsalva and handgrip decrease murmur intensity
Increased pulmonary component of S2 as pulmonary HTN, with aortic regurgitation
What three diagnostic modalities can you use for VSD
ECG: Biventricular hypertrophy when PR is high**
Cxr: Pulmonary artery bigger, seen with increased cardiac silouhette (not due to increased heart size)**
Echo: Septal defect
Softer murmur = bigger VSD
What are four complications of VSD
- ) Endocarditis
- ) Progressive aortic regurgitation
- ) Heart failure
- ) Pulmonary HTN/eisenmangers
Last two overlap with ASD
When is medications indicated and surgical repair indicated for VSD
Medications: diuretics, afterload reductors (ACE), digoxin
When pulmonary flow to systemic flow ratio greater than 2:1, or patient has infective endocarditis (not asymptomatic patients with small defects) - same as ASD
When is endocarditis prophylaxis indicated for patients with VSD
When VSD is complicated or history of endocarditis
What is the pathophysiology of coarctation of the aorta
Has adult and child form, in adults you have narrowing/constriction of aorta distal to aortic arch at origin of left subclavian artery near ligamentum arteriosum, leading to increased left ventricular afterload
What condition is coarctation of the aorta associated with in adults
Bicuspid aortic valve - adults
Turners syndrome - children
What are the symptoms of coarctation of the aorta
Think about less blood flow to legs - hypertension in arms and hypotension in legs, more developed upper body, delayed femoral artery compared to radial artery, cold extremities
Headache (high BP above), claudication with exercise and leg fatigue (less O2 below)
What are two diagnostic modalities used for coarctation of the aorta
- ) ECG - LVH (due to increased afterload)
2. ) CXR - notching of ribs due to collateral circulation across intercostal arteries engorging - impt
What are four complications of coarctation of the aorta
- ) Severe HTN
- ) Rupture of cerebral aneurysms
- ) Aortic dissection
- ) Infective endocarditis
You can remember the first three because of increased HTN around proximal aorta and everything above
What is the standard treatment for coarctation of the aorta
Surgical decompression
Can also use percutaneous balloon aortoplasty in select cases
What is the pathophysiology of patent ductus arteriosus
Communication between aorta and pulmonary artery that persists after birth, forming a left to right shunt
What is the function of the ductus arteriosus in the fetus
To shunt blood away from non-functioning lungs, maintained by low oxygen tension and prostaglandins
What three conditions do you see patent ductus arteriosus occur in
Congenital rubella syndrome, high altitude, premature births
What are the clinical signs of patent ductus arteriosus
LVH secondary to left to right shunt, RVH secondary to pulmonary HTN, pulmonary HTN, eisenmanger’s
- ) Continuous machine murmur with loud P2 due to pulmonary HTN
- ) Wide pulse pressure and bounding peripheral pulses**
- ) Lower extremity clubbing - toes more clubbing than fingers (differential cyanosis - think about it)
