Congenital Heart Dz Flashcards
Atrial Septal Defect (ASD)
Opening in the atrial septum permitting free communication of blood btw the atria. Seen in 10% of all CHD.
Most common type of ASD
Secondum, at the fossa ovalis.
Followed by primum (lower) and
Sinus Venus (high in septum, rare)
ASD S/S
Most are asymptomatic
Rarely presents with CHF and CV S/S
Easy fatiguability, mild growth failure
ASD clinical findings
Hyperactive precordium, RV heave
Widely split S2
Systolic ejection murmor at LSB
Mid diastolic murmor over LLSB
Why are murmors heart with ASD?
Increased flow across the pulmonary valve (or tricuspid)
ASD Tx
Closure electively between ages of 2 and 5
Closure before age 25 shows best prognosis
Is endocarditis prophylaxis required for ASD?
No
Ventricular Septal Defect (VSD)
Abnormal opening in the ventricular septum
Accounts for 25% of congenital abnormalities
Most common type of VSD?
Perimembranous
Small VSD S/S
Small VSD usually asymptomatic
50% will close spontaneously by 2 yrs
Harsh holistic murmor on LSB
Severe VSD S/S
Harsh holosystolic murmor heard along LSB
Prominent PE, diastolic murmor
CHF, FTT, Resp infections, exercise intoleranceHyperactive precordium
Symptomatic VSD Tx
Medical tx with afterload reducers and diuretics
Surgical closure
Atrioventricular Septal Defect (AVSD)
Incomplete fusion of the endorcardial cushions
4% of all Congenital defects
What dz is AVSD more commonly seen in?
Downs syndrome
Seen in 25% of cases
Fixed split second sound =?
ASD
AVSD S/S
CHF in infancy Recurrent pulm infxns Failure to thrive Exercise intolerance Late cyanosis from R to L shunt Cardiac enlargement
AVSD Tx
Surgery is always required
Treat congestion
Patent Ductus Arteriosis (PDA)
Persistence of the normal fetal vessel that joins the PA to the Aorta Normally closes in 1st week of life Accounts for 10% of CHD More females than males Associated with coarctation and VSD
PDA S/S
Asymptomatic for small ones CHF Bounding arterial pulses Widened pulse pressure Enlarges heart CLassic continuous machinary systolic murmor
PDA Tx
Indomethican
Surgical closure
Need to prevent pulmonary vascular dz
Which chambers are enlarged in VSD?
L and R ventricles and L atrium
Pulmonary Stenosis
Obstruction in the region of the pulmonary valve or the subpulmonary ventricular outflow tract.
Accounts for 7-10% of CHD
Can present w/ or w/o intact ventricular septum
What dz is pulmonary stenosis associated with?
Noonan’s Syndrome, secondary to valve dysplasia
Pulmonary Stenosis S/S
Depends on severity
Split 2nd sound with delay
Heart failure and cyanosis in severe cases
Pulmonary stenosis Tx
Stenosis relief
Balloon valvuloplasty
Surgical valvotomy is an option
Aortic Stenosis
An obstruction of LV outflow at or near the aortic valve.
7% of CHD
Valvular is most common
Which syndrome is Aortic stenosis found in?
WIlliams Syndrome
Which chambers are enlarged in aortic stenosis?
LV and LA
Aortic Stenosis S/S
Exercise intolerance CP, dyspnea, dizziness, syncope Weak pulses, L sided heart failure Sudden Death Systolic thrill
Aortic Stenosis Tx
Balloon Valvuloplasty is standard of tx
Coarctation of the Aorta
Narrowing of the aorta.
98% are juxtaductal
3:1 males
7% of all CHD
What other congenital abnormality is coarctation of the aorta seen in?
Bicuspid aortic valve (70% of cases)
What genetic syndrome is coarctation of the aorta seen in?
Turner’s syndrome
Coarctation S/S
Diminution or absent femoral pulses
Higher BP in arms than legs
90% of systolic HTN in upper extremities
Pulse discrepancy in rt and lt arms
What will be seen on Xray with coarctation
rib notching and cardiomegaly
Coarctation Tx
Prostaglandin E
Surgical intervention
Angioplasty
Tetralogy of Fallot
Malignant VSD
Overriding Aorta
Pulmonic Stenosis
RVH
Tetralogy Tx
Surgery…
Transposition D-type
PA arises from LV
Aorta from RV
Cyanosis occurs
Prostaglandin given to keep ductus open
L-Type Transposition
Heart is completely flip flopped
Works until late childhood
Many complications
Ebsteins Anomoly
Atrialization of RV
Massive R atrium
Ebsteins presentation
Pediatric Murmur Atrial arrhythmias cyanosis R to L shunt
