Congenital Heart Problems Flashcards
Explain how the ductus arteriosus closes?
Explain how the pulmonary artery is open.
Explain how foramen closes
Birth –> no placenta –>no PGE2 –> DA close in 2wks
Birth -> Breath -> Increase pAO2 – >
open Pul Art–> decreased lung resistance – >
more blood flow –>
LA pressure > RA pressure –> Foramen ovale close
Indomethacin closes the ductus arteriosus
Explain the fetal circulation.
What do you know about the fetal pulmonary artery?
How was the doctors arteriosus kept open?
IVC – >RA – > foramen ovale – >LA
SVC – > RA –> are V (miss FA for some reason)
Hypertrophied fetal PA due to chronic v.constriction
DA kept open by prostaglandins E2 made by placenta
Indomethacin closes ductus arteriosus open
Risk factors for congenital heart problems
SAD DP PAKI
SLE – >
heart block/Endomyocardial fibrosis/pericarditis
Alcohol @ pregnancy – >PV stenosis, VSD
Diphenylhydantoin –> AV/PV stenosis
Downs – >primum ASD
Previous kid with CH defect = 1/50 chance of another kid with CH defect
Poor D.Mell. control @pregnancy – >
LV outflow obstruction (AV stenosis/IVS hypertrophied)
Aspirin – >
persistent pulmonary HTN syndrome = R->L shunt
Congenital infection e.g. Rubella – >
PV stenosis/PDA ->
Increase age > 45 years
Explain how left-sided -> right-sided shunt leads to right-sided -> left-sided shunt.
L to R shunt –> pul HTN
Pul HTN = congested –> ⬆️ afterload for RV –> Concentric RVH
More blood return from lung to LH than normal -> ⬆️LV vol –> ⬆️preload @ LH = eccentric LVH
RH pressure > LH pressure -> R to L shunt reversal
-> EISENMENGER SYNDRONE
CYANOSIS + POLYCYTHEMIA + CLUB FINGERS
What is the most common congenital heart defect?
VSD causes?
What part of the IVS can it occur in?
Murmur?
Ventricular septal defect
Fetal alcohol syndrome,
poorly controlled diabetes mellitus,
Cri du chat
Membranous part 75–80% >
muscular/trabecular part 5–20%
⬆️vol @ RV –> ⬆️PA flow = harsh PAN systolic
Which type of atrial septal defect is more common?
How is ostium secundum ASD different from patent foramen ovale?
What diseases ostium primum associated with?
Ostium secundum issue >ostium primum issue
@PFO septa = missing rather than unfused like ostium secundum ASD
Down syndrome
Explain paradoxical emboli
Embolus @ RHS eg. DVT – >
Go into RA – > F.Ovale–> LA –> systemic circuit ->
Lodge at left side
Clinical features of atrial septal defect
MRS Fixed
️⬆️PV flow = MMMidsystolic murmur
⬆️ flow of the tricuspid = diastolic RRRRumble
loud SSS1 + wide fixed split SSS2
⬆️ flow-through pulmonic valve = pulmonic greatly delayed = FFFixed spitting regardless of breath
Clinical finding of patent ductus arteriosus
Cause?
Drug stops it?
Pansystolic machine like murmur LOUDEST at S2
Due to congen. infection eg rubella (PDA + PV sten)
Indomethacin = NSAID –> ⬇️ PGE2 –> pda closure
Give the 5 right-sided -> left-sided shunts
- truncus arteriosus
- Great transposition of the great vessels
- tricuspid atresia
- Tetralogy of fallot
- total anomalous pulmonary venous return (TAPVR)
What happens in truncus arteriosus
Failure of truncus arteriosus to divide into pulmonary trunk + aorta
Accompanied with VSD
How does transposition of the great vessels occur.
What do you need to create surgically in order for the baby to live?
Assoc with what disease?
Aorticopulmonary septa fail to spiral –>
separation of systemic + pul circulation =
not compatible with life
Surgically form VSD/ASD
MATERNAL DIABETES
Explain how tricuspid atresia manifests
TV = fail development
Right ventricle = hypoplastic
Associated with
ASD
VSD - prevent hypoplastic right ventricle
What is the most common cause of cyanosis in childhood?
What causes tetralogy of fallot
Anterosuperior displacement
of infundibular Septum –>
most common cause of early childhood cyanosis
What 4 problems do you have in tetralogy of fallot
Clinical signs of tetralogy of fallot
- pulmonary infundibular stenosis
- RVH = Boot shape @x-ray
- Overriding aorta = dextrorotated
- VSD
Rv outflow tract obstruction = harsh systolic crescendo/decrescendo murmur
