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ESA 2- Cardiovascular System > Congential Heart Disease > Flashcards

Congential Heart Disease Flashcards

1
Q

How common is congenital heart disease?

A

Common Incidence of 6-8 per 1000 births

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2
Q

What is the most common type of congenital heart defect?

A

Ventricular septal defects

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3
Q

What is the second most common type of congenital heart disease?

A

Atrial septal defects

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4
Q

What happens in transposition of the great vessels?

A

The septum that forms in truncus anteriosus does not take spiral course, meaning that the great vessels are not connected to the correct chambers

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5
Q

What is the Tetralogy of Fallot?

A

A group of 4 lesions occurring together

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6
Q

What is the Tetralogy of Fallot a result of?

A

A single development defect

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7
Q

What does Tetralogy of Fallot do?

A

Places the outflow portion of interventricular septum too far in anterior and cephalad directions

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8
Q

What can cause CHD?

A

Genetics
Environment
Maternal infections

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9
Q

What environmental factors can cause CHD?

A

Tetragenicity from drugs, alcohol etc

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10
Q

Give two examples of maternal infections that can cause CHS?

A

Rubella

Toxoplasmosis

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11
Q

What does a left to right hunt require?

A

A hole

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12
Q

What happens when there is a left to right shunt?

A

Blood from left heart returns to the lungs instead of going to the body

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13
Q

Is increased lung blood flow damaging?

A

Not by itself

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14
Q

What is the problem with a left to right shunt?

A

Increased pulmonary artery or pulmonary venous pressure can be damaging

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15
Q

What does a right to left shunt require?

A

A hole and distal obstruction

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16
Q

What is the problem with a right to left shunt?

A

Deoxygenated blood bypasses the lungs

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17
Q

What is an acyanotic heart defects?

A

Defects that do not result in a lower than normal concentration of oxygen in the blood

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18
Q

Give 5 acyanotic heart defects

A 
Atrial septal defect
 Patent Foramen Ovale
 Ventricular septum defect
 Patent Ductus Arteriosus
 Coarctation of Aorta
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19
Q

What is an atrial septal defect?

A

An opening in the septum between two atria that persists following birth

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20
Q

What is the incidence of atrial septal defects?

A

67 in 100,000 live births

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21
Q

What does the foramen ovale do?

A

It exists prenatally to permit right to left shunting of oxygenated blood

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22
Q

What is the foramen ovale designed to do?

A

Close promptly after birth

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23
Q

What does failure of the foramen ovale to close allow?

A

Blood to continue to flow between the two atria postnatally

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24
Q

In what direction is flow when there is an atrial septal defect?

A

Mainly from left to right

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25
Q

Why is the flow mainly from left to right when there is an atrial septal defect?

A

Because left atrial pressure is greater than right atrial pressure

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26
Q

What is the result of the flow mainly being from left to right when there is an atrial septal defect?

A

There is no mixing of deoxygenated blood with oxygenated blood being pumped around the circulation

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27
Q

Where do ASD’s occur?

A

Almost anywhere along the septum

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28
Q

What is the most common site for ASDs?

A

The foramen ovale

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29
Q

What is it called when the atrial septal defect is at the foramen ovale?

A

An ostium secundum ASD

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30
Q

Where does an ostium primum ASD occur?

A

At the inferior part of the septum

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31
Q

What are the haemodynamic effects of ASD’s?

A

Increased pulmonary blood flow

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32
Q

What is the result of an increased pulmonary blood flow?

A

Right ventricular volume overload, leading to eventual right heart failure

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33
Q

Is a patent foramen ovale a true ASD?

A

No

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34
Q

What is the prevalence of a patent foramen ovale?

A

May be present in ~20% of the population

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35
Q

What is the result of a patent foramen ovale?

A

Generally, clinically silent

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36
Q

Why is a patent foramen ovale generally clinically silent?

A

Since higher left atrial pressure causes functional closure of the flap valve

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37
Q

How can a patent forman ovale cause problems?

A

It may be a route by which venous embolism reaches the systemic circulation, if the pressure on the right side of the heart increases even transiently

38
Q

What is it called when a patent foreman ovale causes a venous embolism in the systemic circulation?

A

A paradoxical embolism

39
Q

What is a ventricular septum defect?

A

An opening in the interventricular septum

40
Q

Where can a ventricular septum defect occur?

A

At any point

41
Q

Where does a ventricular septum defect most commonly occur?

A

In the membranous portion of the septum

42
Q

What are the haemodynamic effects of a ventricular septum defect?

A

Left to right shunt

43
Q

Why does a ventricular septum defect cause a left to right shunt?

A

Because the left ventricular pressure is much higher than the right

44
Q

What is the result of the left to right shunt?

A

Left ventricular volume overload, causing pulmonary venous congestion

45
Q

What does pulmonary venous congestion eventually lead to?

A

Pulmonary hypertension

46
Q

What is the ductus arteriosus?

A

A vessel that exists in the foetus to shunt blood from pulmonary artery to aorta before lungs are functional

47
Q

What should happen to the ductus arteriosus shortly after birth?

A

It should close

48
Q

Why does the ductus arteriosus close shortly after birth?

A

As pressure in the pulmonary artery drops following perfusion of lungs

49
Q

What does failure of the ductus arteriosus to close cause?

A

Patent ductus arteriosus

50
Q

In what direction would blood flow through the ductus arteriosus after birth?

A

From the aorta to the pulmonary artery

51
Q

Why would blood flow from the aorta to the pulmonary artery if the ductus arteriosus remained open after birth?

A

Because its going from a high pressure to a low pressure

52
Q

What is heard when the ductus arteriosus is patent?

A

A mechanical murmur is heard constantly throughout systole/diastole

53
Q

Why can a mechanical murmur be heard when there is a patent ductus arteriosus?

A

Because pressure in the aorta is always greater than in the pulmonary artery

54
Q

Does left to right shunting of blood cause cyanosis?

A

No

55
Q

What does the extend of the problem caused by a patent ductus arteriosus depend on?

A

The degree of shunting

56
Q

What does chronic left to right shunting lead to?

A

Vascular remodelling of pulmonary circulation, and an increase in pulmonary resistance

57
Q

What happens if the pulmonary circulation increases beyond that of the systemic circulation due to a patent ductus arteriosus?

A

The shunt will reverse direction

58
Q

What is it called when the shunt caused by a patent ductus arteriosus reverses direction?

A

Eisenmeger syndrome

59
Q

What is coarction of the aorta?

A

Narrowing of the aortic lumen in the region of the liganentum arteriosum

60
Q

What makes up the liganentum arteriosum?

A

The former ductus arteriosus

61
Q

What may coarction of the aorta lead to?

A

An increase in afterload on the left ventricle

62
Q

What does an increase in afterload on the left ventricle lead to?

A

Left ventricular hypertrophy

63
Q

What is the effect of a coarctation of the aorta?

A

Blood flow to the body is reduced

64
Q

Where is blood flow not reduced when there is a coarctation of the aorta?

A

The head and upper limb

65
Q

Why is the blood supply to the head and upper limb not affected when there is coarctation of the aorta?

A

Because the vessels to these areas usually emerge proximal to coarctation

66
Q

What does extent of the symptoms of coarctation of the aorta depend on?

A

The severity of the coarctation

67
Q

What may happen with severe coarctation of the aorta?

A

Infant may present with symptoms of heart failure shortly after birth

68
Q

What may happen in mild cases of coarctation of the aorta?

A

Defect may be detected in adult life

69
Q

What are the symptoms of coarctation of aorta?

A

Femoral pulses weak and delayed

Upper body hypertension

70
Q

Give 4 cyanotic heart defects?

A

Tetralogy of Fallot
Tricuspid Atresia
Transposition of the great arteries
Hypoplastic left heart

71
Q

What is Tetralogy of Fallot?

A

A group of 4 lesions occuring together as a result of a single developmental defect placing outflow portions of the interventricular septum too far in anterior and cephalad directions

72
Q

What are the 4 abnormalities in Tetralogy of Fallot?

A

VSD
Overriding aorta
Pulmonary stenosis
Right ventricular hypertrophy

73
Q

To what degree are pulmonary stenosis and right ventricular hypertrophy present in Tetralogy of Fallot?

A

Variable

74
Q

What does pulmonary stenosis cause?

A

Persistance of foetal right ventricular hypertrophy

75
Q

Why does pulmonary stenosis cause right ventricular hypertrophy?

A

As the right ventricle must operate at a much higher pressure to pump blood through the pulmonary artery

76
Q

What aspects of the Tetralogy of Fallot allow right to left shunting?

A

Increased pressure on the right side of the heart
VSD
Overriding aorta

77
Q

What is the result of right to left shunting?

A

A mix of deoxygenated blood with oxygenated blood going into the systemic circulation, resulting in cyanosis

78
Q

What does the magnitude of the shunt and the severity in Tetralogy of Fallot depend on?

A

The severity of pulmonary stenosis

79
Q

When does Tetralogy of Fallot present?

A

May present in infancy

Mild cases can present in adulthood

80
Q

What is Tricuspid Atresia?

A

Lack of development of tricuspid valve

81
Q

What is the problem with tricuspid atresia?

A

It leaves no inlet to the right ventricle

82
Q

What must be present in tricuspid atresia?

A

A complete right to left shunt of all blood returning to the right atrium (ASD or PFO) and a VSD or PDA to allow blood flow to the lungs- there needs to be a right to left shunt of the entire venous return

83
Q

What does transposition of the great arteries result in?

A

Two unconnected parallel circulations, instead of two in series

84
Q

What has happened in transposition of the great arteries?

A

The right ventricle is connected to aorta and the left ventricle to pulmonary trunk

85
Q

What is the prognosis for a patient with transposition of the great arteries?

A

Condition not compatible with life after birth, unless a shunt exists to allow to two circulations to communicate

86
Q

How can a patient with transposition of the great arteries be treated?

A

A shunt must be maintained, or created immediately following birth to sustain life until surgical correction can be made

87
Q

What shunt can allow a patient with transposition of great arteries to survive until after birth?

A

Ductus arteriosus can be maintained patent and/or an atrial septal defect formed

88
Q

What happens in hypoplastic left heart?

A

The left ventricle and ascending aorta fail to develop properly, meaning the ascending aorta is very small

89
Q

What must happen when there is a hypoplastic left heart?

A

The right ventricle supports systemic circulation

90
Q

What is also present with hypoplastic left heart?

A

PFO or ASD

91
Q

What supplies the systemic circulation with hypolastic left heart?

A

Via a PDA

92
Q

What happens if a hypoplastic left heart is not surgically corrected?

A

It is lethal

ESA 2- Cardiovascular System (18 decks)

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