Conginital Heart Disease

Question 1

What is the most common conginital heart disease

Answer 1

VSD

Question 2

What are the risk factors for conginital heart disease

Answer 2

• Maternal conditions (DM, CTD, smoking, alcohol)
• radiation And medication
• chromosomal abnormqlities

Question 3

Name the acyanotic conginital heart diseases

Answer 3

• LR Shunt (VSD, PDA, ASD, ECD)

- obstructive (AS, PS, COA, Ihss)

Question 4

Name cyanotic heart diseases

Answer 4

• decrease blood flow: TOF, TA, PA, ebstein

- increased blood flow:D-TGA, TAPVD, S.v, TR.ar

Question 5

Which one is more common

Acyanotic or cyanotic

Answer 5

Acyanotic

Question 6

Pathophysiology of Left to Right shunt:

Answer 6

• Increase blood flow to pulmonary veins
• Increase pressure of the left side
• Tachypnea and tachycardia will increase heart size and caloric requirment and child will have developmental delay

Question 7

When does signs appear after delivery for left to right shunt

Answer 7

4-6 weeks

Question 8

What are the signs of left to right shunt?

Answer 8

• increased sweating (due to catacheloamines)
• shortness of breath (due to congestion of lungs)
• easy fatigue & prolonged interrupted feeding (increased caloric requirement)
• repeated chest infection
• failure to thrive

Question 9

Where is the defect in the VSD?

Answer 9

Usually peri membranous

And can also be in the muscular side

Question 10

What will you see during the examination of VSD?

Answer 10

• pansystolic murmur at the left lower sternum

- thrill (once the defect gets smaller)

Question 11

How to diagnose VSD?

Answer 11

By echo

Question 12

When and How to manage VSD?

Answer 12

Symptoms are not controlled

• surgery: ultimate tx.
• medical: for associated conditions “CHF, infection, nutrition, SBE Prophylaxis”

Question 13

When is VSD usually close?

Answer 13

At 2 years of age

Question 14

What is eisenmenger disease?

Answer 14

It’s the hardning of the pulmonary vasculature as a complication of VSD.

Question 15

Where is ASD more common?

“Males or females”?

Answer 15

Females

Question 16

Which area is more common to have the defect in ASD?

Answer 16

Septum secondum

Question 17

Which disease is less likely to have symptoms of cyanotic heart diseases

Answer 17

ASD

Question 18

What are the findings during examination of ASD?

Answer 18

Fixed splitting of second heart sound

Question 19

What are the findings in ECG for ASD

Answer 19

RBBB or RAD

Question 20

How to treat ASD?

Answer 20

Usually interventional. If the septum is way too large, we can wait for 4-6years and do surgery

Question 21

When does ductus arterious close?

Answer 21

From 24hours to 2weeks

Question 22

What is the murmur that is typically seen in PDA?

Answer 22

Continues machinery murmur at the base of the heart

Question 23

Type of pulse in PDA

Answer 23

Bounding pulse with wide pulse

Question 24

How to treat PDA?

Answer 24

Inteverntional coil like procedure

Question 25

Atrioventricular canal is:

Answer 25

ASD in septum primum+ VSD + AV valave common

Question 26

What is the most common congenital heart diseases in trisomies

Answer 26

Arterioventicular canal defect | Cushin defect

Question 27

What is very special in endocardial cushin defect?

Answer 27

Left axis deviation in ecg

Question 28

When to treat down syndrome patients with endocardial cushin defect

Answer 28

In the 4th or 6th month, because their pulmonary arteries tend to stenose earlier that any other “Treat by surgery”

Question 29

Where is the site of coarctaion of aorta?

Answer 29

At the isthmus “after the subclavian”

Question 30

In which group of patients do we commonly see coarctation of aorta?

Answer 30

Turner syndrome

Question 31

What is the key sign to observe that may indicate coarctation of aorta?

Answer 31

- Low BP + low/absent pulses in lower limb. | - HTN of upper limb

Question 32

How to diagnose COA?

Answer 32

CT Angio + echo

Question 33

How to treat COA?

Answer 33

Catheter with balloon “balloon vulvoplasty”

Question 34

What are the causes of neonatal cyanosis

Answer 34

- Respiratory (aspiration of meconium, premature causing RDS, pneumothorax during induction) - cardiac - CNS (heavy sedation for mother, neuromuscular) - methemoglobinemia

Question 35

What is the work up for cyanotic neonates

Answer 35

1- history, ABG, CXR, pulse oximeter 2- hyperoxia 3- definite: echo

Question 36

Mixing of venous and arterial blood will definitly cause

Answer 36

Cyanosis

Question 37

What are the consequences of cynosis

Answer 37

- polycythemia (small due to iron) leading to CNS Complications - clubbing - thrombocytopenia and clotting leading bleeding disorder - spells and squatting - depressed intelligence - scoliosis - hyperurecemia and gout