CVS - Acyonotic HD

Question 1

Shunts in fetal circulation

Answer 1

1. Foramen ovale - RA and LA,
   closed after birth
2. Ductus arteriosus - Aorta and pulm artery,
   closed 1-2days of birth
3. Ductus venosus - umblical vein, liver, RA

Question 2

Acyanotic vs cyanotic heart disease

Answer 2

1. Acyanotic - septal defects
   VSD, ASD, PDA, Coarctation of aorta
2. Cyanosis can happen
3. Left to right shunt

Question 3

VSD pathophysio

Answer 3

1. MCC congenital cardiac lesion
2. Blood: LV to RV..
   LEFT TO RIGHT SHUNT …
   RV hypertrophy …
   ↑RV pressure
   RIGHT TO LEFT SHUNT… cyanosis
   EISENMENGER SYNDROME

RV fail - HF symptoms - poor feeding, poor wt gain, tachypnoea

3. Pansystolic, harsh murmur @lower sternal border

Question 4

Mx of VSD

Answer 4

1. Initial: CXR, ECG
   Best inv: ECHO
2. RX:
   Small defect - spontaneous closure 1-2yrs
   Mod-large - Sx

Question 5

ASD

Answer 5

1. 2nd Mc congenital cardiac lesion
2. Patho similar to VSD
3. Murmur:
   ●Small- Ejection systolic @mid-upper left sternal border (↑ pulm flow)
   ●Large - Diastolic rumble @lower sternal border
4. Initial: CXR, ECG - RVH, Right axis deviation
   Best inv: ECHO
5. Spontaneous resolution
   Can be asymptomatic till 30s
   Symptomatic - Sx

Question 6

PDA pathophysio

Answer 6

1. Girls, Cong rubella, premature baby
2. Blood: aorta to pulm artery..
   PULM HTN
   RVH
3. *MACHINERAY continuous MURMUR - large defect
   Asymptomatic - small defect
   Wide pulse pressure
   Bounding artery pulses

Question 7

PDA Mx

Answer 7

1. Initial: CXR, ECG
   Best inv: ECHO
2. Spontaneous closure
   INDOMETHACIN (PG inhibitor)
   -PGs help in keeping DA open
   Sx

Question 8

Coarctation of aorta pathophysio

Answer 8

1. Narrowing of aorta, mainly below lt subclavian branch
   … ↑blood in brachiocephalic, lt carotid, subclavian arteries …
   RADIO-FEMORAL DELAY
   RADIO-RADIO DELAY - ↑blood to lt arm than rt arm
   =DIFFERENTIAL CYANOSIS
2. Systolic pressure:
   arms > leg more than 5% (normally legs > arm)
   Lt arm > rt arm

Question 9

Coarctation of aorta Mx

Answer 9

1. Initial:
   CXR - inferior notching of ribs
   ECG
2. Best: ECHO

Rx:
●Keep ductus arteriosus patent - PGE1 (to ↑blood to LL minimally)
●Sx