CVS - Congenital Heart Defects Flashcards

1
Q

How common are congenital heart defects?

Which are the most common?

A
  • Common (6-8 per 1000 births)
  • Ventricular Septal Defects = most common
  • Atrial Septal Defects = 2nd most common
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2
Q

What happens to the O2 concentration in the blood as a result of acyanotic defects?

A

O2 concentration in the blood is NOT lower than normal

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3
Q

What is an atrial septal defect?

How do they happen?

A
  • An opening in the septum between the two atria, which persists after birth
  • Foramen ovale doesn’t close so blood still flows between atria after birth
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4
Q

What is the function of the foramen ovale?

A
  • Permits right to left shunting of oxygenated blood via the inferior vena cava
  • Allows bypassing of pulmonary circulation
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5
Q

Why are atrial septal defects acyanotic?

A
  • Pressure in left atrium is HIGHER than pressure in right atrium
  • Flow is mostly left to right
  • No mixing of deoxygenated blood with oxygenated blood when being pumped around circulation
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6
Q

Where do atrial septal defects most commonly occur?

A
  • Foramen ovale = ostium secundum and is most common

- Ostium primum = inferior septum but is less common

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7
Q

What is a patent foramen ovale?

A
  • Failure of the foramen ovale to close

- Higher left pressure causes functional closure = no symptoms

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8
Q

When may a patent foramen ovale become a problem?

A
  • Could be a route of a venous embolism to reach systemic circulation
  • If pressure on right side of heart increases transiently
  • Causes a paradoxical embolism
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9
Q

What is a ventricular septal defect?

A
  • An opening in the interventricular septum

- Usually in the membranous portion

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10
Q

Are ventricular septal defects usually problematic?

A
  • Not usually

- Left side pressure is much higher than right so blood flows from left to right

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11
Q

What is the ductus arteriosus?

A
  • A vessel in the foetus
  • Shunts blood from the pulmonary artery to the aorta when lungs are non-functional
  • Usually closes after birth when there is a drop in pulmonary artery pressure
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12
Q

What is a patent ductus arteriosus?

What are the effects?

A
  • Ductus arteriosus fails to close
  • Blood flows from the aorta to the pulmonary artery after birth
  • A mechanical murmur is heard in both systole and diastole
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13
Q

When can a patent ductus arteriosus become a problem?

A
  • Chronic left to right shunting = vascular remodelling of pulmonary circulation and ↑ pulmonary resistance
  • If pulmonary resistance > systemic resistance then the shunt reverses
  • Causes ↑ pressure in the right heart (Eisenmenger syndrome)
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14
Q

What is coarctation of the aorta?

What happens as a result?

A
  • Narrowing of the aortic lumen around the ligamentum arteriosum
  • ↑ afterload of left ventricle = LV hypertrophy
  • Upper limb and head aren’t affected as blood supply emerges before coarctation
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15
Q

How can coarctation of the aorta be detected?

A
  • Weak and delayed femoral pulse
  • Upper body hypertension
    (mild cases)
  • Severe cases = heart failure at birth
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16
Q

Which CHDs are acyanotic?

A
  • Atrial septal defects
  • Patent foramen ovale
  • Ventricular septal defects
  • Patent ductus arteriosus
  • Coarctation of the aorta
17
Q

Which CHDs are cyanotic?

A
  • Tetralogy of fallot
  • Tricuspid atresia
  • Transposition of the Great Arteries
  • Hypoplastic Left Heart
18
Q

What is tetralogy of fallot?

A
  • 4 lesions together due to a single developmental defect

- Causes outflow portion of IV septum to be too far in the anterior and cephalad direction

19
Q

What abnormalities does tetralogy of fallot cause?

A
  • Ventricular septal defects
  • Overriding aorta (aorta = directly over VSD instead of LV)
  • Pulmonary Stenosis
  • Right Ventricular Hypertrophy
20
Q

What can pulmonary stenosis as a result of tetralogy of fallot cause?

A
  • Persistent RV hypertrophy
  • ↑ pressure in RV to overcome ↑ resistance in pulmonary artery
  • ↑ RH pressure + VSD + Overriding aorta = Right to left shunting
  • Deoxygenated blood mixes with oxygenated in systemic circulation = cyanosis
21
Q

What is tricuspid atresia?

What can happen as a result?

A
  • Tricuspid valve doesn’t develop properly

- Blood can’t get into right ventricle

22
Q

If tricuspid atresia has taken place, how can blood flow to the lungs?

A
  • Needs a complete right to left shunt of blood returning to right atrium
  • Atrial septal defect/ patent foramen ovale
    AND
  • Ventricular septal defect/ patent ductus arteriosus
23
Q

What is transposition of the great arteries?

A
  • Two parallel circulations that aren’t connected instead of two in series
  • RV is connected to aorta
  • LV is connected to pulmonary trunk
24
Q

Can a baby survive if transposition of the great arteries?

A
  • ONLY IF A SHUNT EXISTS OTHERWISE NO
  • Maintenance of ductus arteriosus/ formation of an atrial septal defect
  • Allows two circulations to communicate
25
Q

What is a hypoplastic left heart?

A
  • Development of left ventricle and ascending aorta is poor
  • Patent foramen ovale and atrial septal defect also present
  • Patent ductus arteriosus = allows circulation
  • Will die unless treated with surgery