CVS - Ventricular Septal Defects (VSDs) Flashcards
1
Q
What is a Ventricular Septal Defect?
A
Congenital hole in the septum between the two ventricles, which can vary in size from tiny to the entire septum to form one large ventricle.
2
Q
Associated Conditions of VSD (7).
A
- Can occur in isolation but often underlying genetic condition.
- Down’s syndrome.
- Turner’s Syndrome.
- Patau Syndrome.
- Cri-du-Chat Syndrome.
- Congenital Infections.
- Post-Myocardial Infections.
3
Q
Epidemiology of VSD.
A
Commonest cause of CHD.
4
Q
Clinical Features of VSD (8).
A
- Often asymptomatic and can present as late as childhood.
- Poor Feeding.
- Dyspnoea.
- Tachypnoea.
- Failure to Thrive (more energy diverted to breathing instead of growing).
- Pan-Systolic Murmur (over Tricuspid Area).
- Systolic thrill on palpation.
- Heart Failure - Hepatomegaly, Tachycardia, Pallor.
5
Q
Pathophysiology of VSD (4).
A
- Increased pressure in LV (than RV) means blood flows from LV to RV.
- Blood can still flow around lungs before entering rest of the body so acyanotic.
- Left-to-right shunt leads to right-sided overload, right heart failure and increased blood flow to pulmonary vessels.
- All is ok until Eisenmenger Syndrome.
6
Q
Diagnosis of VSD (2).
A
- Antenatal Scans.
2. Murmur in Newborn Baby Check.
7
Q
Management of VSD (2).
A
- Small/Asymptomatic/No Evidence of Pulmonary Hypertension or Heart Failure = Watch-and-Wait (Close spontaneously).
- Surgical Correction - Transvenous Catheter Closure via Femoral Vein or Open Heart Surgery.
8
Q
Prognosis of VSD (2).
A
- Close spontaneously in around 50% of cases.
- Moderate-to-large VSDs usually result in a degree of HF in the first few months so require nutritional support, medications e.g. Diuretics and surgical closure.
9
Q
Complications of VSD (5).
A
- Aortic Regurgitation (poorly supported right coronary cusp = cusp prolapse).
- Infective Endocarditis.
- Eisenmenger’s Complex (indication for heart-lung transplant).
- Right Heart Failure.
- Pulmonary Hypertension (pregnancy is contraindicated, due to a 30-50% risk of mortality).