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.

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2
Q

Associated Conditions of VSD (7).

A
  1. Can occur in isolation but often underlying genetic condition.
  2. Down’s syndrome.
  3. Turner’s Syndrome.
  4. Patau Syndrome.
  5. Cri-du-Chat Syndrome.
  6. Congenital Infections.
  7. Post-Myocardial Infections.
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3
Q

Epidemiology of VSD.

A

Commonest cause of CHD.

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4
Q

Clinical Features of VSD (8).

A
  1. Often asymptomatic and can present as late as childhood.
  2. Poor Feeding.
  3. Dyspnoea.
  4. Tachypnoea.
  5. Failure to Thrive (more energy diverted to breathing instead of growing).
  6. Pan-Systolic Murmur (over Tricuspid Area).
  7. Systolic thrill on palpation.
  8. Heart Failure - Hepatomegaly, Tachycardia, Pallor.
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5
Q

Pathophysiology of VSD (4).

A
  1. Increased pressure in LV (than RV) means blood flows from LV to RV.
  2. Blood can still flow around lungs before entering rest of the body so acyanotic.
  3. Left-to-right shunt leads to right-sided overload, right heart failure and increased blood flow to pulmonary vessels.
  4. All is ok until Eisenmenger Syndrome.
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6
Q

Diagnosis of VSD (2).

A
  1. Antenatal Scans.

2. Murmur in Newborn Baby Check.

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7
Q

Management of VSD (2).

A
  1. Small/Asymptomatic/No Evidence of Pulmonary Hypertension or Heart Failure = Watch-and-Wait (Close spontaneously).
  2. Surgical Correction - Transvenous Catheter Closure via Femoral Vein or Open Heart Surgery.
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8
Q

Prognosis of VSD (2).

A
  1. Close spontaneously in around 50% of cases.
  2. 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.
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9
Q

Complications of VSD (5).

A
  1. Aortic Regurgitation (poorly supported right coronary cusp = cusp prolapse).
  2. Infective Endocarditis.
  3. Eisenmenger’s Complex (indication for heart-lung transplant).
  4. Right Heart Failure.
  5. Pulmonary Hypertension (pregnancy is contraindicated, due to a 30-50% risk of mortality).
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