L4 - Structural / congenital heart disease

Question 1

Atrial septal defect

Answer 1

Defect in interatrial septum (doesn’t close).

Pulmonary venous return from LA passes directly into RA.

Left to right shunting.

Question 2

Left to right shunting will result in

Answer 2

increased pulmonary BF.

diastolic overload in RV.

Question 3

Chronic significant left to right shunting of blood may result in…

Answer 3

alteration of pulmonary vascular resistance.

leading to pulmonary arterial hypertension.

Question 4

Clinical sign of ASD

Answer 4

split 2nd heart sound.

ejection systolic murmur?

Question 5

Ventricular septal defect

Answer 5

developmental defect of inter-ventricular septum.

left to right shunting from higher pressure LV.

Question 6

Classic clinical sign of VSD

Answer 6

loud / harsh pansystolic murmur

high pitched, continuous

Question 7

Treatment of ASD

Answer 7

closure

Question 8

Treatment of VSD

Answer 8

closure

Question 9

Atrioventricular septal defect (2 types)

Answer 9

Complete AVSD

Incomplete AVSD

Question 10

AVSD common in

Answer 10

Down’s syndrome

Question 11

Clinical signs AVSD

Answer 11

pansystolic murmur from left AV valve regurgitation.

Question 12

Complete AVSD

Answer 12

• large hole in centre of heart, blood flows in all four chambers.
• one common atrial valve instead of two separate (mitral, tricuspid)

Question 13

Incomplete AVSD

Answer 13

• usually hole in atrial wall or ventricular wall near centre of heart.
• has both mitral and tricuspid, but one of the valves (usually mitral) may not close properly
• allowing blood to leak from LV to LA.

Question 14

Tetralogy of fallot

Answer 14

1. right ventricular outflow tract obstruction (pulmonary stenosis)
2. ventricular septal defect
3. overriding aorta
4. RV hypertrophy

Question 15

What is an over-riding aorta?

Answer 15

aorta next to VSD. allowing oxygen poor blood to flow through it.

Question 16

Clinical presentations of TOF

hint: auscultation

Answer 16

ejection and pan-systolic murmur.

extremely rare to see unrepaired in adulthood.

Question 17

Primary treatment of TOF

Answer 17

always surgical!

aim is to a primary repair.

Question 18

Stenotic lesions would lead to (2)

Answer 18

1. increase pressure in chamber before –> dilation, hypertrophy.
2. leads to lower end diastolic pressure in chamber after.

Question 19

regurgitant lesions will…

Answer 19

• increase volume in atria / ventricle.

- increased volume = increased chamber size to cope

Question 20

Adult presentations of ASD repaired previously? (3)

Answer 20

• atrial arrhythmias
• residual leaks
• pulmonary hypertension if late closure

Question 21

Adult presentations of unrepaired ASD? (4)

Answer 21

• rhs heart failure
• atrial arrhythmias
• emboli
• pulmonary hypertension

Question 22

Adult presentations of TOF (3)

Answer 22

• atrial arrhythmias common due to surgical scar / atrial dilatation
• ventricular arrhythmias can also occur related to scar from operation
• pulmonary valve repairs / replacement may fail with time leading to pulmonary regurgitation

Question 23

symptoms in a neonate of tof

Answer 23

1. cyanosis
2. poor feeding
3. sweating during feeds.

Question 24

management of neonates with severe cyanosis

Answer 24

prostaglandin infusion to maintain patency of ductus and pulmonary flow until time of surgical repair.

Question 25

Describe coarctation of aorta?

Answer 25

- outflow tract obstruction. - obstruction to LV outflow tracts leads to increase in left ventricular after-load. - left ventricular hypertrophy

Question 26

Describe a patent foramen ovale

Answer 26

- flaplike opening between atrial septum primum and secundum at location of fossa ovalis. - in womb serves as right to left shunting - at birth left atrial pressure increases allowing functional closure of foramen ovale. - followed by anatomical closure of septum primum and secundum by age of 1.

Question 27

Describe Marfan's syndrome and how it may lead to dissection

Answer 27

- heritable disorder of fibrillin 1 (FBN1) gene, connective tissue protein - connective tissue disorder may lead to abnormalities in aortic wall - causing progressive aortic dilatation - thus increasing risk of acute aortic dissection.

Question 28

Prophylaxis to endocarditis

Answer 28

- avoid anything that breaks skin barrier | - anti-biotics pre procedure (pulmonary valve replacements)

Question 29

endocarditis

Answer 29

commonly mitral valve affected. staph. aureus. bacteraemia adherence of organisms eventual invasion of valvular leaflets