Lecture 5: Congenital Heart Defects Flashcards
Acyanotic defects
- ASD
- VSD
- PDA
- PV Stenosis
- Coarctation of aorta
- Aortic stenosis
Cyanotic defects
- Tetralogy of fallot
- Pulmonary atresia
- Tricuspid atresia
- Hypoplastic left heart syndrome
- TGA
- TAPVR
Everything that starts with T + Pulmonary atresia and Hypo
Pulm atresia is not on PANCE
What kind of shunt do ASD, PDA, and VSD make?
Left to right shunt
Oxygenated to deoxygenated.
What do acyanotic diseases eventually result in?
- HF
- Eisenmenger syndrome with exertion
Eisenmenger results in pulmonary arterial hypertension
What are the outflow obstruction congenital heart defects?
- Pulmonary stenosis
- Aortic stenosis
- Coarctation of the aorta
How does HF tend to present in infants?
- Poor feeding/failure to thrive
- pulm congestion/resp distress
- Fluid retention
- Elevated JVP
- Hepatomegaly
ASD S/S
- Fixed, split S2 and pulmonic ejection murmur
- Respiratory infections and failure to thrive in infants
- Prior to age 40: palps, exercise intolerance, dyspnea, fatigue
Symptoms depend on size
split S2 because A looks like its in the splits.
What are the two ASD types and features?
- Ostium secundum (MC), associated with fetal alcohol syndrome.
- Ostium primum, associated with Down’s syndrome as a endocardial cushion defect
Dx of an ASD
- CXR showing R heart dilation and prominent pulmonary vascularity
- TEE showing size and location
- R Heart catheterization showing increased o2 sat in RA and PA.
Tx of an ASD
- Wait and watch for small
- Asymptomatic but large = can wait 1-3 yrs
- Need closure if symptomatic or > 8mm
if adult do sx in RV enlargment, paradoxical embolism and R-L shunt
Sometimes it is better to wait since the heart will be bigger and the patient can tolerate anesthesia better.
Where is more blood pumped into for a VSD?
More blood into lungs and pulmonary artery
Higher risk of pulm HTN, arrhythmias, stroke
Which region typically is responsible for most VSDs?
Membranous, easier to fix and more asymptomatic
What are the 3 types of VSDs?
- Membranous, MC, easiest to fix
- Muscular (lower septum)
- Inlet (Posterior portion beneath the TV)
What is the MC congenital heart defect?
VSD
Image of VSD pathophysiology
S/S of a symptomatic VSD
- Holosystolic murmur in lower left sternal border
- small = aymptomatic w mumur
- mod-large:Poor feeding, respiratory infections, thrill, diastolic rumble in mitral area
- signs of CHF
- Eventually, eisenmenger syndrome will occur
holo because it can be in 3 diff parts of ventricle aka “whole thing”
Best diagnostic imaging for VSD
Echo
CXR unreliable. use MRI if echo does not diagnose.
What will EKG show usually for VSD?
LVH
Management of VSDs
- Small ones close on their own
- Diuretics + higher calorie intake
- Surgery: for larger shunts by age 2 via patch closure ideally, or transcatheter closure
When is surgical closure indicated for VSD?
- > 8mm with symptoms
- Pulmonary HTN
- Aortic insufficiency
- LA/LV dilation
What does the PDA connect?
Pulmonary artery to aorta
When does a PDA normally close?
By week 1
Becoming the ligamentum arteriosum
What are the risk factors for PDA?
- Female
- Preemies
- High altitude births (> 10k ft)
S/S of PDA
- Holosystolic “machine-like” murmur on auscultation pathognomonic
- Differential cyanosis
- Widened PP
- PMI displacement
- Large eventually leads to HF and eisenmenger syndrome
What is differential cyanosis?
Cyanosis/clubbing of the lower extremities, seen in PDA.
Rest of the body is normal.
This + pulmonary HTN is diagnostic.
VIAGOOGLE not slides
EKG finding for PDA
LVH + LAE
Tx of PDA
- Small: monitor
- To close a PDA in a neonate over day 10, use PGE inhibitor
- Symptomatic/large PDA: Digoxin & furosemide
When is surgery indicated for PDA?
Failure of PGE inhibitor, done via surgical ligation