Left to right shunts

Question 1

What are the two main types of ASD’s?

Answer 1

secundum ASD (80%)- in the centre of the atrial septum
partial av septal defect-has inter atrial communication between th eatrial septum and AV valves, also leads to AV valve regurg

Question 2

What are the symptoms of ASD’s?

Answer 2

commonly none
recurrent chest infections/ wheeze
heart failure
arrhythmias

Question 3

What are the physical signs of ASD’s?

Answer 3

fixed and widely split second heart sound: stroke volume equal in inspiration and expiration

ejection systolic murmur: best heard at upper left sternal edge

apical pansystolic murmur: if partial AVSD

Question 4

ASD investigations

Answer 4

CXR

ECG

• secundum often has RBBB, right axis deviation due to RV enlargement
• partial often has left axis deviation

Cross sectional echocardiography

Question 5

ASD management

Answer 5

secundum: cardiac catheterisation
partial: surgical correction, usually aged 3-5 to avoid RHF

Question 6

Epidemiology of VSD’s and the different types

Answer 6

account for 30% of all CHD
can be perimembranous or muscular
small vs large

Question 7

symptoms of small VSD’s

Answer 7

smaller than the aortic valve in diameter

asymptomatic

Question 8

physical signs of small VSD’s

Answer 8

thrill at lower sternal edge

loud pansystolic murmur

quiet pulmonary second sound

Question 9

small VSD investigations

Answer 9

CXR: normal

ECG: normal

Echo

Question 10

small VSD management

Answer 10

most lesions close spontaneously
usually shown by disappearance of murmur with a normal ECG
prevent IE by maintaining good dental hygeine

Question 11

Large VSD symptoms

Answer 11

heart failure with breathlessness

recurrent chest infections

Question 12

Large VSD physical signs

Answer 12

active precordium
soft pansystolic murmur
apical mid-diastolic murmur
loud P2 from raised pulmonary arterial diastolic pressure
tachypnoea
tachycardia
enlarged liver

Question 13

Large VSD investigation

Answer 13

CXR- cardiomegaly, enlarged pulmonary vessels, increased pulmonary vascular markings, pulmonary oedema

ECG- biventricular hypertrophy

echo

Question 14

management of VSD

Answer 14

heart failure treated with diuretics and captopril
additional calorie input given
surgery 3-6 months:
-manage heart failure
prevent permanent lung damage from pulmonary HTN

Question 15

what is persistent ductus arteriosus?

Answer 15

when the ductus arteriosus fails to close due to a defect in the constrictor mechanism of the duct.
The flow goes from the aorta to the pulmonary artery

Question 16

clinical features of PDA

Answer 16

continuous murmur below left clavicle which continues into diastole

collapsing/ bounding pulse

usually asymptomatic

Question 17

PDA investigations

Answer 17

CXR

ECG

Echo and doppler essential

Question 18

management of PDA

Answer 18

closure with a coil/ occlusive device is recommended to reduce lifetime risk of BE