structural heart defects Flashcards

1
Q

define congenital heart disease

A

A general term for a range of birth defects that affect the normal way the heart works.
-Vary from minor to incompatible with life ex-utero
-Many lesions used to have very poor prognosis

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2
Q

describe the physiology of congenital heart disease

A

-The stenosis of the RV outflow leads to the RV being at a higher pressure than the left
-There blue blood passes from the RV to the LV
-The patients are blue

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3
Q

name 7 structural heart defects

A

-Ventricular septal defect
-Atrio-ventricular septal defects
-Patent ductus arteriosus
-Coarctaction of the aorta
-Bicuspid aortic valve and aortopathy
-Pulmonary stenosis
-Eisenmenger syndrome (any untreated congenital cardiac defect with intracardiac communication that leads to pulmonary hypertension, cyanosis, reversal of flow).

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4
Q

what is the Tetralogy of Fallot

A
  1. ventricular septal defect
  2. pulmonary stenosis
  3. hypertrophy of Rt ventricle
  4. overriding aorta
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5
Q

describe the physiology of tetralogy of fallot

A

-The stenosis of the RV outflow leads to the RV being at higher pressure than the left
-Therefore blue blood passes from the RV to the LV
-The patients are BLUE

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6
Q

describe what ventricular septal defects are

A

-Abnormal connection between the two ventricles
-Many close spontaneously during childhood

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7
Q

describe the physiology of ventricular septal defects

A

-High pressure LV
-Low pressure RV
-Blood flows from high pressure chamber to low pressure chamber
-Therefore NOT blue
-Increased blood flow through the lungs

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8
Q

what are the symptoms of ventricular septal defects?

A
  • very high pulmonary blood flow in infancy
  • breathless
  • poor feeding
  • failure to thrive
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9
Q

what are the clinical signs of ventricular septal defects?

A
  • small, breathless, skinny baby
  • increased respiratory rate
  • tachycardia
  • big heart on chest x- ray
  • murmur varies in intensity
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10
Q

what is Eisenmengers syndrome

A
  • high pressure pulmonary blood flow
  • damages to delicate pulmonary vasculature
  • the resistance to blood flow through the lungs increases
  • the RV pressure increases
  • the shunt direction reverses
    -the patient becomes blue

( untreated tetralogy of fallot may result in eisenmengers syndrome )

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11
Q

define atrial septal defects ASD

A

an abnormal connection between the two atria

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12
Q

describe the physiology of ASD

A

-slightly higher pressure in the LA than the RA
- shunt is left to right ( therefore not blue)
- increased flow into right heart and lungs

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13
Q

what are the symptoms of ASDs?

A
  • significant increased flow though the right heart and lungs in childhood
  • right heart dilation
  • shortness of breath on exertion
  • increased chest infections
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14
Q

what are the clinical signs of ASDs?

A
  • pulmonary flow murmur
  • fixed split second heart sound- delayed closure of PV because more blood has to get out0
  • big pulmonary arteries on CXR
  • big heart on chest x ray
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15
Q

describe atrio-ventricular septal defects- AVSD

A

-a hole in the very centre of the heart
- involves the ventricular septum, atrial septum, mitral and tricuspid valves
- can be complete or partial

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16
Q

In atrio ventricular septal defects- AVSD what do the AV valves look like?

A

instead of two separate valves, there is one big malformed one

17
Q

what do those with a complete defect in AVSD look like?

A
  • poor feeding. poor weight gain
  • torrential pulmonary blood flow
  • breathless as neonate
  • needs repair or PA band in infancy
18
Q

what do those with a partial defect in AVSD look like?

A
  • presents like a small VSD/ASD
  • can present in late adulthood
    -may be left alone if there is no right heart dilation
19
Q

what is a patent ductus arteriosus?

A

when the ductus arteriosus fails to close after birth, leaving a vessel connecting the aorta and pulmonary artery.

20
Q

what are the clinical signs of patent ductus arteriosus?

A
  • continuous murmur
  • if large- big heart, breathless
  • eisenmenger’s syndrome- cyanosis
21
Q

what is the physiology of patent ductus arteriosus?

A
  • breathless, poor feeding, failure to thrive
    -torrential flow from the aorta to the pulmonary arteries in infancy
22
Q

how is closure usually done in someone with the patent ductus arteriosus?

A

usually done through surgery
under local anaesthetic
- there is a low risk of complications

23
Q

what is the coarctation of the aorta?

A

the narrowing of the aorta- usually at the site of insertion of the ductus arteriosus

24
Q

describe the physiology behind severe coarctation of the aorta

A
  • complete or almost obstruction to aortic flow
  • collapse with heart failure
  • needs urgent repair
25
Q

describe the physiology behind mild coarctation of the aorta

A
  • presents with hypertension
  • incidental murmur
  • should be repaired to try to prevent problems in the long term
26
Q

what are the clinical signs of coarctation of the aorta?

A
  • right arm hypertension
  • Bruits ( buzzes) over the scapulae and back from collateral vessels
  • murmur
27
Q

what are the long term problems with coarctation of the aorta?

A
  • hypertension
    - early CAD
    - Early strokes
    - sub arachnoid haemorrhage
  • re- coarctation requiring repeat intervention
  • aneurysm formation at the site of repair
28
Q

what is pulmonary stenosis?

A

the narrowing of the outflow of the right ventricle

29
Q

describe severe pulmonary stenosis

A
  • right ventricular failure as a neonate
    -collapse
  • poor pulmonary blood flow
  • tricuspid regurgitation
30
Q

what is the treatment for pulmonary stenosis?

A

-Balloon valvuloplasty
-Open valvotomy
-Shunt (to bypass the blockage)