structural heart defects

Question 1

list 5 congential heart defects from most common to least common

Answer 1

Bicuspid aortic valve
Atrial septal defect
Ventricular septal defect
Coarctation of the aorta
Pulmonary stenosis

Question 2

pathology of bicuspid aortic valve

Answer 2

Typically, aortic valve has 3 cusps but in BAV there are only 2

Leads to aortic stenosis ± aortic regurgitation

Valves degenerate quicker than normal valves

Question 3

what does biscuspid aortic valve pre dispose an individual to

Answer 3

to IE, aortic dilation and aortic dissection

Question 4

investigations for bicuspid aortic vav

Answer 4

Echocardiograms – intense exercise may make complications appear faster

Question 5

managemnt for bicuspid aortic vakve

Answer 5

Surgical valve replacement

Question 6

what is atrial septal defect

Answer 6

Abnormal connection between the two atria

Affect higher in the septum

May not present until adulthood

Question 7

what is secondum atrial septal defect

Answer 7

occurs in the middle part of the atrial septum.

May be asymptomatic until adulthood
Commonest

Question 8

what is primum atrial septal defect

Answer 8

occurs in the lower part of the atrial septum close to the tricuspid and mitral valves.

Question 9

pathology atrial septal defect

Answer 9

1. Pressure slightly higher in LA than RA
2. causes a left to right shunt
3. Increased flow into right heart and lungs
4. As heart compliance falls with age, the shunt increases
5. This can lead to heart failure and SOB by 40
6. If left untreated the patient develops right heart overload and dilatation

Question 10

which ventricle is more compliant

Answer 10

Right ventricle is compliant and easily dilates to accommodate the increased pulmonary flow but can result in

• RV hypertrophy
• Pulmonary hypertension – Eisenmenger’s complex
• Increased risk of Infective Endocarditis

Question 11

impact of large hole in atrial septal defect

Answer 11

Significant increased flow through the right heart and lungs in childhood
Right heart dilatation
SOB on exertion
Increased chest infections
If any stretch on the right heart should be closed

Question 12

impact of small hole in atrial septal defect

Answer 12

Small increase in flow
No right heart dilatation
No symptoms
Leave alone

Question 13

what is Eisenmenger’s complex:

Answer 13

• Can occur in VSD or ASD
• Reversal of L to R shunt due to pulmonary hypertension leading to right heart hypertrophy (vicious cycle, works harder and so maladaptation increases)
• Causes de-oxygenated blood to skip the lungs and go back around the body
• Once pulmonary HTN is high enough to cause the reversal, only a transplant is curative

Question 14

investigatons for atrial septal defect

Answer 14

Chest x ray
ecg
echocardiogrm

Question 15

what would chest x ray of atrial spetal defec show

Answer 15

Large heart
Large pulmonary arteries

Question 16

what would ecg of atrial septal defect show

Answer 16

Right bundle branch block (RBBB) due to RV dilatation

Question 17

what would echocardiogram of atrial septal defect show

Answer 17

Hypertrophy and dilation of right side of heart and pulmonary arteries

Question 18

signs and symptoms of atrial septal dfect

Answer 18

Pulmonary flow murmur
Fixed split-second heart sound (delayed closure of pulmonary valve because more blood has to get out)
Dyspnoea
Exercise intolerance
Atrial arrhythmias from RA dilation

Question 19

management of atrial septal defect

Answer 19

Surgical closure
Percutaneous (key hole technique)