Structural Heart defects Flashcards
What is the most commonly inherited heart defect?
Bicuspid aortic valve
What does a bicuspid aortic valve mean?
Will degenerate faster than a normal tricuspid aortic valve and will become regurgitative earlier
What structure does an atrial septal defect involve?
Patent foramen ovale
Will a patient with an atrial septal defect be cyanotic?
No as blood will be shunted from the left side back to the right
(Unless severe and causes Eisenmenger syndrome and shunt reverses)
An atrial septal defect may cause overload in the ___ _______ and lead to ___ _______ __________
RHS circulation
right ventricular hypertrophy
In severe cases of atrial septal defect, the RVH can cause pulmonary hypertension. This can cause a r_____ of s____
reversal of shunt
What is it called when there is a reversal of the shunt in atrial septal defect so blood is going from the right atria straight to the left atria due to the pulmonary hypertension?
Eisenmenger syndrome
In Eisenmenger syndrome in severe cases of atrial septal defect, ________ blood is pumped systemically
deoxygenated
In an older patient with atrial septal defect there is more shunting causing what symptom?
Dyspnoea
How is an atrial septal defect diagnosed?
ECHO
How is atrial septal defect treated?
Sometime there is spontaneous closure
Otherwise closure via cardiac catheterisation/ heart surgery
What direction is the shunt in Ventricular septal defect?
Left to right (non-cyanotic shunt)
What is there a risk of in ventricular septal defect?
Eisenmenger syndrome (shunt reverses due to pulmonary hypertension) and RVH
A small ventricular septal defect is often asymptomatic.
A large ventricular septal defect can cause…
Exercise intolerance
Failure to thrive
Harsh pan systolic murmur
How is a ventricular septal defect diagnosed?
ECHO
What is treatment for ventricular septal defect?
Sometimes there is spontaneous closure
Can have closure via heart surgery or cardiac catheterisation
Describe an atrioventricular septal defect
Hole down middle of heart, no atrial or interventricular septum
What is atrioventricular septal defect associated with?
Down’s syndrome
What can atrioventricular septal defect cause?
Dyspnoea
Exercise intolerance
Eventually Eisenmenger’s syndrome
Hard to treat
Where is a patent ductus arteriosus?
Opening between the aorta and pulmonary artery which fails to close after birth
Describe the blood shunt that occurs in a patent ductus arteriosus
Blood shunts from the aorta to the pulmonary trunk.
This increases risk of pulmonary overload and hypertension which leads to Eisenmenger’s syndrome
What are symptoms of patent ductus arteriosus?
Dyspnoea
Failure to thrive
Machine-like murmur
How is a patent ductus arteriosus diagnosed?
CXR
ECG
ECHO (gs)
How is patent ductus arteriosus treated?
A prostaglandin inhibitor like indomethacin may induce closure
Otherwise consider surgery
What is the congenital heart condition involving 4 specific abnormalities occurring together called?
Tetralogy of Fallot
What are the 4 abnormalities in Tetralogy of Fallot?
Ventricular septal defect
Overriding aorta
RVH
RV outflow obstruction (pulmonary stenosis)
What is an overriding aorta?
A congenital heart defect where the aorta is directly over a ventricular septal defect rather than over the LV
This means some deoxygenated blood from RV can enter systemic circulation
Does Tetralogy of Fallot cause cyanosis?
Yes
What is a characteristic CXR finding in Tetralogy of Fallot?
Boot shaped heart
How is Tetralogy of Fallot diagnosed?
ECHO
CXR showing boot shaped heart
What position do infants with Tetralogy of Fallot often acquire?
Knee to chest squatting position
Increases preload and afterload (by forcing blood from legs to return to heart) so improves cyanosis
What is it called when a baby with Tetralogy of Fallot suddenly develops deep blue/grey skin, nails and lips?
Tet spells
Often happens when baby cries, eats or is upset. Caused by rapid hypoxia
What is treatment for Tetralogy of Fallot?
Full surgical repair within 2 years of life
Then have good prognosis
Where is a coarctation of aorta?
When the aorta narrows at/just distally to the ductus arteriosus (hole between aorta and pulmonary artery)
What happens in a coarctation of aorta?
Blood is diverted massively through aortic arch branches so there is increased perfusion to the upper body compared to lower body
What are symptoms of coarctation of aorta?
Scapular bruits (due to hypertension in collaterals)
Upper body hypertension
How is coarctation of aorta diagnosed?
CXR shows “notched ribs” due to dilated intercostal vessels
CT angiogram
How is coarctation of aorta treated?
Surgical repair or stenting
