Structural heart defects

Question 1

Atrial septal defect

Answer 1

Abnormal connection between the 2 atria

Question 2

Pathophysiology ASD

Answer 2

Left –> Right Shunt (blood circulates through lungs)

As slightly higher pressure in LA than RA

Question 3

Signs ASD

Answer 3

AF, pulmonary ejection systolic murmur, pulmonary hypertension (causing pulmonary/ tricuspid regurgitation)

Question 4

Complications ASD

Answer 4

Eisenmenger’s complex (reversal of L–>R shunt)

Initial LR shunt –> pulm hypertension –> high RA pressure –> shunt direction reverses –> cyanosis

Question 5

Diagnostic tests for ASD

Answer 5

CXR: big pulmonary arteries, big heart, progressive atrial enlargement

ECG: RBBB with LAD and prolonged PR interval

Question 6

Tx

Answer 6

Closing via surgery

Percutaneously or transcatheter

Question 7

Ventricular septal defect cause

Answer 7

congenital, post-MI

its acyanotic

Question 8

Pathology VSD

Answer 8

Blood: LV –> RV –> increased blood flow to lungs

Question 9

VSD symptoms

Answer 9

depend on size + site
Smaller defect = asymptomatic, but louder systolic murmur, thrill

Larger = small breathless skinny baby, increased resp rate, tachycardia, big heart

Question 10

VSD complications

Answer 10

pulmonary hypertension

Eisenmenger’s complex

Question 11

VSD ECG

Answer 11

varies

from normal size heart + mild pulmonary plethora –> cardiomegaly, marked pulmonary plethora

Question 12

features of tetralogy of fallot

Answer 12

Cyanotic disorder

4 features:

• VSD
• pulmonary stenosis
• RV hypertrophy
• aorta overriding the VSD

Question 13

Pathology of tetralogy of fallot

Answer 13

Pulm stenosis –> RL shunt through VSD –> cyanosis

Question 14

Why could infants with ToF be acyanotic at birth?

Answer 14

gradual closure of Ductus arterioles –> cyanotic due to decreasing flow of blood to lungs

Question 15

Tx ToF

Answer 15

surgery

CXR may be normal
Echo shows anatomy + degree of stenosis

Question 16

What does the Ductus Arteriosus do?

Answer 16

Before birth DA: blood from pulmonary artery by passing the lungs and goes to the aorta

Is supposed to close in 1st week of life

Question 17

Patent DA

Answer 17

If left open after birth, aortic blood –> pulmonary artery –> unrestricted blood flow to lungs –> pulmonary hypertension

high pressure back flow from aorta into the lungs

Question 18

Presentation of patent DA

Answer 18

continous “machinery” murmur.

If large PDA, big heart & breathless

Question 19

Tx for PDA

Answer 19

surgical or percutaneous

low risk of complications

Question 20

Coarctation of aorta

Answer 20

Congenital narrowing or descending aorta

Usually occurs just distal to the origin of the left subclavian artery

Question 21

Signs of coarctation of aorta

Answer 21

Radio femoral delay
Weak femoral pulse
Systolic murmur
Right arm hypertension

Question 22

Whats coarctation of the aorta associated with?

Answer 22

Bicuspid aortic valve, turner’s syndrome

Question 23

Long term complications of coarctation of the aorta

Answer 23

HTN, re-coarctation needing repeat intervention

aneurysm forming at repair site

Question 24

Tx coarctation of the aorta

Answer 24

Surgery, or balloon dilatation +/- stenting

Question 25

2 other structural heart defects (less common)

Answer 25

Atrio-ventricular septal defects

Bicuspid aortic valve