Structural heart defects Flashcards
Atrial septal defect
Abnormal connection between the 2 atria
Pathophysiology ASD
Left –> Right Shunt (blood circulates through lungs)
As slightly higher pressure in LA than RA
Signs ASD
AF, pulmonary ejection systolic murmur, pulmonary hypertension (causing pulmonary/ tricuspid regurgitation)
Complications ASD
Eisenmenger’s complex (reversal of L–>R shunt)
Initial LR shunt –> pulm hypertension –> high RA pressure –> shunt direction reverses –> cyanosis
Diagnostic tests for ASD
CXR: big pulmonary arteries, big heart, progressive atrial enlargement
ECG: RBBB with LAD and prolonged PR interval
Tx
Closing via surgery
Percutaneously or transcatheter
Ventricular septal defect cause
congenital, post-MI
its acyanotic
Pathology VSD
Blood: LV –> RV –> increased blood flow to lungs
VSD symptoms
depend on size + site
Smaller defect = asymptomatic, but louder systolic murmur, thrill
Larger = small breathless skinny baby, increased resp rate, tachycardia, big heart
VSD complications
pulmonary hypertension
Eisenmenger’s complex
VSD ECG
varies
from normal size heart + mild pulmonary plethora –> cardiomegaly, marked pulmonary plethora
features of tetralogy of fallot
Cyanotic disorder
4 features:
- VSD
- pulmonary stenosis
- RV hypertrophy
- aorta overriding the VSD
Pathology of tetralogy of fallot
Pulm stenosis –> RL shunt through VSD –> cyanosis
Why could infants with ToF be acyanotic at birth?
gradual closure of Ductus arterioles –> cyanotic due to decreasing flow of blood to lungs
Tx ToF
surgery
CXR may be normal
Echo shows anatomy + degree of stenosis
What does the Ductus Arteriosus do?
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
Patent DA
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
Presentation of patent DA
continous “machinery” murmur.
If large PDA, big heart & breathless
Tx for PDA
surgical or percutaneous
low risk of complications
Coarctation of aorta
Congenital narrowing or descending aorta
Usually occurs just distal to the origin of the left subclavian artery
Signs of coarctation of aorta
Radio femoral delay
Weak femoral pulse
Systolic murmur
Right arm hypertension
Whats coarctation of the aorta associated with?
Bicuspid aortic valve, turner’s syndrome
Long term complications of coarctation of the aorta
HTN, re-coarctation needing repeat intervention
aneurysm forming at repair site
Tx coarctation of the aorta
Surgery, or balloon dilatation +/- stenting
2 other structural heart defects (less common)
Atrio-ventricular septal defects
Bicuspid aortic valve
