Structural heart disease Flashcards

1
Q

Ductus arteriosus

A

Stops functioning within 1-3days of birth
Closes within first 2-3 weeks
If this fails = patent ductus arteriosus (PDA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes/risk factors of PDA

A

Genetic
Maternal infections - rubella
Prematurity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PDA pathophysiology

A

Link b/ween aorta and pulmonary vessels
Blood: aorta to pulmonary vessels - L to R shunt
Pulmonary hypertension
R sided heart strain
R ventricular hypertrophy
L ventricular hypertrophy, as blood returns to L side of heart after pulmonary vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PDA presentation

A

SOB
Difficulty feeding (kids)
Poor weight gain (kids)
Lower respiratory tract infections
Heart failure
Asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

PDA murmur

A

Normal S1
Continuous crescendo to decrescendo machinery murmur - continues during S2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PDA diagnosis

A

Echo
Doppler flow used to assess left to right shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PDA management

A

Monitored till 1 year of age using echos if asymptomatic
Trans-catheter or surgical closure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Atrial septal defect definition

A

Hole in septum between two atria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ASD embryology

A

Walls of atria grow downwards from top of heart
Then fuse together with endocardial cushion in middle - separates the atria
Walls =septum primum and septum secondum
Septum secondum has hole called foramen ovale - normally closes at birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ASD pathophysiology

A

ASD
Shunt - blood moves from RA to LA (higher pressure in RA)
Blood flows to pulmonary vessels - no cyanosis
R sided overload and heart strain
Right heart failure + pulmonary hypertension
Can lead to Eisenmenger syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Types of ASD

A

Ostium secondum (septum secondum fails to fully close)
Patent foramen ovale (not strictly ASD)
Ostium primum (septum primum fails to fully close - atrioventricular septal defect)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ASD complications

A

Stroke if venous thromboembolism (DVT) - instead of travelling to lungs (PE) it can now travel to brain
AF/atrial flutter
Pulmonary hypertension/right sided heart failure
Eisenmenger syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ASD murmur

A

Mid-systolic
Crescendo-decrescendo
Loudest at upper left sternal border
Fixed split S2 - aortic and pulmonary valves shut at slightly different times - does not change with inspiration/expiration (normal at inspiration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ASD symptoms

A

SOB
Difficulty feeding
Poor weight gain
Lower respiratory tract infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ASD managmeent

A

Refer to paeds cardiologist
Transvenous catheter closure via femoral vein
Open heart surgery
Anticoagulants in adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ventral septal defect definition

A

Congenital hole in ventricle septum
Entire septum or small hole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

VSD associations

A

Down’s and Turner’s syndrome
Can occur in isolation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

VSD pathophysiology

A

Blood flows from LV to RV
Remain acyanotic
Right sided overload, right heart vailure and pulmonary hypertension
Can cause Eisenmenber syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

VSD presentation

A

Initially symptomless
Poor feeding
Dysponea
Tachypnoea
Failure to thrive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

VSD murmur

A

Pan-systolic
Left lower sternal border
3rd/4th ICS
Systolic thrill

21
Q

VSD treatment

A

Paeds cardiologist
Transvenous catheter closure via femoral vein
Open heart surgery
Increased risk of IE - antibiotic prophylaxis

22
Q

Eisenmenger syndrome causes

23
Q

Eisenmenger syndrome timeline

A

develops after 1-2 years with large shunts or with small shunts in adulthood
More quickly in pregnancy

24
Q

Eisenmenger syndrome pathophysiology

A

L to R shunt
Pulmonary hypertension
Pulmonary pressure > systemic pressure
R to L shunt
Blood bypasses lungs
Cyanosis

25
Cyanosis
Blue discolouration of skin due to low level of O2 sats Bone marrow responds - produces more RBC and Hb Polycythaemia (high Hb) Plethoric complexion Blood more viscous - blood clots
26
Eisenmenger syndrome signs
Pulmonary hypertension: R ventricular heave - contracts forcefully against pressure Loud S2 Raised JVP Peripheral oedema R-L shunt and hypoxia: Cyanosis Clubbing SOB Plethoric complextion (red)
27
Eisenmenger mortality
Reduce life expectancy of 20 years Heart failure Infection Thromboembolism Haemmorrhage Increased in pregnancy
28
Eisenmenger management
Heart-lung transplant is only definitive treatment Oxygen to manage symptoms Sildenafil - pulmonary hypertension Tx arrhythmias Tx of polycythaemia with venesection Anticoagulation Prophylactic antibiotics
29
Coarctation of aorta pathophysiology
Narrowing of aortic arch, usually around ductus arteriosus Linked with Turner's syndrome Reduced pressure of blood distal to narrowing Increased pressure of blood proximal to narrowing (in heart and first three branches of aorta)
30
Coarctation of aorta presentation
High blood pressure in limbs supplied from proximal arteries Low blood pressure in limbs supplied from distal arteries Systolic murmur in left infraclavicular area and left scapula Tachypnoea SOB Poor feeding Grey/floppy baby Left ventricular heave (hypertrophy) Underdeveloped left arm / legs Weak femoral pulses
31
Coarctation of aorta management
Prostaglandin E - keep ductus arteriosus open while waiting for surgery Surgery to correct coarctation + ligate DA
32
Tetralogy of Fallot pathologies
VSD Overriding aorta (entrance is further to right than normal - above VSD) Pulmonary valve stenosis RV hypertrophy
33
ToF pathophysiology
Deoxygenated blood enters aorta from RHS - VSD allows mixing of blood - Aorta in direction of travel of blood from RHS - resistance of blood through pulmonary valve (stenosis) R to L shunt - cyanosis Increased strain of RV - R ventricular hypertrophy
34
ToF risk factors
Rubella Increased age of mother Alcohol consumption in pregnancy Diabetic mother
35
ToF investigations
Echo Doppler flow studies CXR - boot shaped heart due to RV hypertrophy
36
ToF presentation
Ejection systolic murmur esp in pulmonary area Cyanosis Clubbing Poor feeding Poor weight gain Tet spells
37
Tet spells pathophysiology
Intermittent symptomatic periods R to L shunt worsened Pulmonary vascular resistance increases / systematic resistance decreases Physical exertion - generate CO2 - vasodilation - reduces systematic vascular resistance - increases R to L shunt
38
Tet spell presentation
Precipitated by waking, physical exertion or crying Irritable, cyanotic and SOB Reduced consciousness, seizures and death
39
Tet spell treatment
Squat/position with knees to chest - increase systemic resistance Oxygen Beta blockers - relax right ventricle Iv fluids - increase preload Morphine - decrease respiratory drive Sodium bicarbonate - buffer metabolic acidosis Phenylephrine infusion - increase systemic resistance
40
ToF management
Prostaglandin infusion in neonates - maintain ductus arteriosus Total surgical repair by open heart surgery
41
Ebstein anomaly pathophysiology
Tricuspid valve set lower in RHS Bigger RA and smaller RV Poor flow to RV and pulmonary vessels Associated with R to L shunt across ASD Cyanosis Associated with Wolff-Parkinson-White syndrome
42
Ebstein anomaly presentation
Heart failure Gallop rhythm (S3 and S4) Cyanosis SOB Tachypnoea Poor feeding Collapse / cardiac arrest If ASD - presents after ductus arteriosus closes
43
Ebstein anomaly diagnosis
Echo
44
Ebstein anomaly management
Tx arrhythmias and heart failure Prophylactic antibiotics Surgical correction
45
Transposition of great arteries pathophysiology
Aorta and pulmonary trunk are swapped Two separate circulations that don't mix Pregnancy - placenta does work for lungs Life threatening at birth Cyanosis Need shunt to survive - PDA, ASD, VSD
46
Transposition of great arteries associated conditions
VSD Coarctation of aorta Pulmonary stenosis
47
Transposition of great arteries presentation
Cyanosis Respiratory distress Tachycardia Poor feeding Poor weight gain Sweating
48
Transposition of great arteries managment
Prostaglandin infusion when neonate Balloon septostomy - catheter into foramen ovale via umbillicus - create ASD Open heart surgery - cardiopulmonary bypass machine performs arterial switch