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Y4 Child Health > Ventricular Septal Defect > Flashcards

Ventricular Septal Defect Flashcards

1
Q

What is the most common Congenital Heart Defect?

A

Ventricular Septal Defect (VSD)

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2
Q

What is VSD?

A

Congenital hole in septum between ventricles

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3
Q

What direction is the shunt in VSD? Why?

A
  • L –> R
  • Because pressure in L ventricle > R ventricle
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4
Q

What are the different types of VSD? (3 things)

A
  1. Very small VSD (aka Restrictive VSD)
  2. Moderate sized VSD
  3. Large VSD
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5
Q

What happens in a Very small VSD (aka Restrictive VSD)?

A

Blood flow thru VSD so minimal so no significant increase in pulm blood flow

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6
Q

What happens in a Moderate sized VSD?

A

Blood flow thru VSD great enough to cause increase in pulm blood flow

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7
Q

What part of heart contraction is the Shunt in VSD happening in?

A

Systole

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8
Q

What is the pathophysiological steps of Moderate sized VSDs complications? (6 steps)

A
  1. L-R Shunt in systole
  2. Extra blood pumped directly into pulm circulation
  3. So no initial effect on R ventricle
  4. L heart receiving greater volume of blood
  5. L Atrium + Ventricle dilation
  6. Risk of CHF + Arrhythmias + Pulm HTN
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9
Q

What can the Pulm HTN from VSD lead to in the heart?

A

R ventricle wall hypertrophy as pumping against high pulm pressure

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10
Q

What is the pathophysiology of Large VSDs complications? (2 steps)

A
  1. Significant amount of blood passing thru L-R shunt
  2. HF + Severe Pulm HTN
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11
Q

When will you see signs of HF in a Large VSD?

A

After first wks of life

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12
Q

How do you get CF of HF from VSD? (3 steps)

A
  1. Initially high pulm artery pressure drops
  2. More blood allowed thru L-R shunt –> lungs
  3. Pulmonary Plethora + Cardiomegaly
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13
Q

How do you get CF of HF from VSD? (3 steps)

A
  1. Initially high pulm artery pressure drops
  2. More blood allowed thru L-R shunt –> lungs
  3. Pulmonary Plethora + Cardiomegaly
Pulm plethora
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14
Q

What is Pulm Plethora?

A

Appearance of increased pulm perfusion on CXR

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15
Q

What are the RF for VSD? (6 things)

A
  1. Maternal DM
  2. Maternal rubella (during preg)
  3. Alcohol (–> Foetal alcohol syndrome)
  4. Maternal Phenylketonuria (during preg)
  5. FHx of VSD
  6. Chromosomal abn
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16
Q

What are the CF of Very Small VSD (aka Restrictive VSD)?

A

Asymptomatic (or mild symptoms)

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17
Q

When would you even see a Very Small VSD pt?

A

When infant brought to med attention bc systolic murmur detected during routine exam

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18
Q

What are the CF of Moderate Sized VSD? (3 things)

A
  1. Sweating
  2. Fatigue
  3. Tachypnoea
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19
Q

When are CF of Moderate Sized VSD especially notable?

A

During feeding

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20
Q

What age do CF of Moderate Sized VSD appear?

A

2-3 months

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21
Q

Why do CF of Moderate Sized VSD only appear after 2-3 months?

A

Bc pulm vasc resistance decreases –> increase in L-R shunting

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22
Q

What are the CF of Large VSDs? (8 things)

A
  1. CHF symptoms
  2. SOB
  3. Feeding problems
  4. Dev issues (aka weight + height)
  5. Freq chest inf
  6. Clubbing
  7. Cyanosis (if Eisenmenger Syndrome develops)
  8. Haemoptysis (severe)
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23
Q

What murmurs might you hear in VSD? (2 things)

A
  1. Systolic murmur
  2. Diastolic murmur
24
Q

When do Systolic murmurs of VSD occur?

A

Between S1 + S2

25
Q

Where are the Systolic murmurs of VSD heard best?

A

Lower L sternal border

26
Q

What is the Quality of the Systolic murmur in VSD?

A

Uniform high pitched

27
Q

Why might you get a Diastolic murmur in VSD?

A

Increased blood flow thru Mitral valve –> Relative mitral stenosis

28
Q

Where is the Diastolic murmur in VSD best heard?

A

Apex

29
Q

When do Diastolic murmurs in VSD occur?

A

Early to mid-diastole

30
Q

What are some differentials that present similarly to VSD? (6 things)

A
  1. Mitral regurg
  2. Tricuspid regurg
  3. ASD
  4. Patent ductus arteriosus
  5. Pulmonary stenosis
  6. Tetralogy of Fallot
31
Q

How do you differentiate between VSD and Mitral regurg?

A

Echo

32
Q

How do you differentiate between VSD and Tetralogy of Fallot?

A

CF of ToF more severe

33
Q

What investigations can you do for sus VSD? (2 things)

A
  1. ECG
  2. Bloods
34
Q

What will a ECG show in VSD?

A

Left or Bilateral Ventricular Hypertrophy

35
Q

What bloods should you do for sus VSD? (3 things)

A
  1. Septic screen (to rule out non-cardiac causes of collapse / deterioration)
  2. Kidney function (before starting tx)
  3. Microarray (if chromosomal abn sus)
36
Q

What imaging can you do for sus VSD? (4 things)

A
  1. CXR
  2. Echo
  3. Cardiac CT angiography
  4. MRI
37
Q

What might you see on a CXR in VSD? (4 things)

A
  1. Cardiomegaly
  2. Pulm oedema
  3. Pleural effusion
  4. Pulm HTN
38
Q

What is the GOLD standard imaging for confirming VSD Dx?

A

Echo

39
Q

What will the Echo tell you about the VSD? (4 things)

A
  1. Size
  2. Location
  3. Severity
  4. Relation to nearby valves
40
Q

What is an invasive investigation technique for VSD?

A

Cardiac catheterisation

41
Q

What is the benefits of Cardiac catheterisation in CHDs (VSD)? (4 things)

A
  1. Dx
  2. Tx
  3. Determine relative pressures + Pulm vasc resistance
  4. Determine significance of shunt
42
Q

What does the Mx of VSD depend on?

A

Size of VSD

43
Q

What are the Mx options for asymptomatic small VSD?

A

Maintain good hygiene (to reduce risk of inf endocarditis)

44
Q

What are the M EDICAL Mx options for VSD? (4 things)

A
  1. Increased Calories
  2. Diuretics
  3. ACEi (2nd stage meds after diuretics)
  4. Digoxin
45
Q

Why is Increased Calories needed for VSD babies?

A

Because CHF from VSD will cause them poor feeding

46
Q

How do Diuretics work to manage VSD? (2 steps)

A
  1. Reduces fluid in pulm + systemic circulation
  2. Relieves pulm congestion
47
Q

What should you add to minimise Potassium loss with diuretics for VSD?

A

Spironolactone

48
Q

How do ACEi work to manage VSD? (4 steps)

A
  1. Reduce systemic arterial pressures (afterload reduction)
  2. Allow more blood flow thru Aortic valve
  3. Less blood flow thru VSD
  4. Reduced L-R shunt
49
Q

When you add ACEi to VSD Mx, what other meds should you stop and why?

A
  • Stop Spironolactone
  • Bc ACEi increase K levels
50
Q

How does Digoxin work to manage VSD? (4 things)

A
  1. Tx CHF
  2. Increases heart muscle strength
  3. Helps maintain normal heart rhythm
  4. Removes excess water from body
51
Q

When is Digoxin indicated in VSD?

A

Diuretics not adeq relieving CF

52
Q

Do most UK centres use Digoxin in VSD? Why?

A

No, data on efficacy is controversial

53
Q

When is Surgery indicated for VSD?

A

@ Qp/Qs = 2+

(pulm-to-systemic blood flow ratio)

54
Q

What are the Surgical Mx options for VSD? (3 things)

A
  1. Surgical repair (open heart surgery)
  2. Catheter procedure
  3. Hybrid approach
55
Q

What is the Catheter procedure for VSD Mx? (2 steps)

A
  1. Catheter inserted thru femoral artery
  2. Mesh device put in to close hole
56
Q

What is the Hybrid approach procedure for VSD Mx? (2 steps)

A
  1. Surgeon creates small access thru LV
  2. Interventional cardiologist puts in mesh device
57
Q

What are the Long term Mx options for VSD? (2 things)

A
  1. Maintain good dental hygiene
  2. Avoid non-medical procedures (piercing / tattoos)

(to reduce inf endocarditis risk)

Y4 Child Health (18 decks)

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