VSD and ASD Flashcards
What is the key epidemiology of a VSD?
Most common congenital heart defect - affecting 50%
Associated with other congenital conditions such as Down syndrome
What is the key aetiology of a VSD?
Failure of the membranous or muscular portion of the septum to develop in the foetus
Allows blood to pass from left to right ventricle -> this increases left ventricle load and right heart pressure
May sometimes reverse if pressure in the right becomes higher
What is eisenmengers syndrome?
In severe cases of VSD
Originally blood left -> right
This leads to increased work load of the right ventricle, right ventricle pressure may increase to exceed left reversing the shunt leading to a cyanotic conditions.
Presents with clubbing and cyanosis
What are the signs of a small VSD?
Asymptomatic
Found incidentally due to murmur
What are the signs of a large VSD?
Shortness of breath on exertion, faltering growth and fatigue
Undetected may present in HF or eisenmengers syndrome (clubbing and cynaosis) when decompensates
What does a VSD sound like on auscultation?
Loud, harsh pan systolic murmur at the left lower sternal edge.
What investigations should be done for a VSD?
bedside: ECG - LVHT, p pulmonale or biVHT
CXR - enlarged pulmonary arteries
Transthoracic echo - definitive diagnosis and severity gradind
What is the key management for a VSD?
Majority self resolve 90% by 6yrs, remaining 10 by 20yrs- close observation and nutritional support
Larger defects - as heart failure, high energy feeds for growth, referral for surgical assessment for closure (norm a catheter intervention)
What are the potential complications of a VSD?
Heart failure
Eisenmenger syndrome
Stroke
Pulmonary HTN
Infective endocarditis
In atrial septal defect what is the common defect in during embryological development?
The septum secundum
What is the key epidemiology of an atrial septal defect?
10% of all congenital hert disease
Patent Foramen ovale in 35% of the adult population
Higher in females 2:1
What are the key risk factors for a ASD?
Maternal alcohol/smoking in the first/second trimester.
Rubella infection during pregnancy.
Maternal diabetes
Family history of secundum ASD
Certain syndromes i.e Noonan’s syndrome and Down syndrome
What are the different classification of atrial septal defects?
Secundum ASD = most common, defect in fossa ovalis
Primum ASD = defect in lower atrial wall, may also have AVSD or mitral valve abnormalities
Sinus venosus = pulmonary vein abnormalities
What are the typical signs and symptoms of an ASD?
Often asymptomatic
Incidental - ejection systolic murmur on auscultation, loudest on lower-left sternal edge due to flow of blood through pulmonary valve
Decompensates = HF
On auscultation what does an ASD sound like?
Fixed - (no variation with respiration) split second heart sound
Soft systolic ejection murmur heard best at upper left sternal border
What investigations should be done for an atrial septal defect?
ECG - normal or tall p waves due to atrial enlargement
CXR - usually norm, cardiomegaly if large defect
ECho - diagnostic, abnormal blood flow
Cardiac MRI if requested by a specialist
What is the typical management of an atrial septal defect?
Most are conservatively managed - routine echo to monitor for changes
Surgical closure or transcatheter approach if larger or significant symptoms/complications
What are some potential complications of an atrial septal defect?
Heart failure - 20s or 30s
Paradoxical embolism
Migraine
Pulmonary vascular disease
Atrial fibrillation and flutter
