Congenital Heart Diseases

Question 1

How often do congenital heart diseases occur?

Answer 1

6-21 / 1000 births

Question 2

RF of CHD

Answer 2

Maternal h/o DM, obesity, fever, flu, smoking, alcohol, drugs

Question 3

Ventricular Septal Defect (VSD)

Answer 3

• Hole bt ventricles
• Most are perimembranous (close association w/ conduction system)
• Most common CHD (can have multiple VSDs or VSD + another CHD)

Question 4

Sx of VSD

Answer 4

• Murmur (PVR high at birth, decreases –> murmur gets louder)
• Irritable when feeding
• Tachypnea
• Grunting
• Slow wt gain
• Sweating

Question 5

Is VSD cyanotic or non-cyanotic?

Answer 5

Non-cyanotic

Question 6

How to diagnose VSD?

Answer 6

• Echo

- If complicated, heart cath: would show increase in O2 sat in RV compared to venous blood (due to blood mixing)

Question 7

Atrial Septal Defect (ASD)

Answer 7

• Hole bt atria
• 2nd most common CHD
• F > M
• Kids have nl life, some decrease in exercise stamina

Question 8

When to surgically treat ASD?

Answer 8

If not closed by age 5

Question 9

Is ASD cyanotic or non-cyanotic?

Answer 9

Non-cyanotic

Question 10

Coarctation of Aorta

Answer 10

• Narrowing of distal segment of aorta
• M > F
• Often associated w/ other abnormalities (esp. Turner’s)

Question 11

How does pt w/ coarctation of aorta present?

Answer 11

• BP difference bt upper and lower extremities
• HF sx w/in 1-2 months
• Murmur heard best in interscapular area

Question 12

How to treat coarctation of aorta?

Answer 12

• In newborns: PGE1 infusion (to keep ductus open)–vasodilates and increases CO
• Surgical repair. If delayed until after 1 y/o, some success w/ balloon dilation
• If untreated: avg lifespan=34 yrs

Question 13

Is coarctation of aorta cyanotic or non-cyanotic?

Answer 13

Non-cyanotic

Question 14

Patent Ductus Arteriosus (PDA)

Answer 14

• Ductus does not close (due to lung failure or idiopathic)

- RF: premature, F

Question 15

How do the different sizes of PDA present?

Answer 15

• Small: murmur (systolic, then continuous)
• Medium: mild sx of HF
• Large: LV volume overload –> HF

Question 16

How to treat PDA?

Answer 16

Depends on size and age

• COX inhibitor (x2 if it fails)
• Surg

Question 17

Is PDA cyanotic or non-cyanotic?

Answer 17

Non-cyanotic

Question 18

Tricuspid Atresia (Ebstein’s anomaly)

Answer 18

• Incompetent TV, small RV
• One leaflet of TV is nl, other 2 are displaced into RV
• Uncommon

Question 19

Sx of Tricuspid Atresia

Answer 19

HF sx, palpitations, arrhythmias, murmur, hepatomeg, cyanosis
- Usually live nl life

Question 20

How to treat Tricuspid Atresia

Answer 20

Meds for most

Surg if severe (Fontan, Glenn shunt)

Question 21

Is Tricuspid Atresia cyanotic or non-cyanotic?

Answer 21

Cyanotic

Question 22

Tetralogy of Fallot

Answer 22

1. RV outflow obstruction
2. VSD
3. Overriding aorta
4. Concentric RV hypertrophy
   (10% of all CHD)

Question 23

How does Tetralogy of Fallot present?

Answer 23

Depends on degree of obstruction:

• Mild: too much pulm blood flow –> HF
• Moderate: balanced pulm and systemic flow –> murmur
• Severe: too little pulm flow –> cyanosis

Question 24

How to treat Tetralogy of Fallot?

Answer 24

Surgery: close VSD, enlarge RV outflow tract

Question 25

Is Tetralogy of Fallot cyanotic or non-cyanotic?

Answer 25

Cyanotic

Question 26

Transposition of Great Arteries (TGA)

Answer 26

• Aorta comes off RV, pulm artery comes off LV (opposite of nl)
• Cannot survive unless there is some blood mixing

Question 27

How to treat TGA?

Answer 27

Arterial switch: switch vessels back to where they belong

Question 28

Is TGA cyanotic or non-cyanotic?

Answer 28

Cyanotic

Question 29

SUMMARY: how to diagnose CHD?

Answer 29

Careful PE and pulse ox (most get echo)

REFER to save lives!

Question 30

Cyanotic Lesions

Answer 30

• Tetralogy of fallot
• Transposition of great vessels
• Tricuspid atresia (Ebstein’s anomaly)

Question 31

Non-Cyanotic Lesions

Answer 31

• VSD
• ASD
• Coarctation of aorta
• PDA