Ventricular Septal Defect Flashcards
1
Q
Ventricular Septal Defect presentation
A
This patient has developed sudden shortness of breath. Examine his heart.
2
Q
Clinical signs of Ventricular septal defect
A
- Thrill at the lower left sternal edge
-
Auscultation:
- Systolic murmur well localized at the left sternal edge with no radiation.
- No Audible A2.
- Loudness does not correlate with size (Maladie de Roger: loud murmur due to high-flow velocity through a small VSD).
- If Eisenmenger’s develops the murmur often disappears as the gradient diminishes. - Other associated lesions: AR, PDA (10%), Fallot’s tetralogy and coarctation
- Pulmonary hypertension: loud P2 and RV heave + cyanosis and clubbing (Eisenmenger’s)
- Endocarditis
3
Q
Auscultation in VSD
A
- Systolic murmur well localized at the left sternal edge with no radiation.
- No Audible A2.
- Loudness does not correlate with size (Maladie de Roger: loud murmur due to high-flow velocity through a small VSD).
- If Eisenmenger’s develops the murmur often disappears as the gradient diminishes.
4
Q
Causes of VSD
A
- Congenital
- Acquired (traumatic, post‐operative or post‐MI)
5
Q
Investigation for VSD
A
- ECG: conduction defect: BBB
- CXR: pulmonary plethora
- TTE/TOE: site, size, shunt calculation and associated lesions
- Cardiac catheterization: consideration of closure
6
Q
Management of VSD
A
Surgical (pericardial patch) or percutaneous (Amplatzer® device) closure of haemodynamically significant defects.
7
Q
Associations with VSD
A
- Fallot’s tetralogy
- Coarctation
- Patent ductus arteriosus (PDA)
8
Q
Fallot’s tetralogy
A
- Right ventricular hypertrophy
- Overriding aorta
- VSD
- Pulmonary stenosis
9
Q
Blalock–Taussig (BT) shunts
A
- Partially corrects the Fallot’s abnormality by anastomosing the subclavian artery to the pulmonary artery
- Absent radial pulse and scar
10
Q
causes of an absent radial pulse
A
-
Acute:
1. Embolism,
2. Dissection
2. Trauma, e.g. radial artery sheath -
Chronic: ABCT
1. Atherosclerosis,
2. Blalock-Taussig (BT) Shunts
3. Coarctation,
4. Takayasu’s arteritis (‘pulseless disease’),
11
Q
Coarctation of Aorta
A
A congenital narrowing of the aortic arch that is usually distal to the left subclavian artery.
12
Q
Clinical signs of Coarctation of Aorta
A
- Hypertension in right ± left arm (coarctation usually occurs between left common carotid and left subclavian arteries)
- Prominent upper body pulses, absent/weak femoral pulses, radiofemoral delay
- Heaving pressure loaded apex
-
Auscultation:
- Continuous murmur from the coarctation and collaterals radiating through to the back.
- There is a loud A2.
- There may be murmurs from associated lesions
13
Q
Auscultation in Coarctation of Aorta
A
- Continuous murmur from the coarctation and collaterals radiating through to the back.
- There is a loud A2.
- There may be murmurs from associated lesions
14
Q
Associations of Coarctation of Aorta
A
- Cardiac: VSD, bicuspid aortic valve and PDA
- Non‐cardiac: Turner’s syndrome and Berry aneurysms
15
Q
Investigation of Coarctation of Aorta
A
- ECG: LVH and RBBB
- CXR: rib notching, double aortic knuckle (post stenotic dilatation)
