Flashcards in acyanotic congenital heart disease Deck (11)
what are the classifications of ASDs? What is the epidemiology?
1. ostium primum. in lower portion. common in trisomy 21. defect can cause mitral regurg.
2. ostium secundum: defect in middle portion. most common asd.
3. sinus venosus: defect high in the septum near the right atrium and SVC. right pulm veins often drain into SVC instead of left atrium
What are the clinical features of an ASD?
Fixed split S2
systolic ejection murmur, esp in mid and upper left sternal borders
increased RV impulse
can cause pulm htn, right heart failure
What determines the severity of the shunt in VSD?
size of the defect and degree of pulmonary vascular resistance
How do small VSDs present and what is their course?
-may close spontaneously
-holosystolic murmucm, esp at low left sternal border
-as VSD size decreases, murmur intensity increases
What is the pathophysiology of a PDA?
blood flows through the ductus from the aorta to the pulmonary artery (left to right shunt). causes increased pulmonary blood flow
What are some of the exam findings for PDA?
machine like continuous murmur at the upper left sternal border
-possible diastolic rumble of blood flow across the mitral valve, widened pulse pressure. risk of pulm htn
how do neonates/infants with severe coarctation of the aorta present?
depend on a right to left shunt through the PDA to perfuse the lower aorta. they begin minimally symptomatic, but get worse as the PDA closes.
what other anomalies are associated with coarctation of the aorta?
bicuspid aortic valve or aortic stenosis
How is coarctation of the aorta managed?
-initially in a neonate, it is managed with PGE to keep the PDA open, and inotropic meds.
-then, corrective repair. may be excision of narrowed segment or balloon angioplasty. balloon angioplasty is treatment of choice for recurrance
What are some complications of aortic stenosis.
reduced LV output. may cause ischemia (higher than average LV demand with lower output). may also lead to LV hypoplasia due to impaired fetal LV development