CHD Flashcards
(28 cards)
Acyanotic CHD names
VSD (L->R shunt) ASD (L->R shunt) Aortic stenosis COA Pulmonary stenosis APW PAPVD
nb: Aortic pulm. window
nb: Partial Anomalous Pulm. venous drainage
Cyanotic CHD names
TOF 10% all CHD and most common cyanotic CHD(R->L shunt)
Trans. great arteries 5% all CHD(R->L)
Tricuspid atresia 2% all CHD (R->L) -all venous return must go through foramen ovale. Then if there is VSD or PDA, also L–>R shunt appears where mixed blood goes into RV.
Truncus arteriosus- mixed blood from RV and LV goes into aorta
TAPVR (venous ret.)
Pulm. atresia (R->L shunt):
nb: Total anomalous pulm. venous return
VSD types and how common
Most common CHD
Perimembranous (most common)
Muscular (lower down)
Supracristal (near PV outlet)
VSd: location and size changes what?
During changes in resp system @birth what happens?
Location: prognostics and repair
Size: symptoms
VSD becomes more symptomatic as the pulm. resistance decreases and more blood flows L->R and through pulm. system
Small VSD presents with?
Small 80-90%- Loud murmur but asymptomatic
Large VSD presents with?
Symptomatic RHF Physical dvt problems Resp infections (congestion in lungs) Dyspnea, trouble feeding, ... Pulm.HT (develops later nb: splitting : wide splitting in vsd, means longer between s2 in inspiration is increased, ie normal situation is just exaggerated but the fixed splitting is s2 splitting in both inspiration and expiration which happens in ASD and eisenmanger ie reversal of large VSD shunt. To do with atrial pressures being similar what with venous return as well as shunt. However in VSD, ventricular pressure of left almost always higher than right so split is only really in inspiration ie not fixed
Symptomatic VSD presents with examination?
ECG?
Xray?
TT
Systolic murmur
S1 ssss S2 S1 sssss S2 (erb’s point and pulm.valve) radiates to liver
LA & LV enlargement (biphasic P wave II and V1) –> extra pulm. flow and return to LA
RA/RV if pulm.HT starts due to increased blood flow- back up but also due to increased blood flow to RH
Xray: Enlarged pulm.trunk, congestion in lungs, cardiomegaly
1/3 spontaneous closure
Diuretics + captopril (vasodilate and decrease CO so end goal of decreasing LVEDP)
Surgery @ 3-6m
ASD happens because of what?
Failure of septal growth towards endocardial cushion or excessive reabsorption of tissue
ASD types
secundum (most common)- in foramen ovale region
primum
sinus venosum
ASD presents with?
Asymptomatic (most)
Resp infections
HF is rare
ASD examination presents with?
ECG?
Xray
TT
Systolic murmur soft (Grade 1/2)
S1SSSssssS2 S1
Splitting S2
R axis deviation (reaching)
RV overload (+ v1v2, -v5v6)
RA enlarg. ( peaked P wave)
Cardiomegaly and RA/RV and PA dilation
if symptomatic and Qp1.5:1>Qs- is interventional closure with occluder device, if not surgery 3-5 yo
PDA presents with examination?
ECG
Xray
TT
Systolic and disastolic mumur (continuous)
S1sssssssS2ssssssS1 radiates to pulm.arteries and back
Increased pulse pressure (Sys high and Dias low):
- BF less in arteries due to run off to pulm. vasculature through PDA
- systolic increases to try and counteract this low BF
+ water hammer pulse: bounding then plummeting (blood into aorta then filters through PDA)
Normal (majority) if symptomatic- LVH, LA overload,
Enlarged pulm.art, cardiomegaly,
Don’t close spontaneously so closure with ligation or coil.
AVSD most common in which disease?
Presents with?
TT
Down’s syndrome
HF, valve insufficiency,
cardiosurgical @ 4-6 months, can do PT banding first if need palliative tt
Pulmonary stenosis (10% of CHD) presents with symptoms?
Examination
ECG
Xray
ECHO
TT
Asymptomatic
If symptomatic- physical effort intolerance, HF
Thrill radiates to back, systolic murmur harsh, S2 splitting
ECG shows RAD and RVH
Xray, normal, or dilated PA
Echo: look for turbulent flow through PV, RVH, valve morphology
TT: if RV pressure: MPA pressure is >64mmHg, or if RV is 70% of LV pressure then we do BALLOON VALVULOPLASTY
Aortic stenosis
unicuspid, bicuspid, tricuspid
-A systolic ejection murmur is heard at the right second
intercostal space,radiating into theneck. The murmur increases in length and becomes higher in frequency as the degree of stenosis increases.
ECG: LVH
X-ray : cardiomegaly
ECHO: see stenosis, dilated aorta
TT: balloon (not as good as PA balloon), if doesn’t work- surgery
TOF what is it?
what causes? and what embryological fault?
Accounts for 70% of cyanotic HD, and 10% of all CHD
- Pulmonary stenosis
- VSD
- Overriding aorta
- RVH
Causes: Digeorge’s syndrome and chr.22 deletions (abnormal cotruncation of ductus arteriosus in PT and Aorta)
TOF presentation?
examination? ecg? xray? echo
TT
Tett spells (spells of cyanosis where baby becomes restless,cries. A toddler might squat to increase blood flow)
- Murmur soft of pulm stenosis ( decreases with increasing shunt R to L)
- single s2 sound and heave of RV on left lower sternal border felt
- boot shape XRAY ( RV hypertrophy and
- RVD and RVH on ecg
TT: optimal @ 4-6 months- surgical repair (closure VSD and increase right outflow tract) but if can’t wait or hypoplasia of PT and arteries, or anoxemic shock, then palliative first with BT anastomosis (increasing BF to lungs from subclavian artery) +valvuloplasty /stent
+6months endocarditis prophylaxis
Anoxemic shock (Pa02 low, so no 02 of mitochondria of tissues- so death): give propanolol (increases VR), 02, morphine/dolantine (pethidine) for sedation and intubation.
Transposition of great arteries- what types and what happens?
D-tga: complete switch, aorta leaves RV with deoxgenated blood pumped to body and PT leaves left ventricle, goes to the lungs and back to LV.
I-tga: ventricles switch along with valves- problem here is that the LV and mitral valve made to withstand high pressures, pump to the pulmonary system and vice versa.
Transp. of great arteries clinical symptoms, exam, ecg, xray, echo?
Clinically- D-TGA no symptoms in utero because of lungs not being used, but when born, no oxygenated blood goes to body–> cyanosis–> death. Unless mixing occurs via VSD, PDA,…
May be no murmur if no VSD or PDA, however heart is hyperdynamic and heaves palpable.
RAD, RVH
Xray shows increased pulm.vasculature EGG ON A STRING
TT: PGE1 infusion + Consider Rashkind (atrioseptostomy with catheter/
Then @ 2 weeks –> arterial switch ‘Jantene’ surgery
What is cyanosis? lab value? 02 saturation?
reduction of > 5g/100ml Hb in blood
02 saturation is not definition of cyanosis but is consequence
Aortic stenosis - what %, what is it? presents with? Examination ECG Xray
TT
5%, leaflets malformed or tissue not resorbed around valves
Asymptomatic-small obstruction
SYmptomatic- fatigability, chest pain, syncope.
Systolic murmur- radiates to neck (carotids)
Thrill (jugular notch if Ao:LV >25mmHg, precordial area if >50mmHg)
Displaced apex beat (cardiac enlargement so no longer in 4th IC space)
S2 quiet (closing is less apparent)
LA overload, LVH, LAD
Arrythmia
Ascend.aorta dilation (unsure aetiology)
LV/LA enlargement
TT if severe stenosis or symptomatic:
balloon valculoplasty /1
Surgery : vavulotomy, prothesis, Ross’s surgery
ns ross’ surgery: PV goes to AV, PV replaced with cadaver PV
Coarctation of aorta what is it?
Stenosis if isthmus- tubular or annular
+hypoplasia of aortic arch +SCA origin issues
Coarctation presents with?
Examination
Poor feeding, hypertension, syncope, nose bleeds,…
Systolic murmur irradiate to scapulars
Decreased pulse femoral/ and or L arm (if SCA comes off after coarctation)
LV/LA overload
Cardiomegaly , pulmonary edema, digit 3 (dilation pre, and stenosis post), rib notching secondary to reverse flow in intercostals.
Coarctation presents with?
Examination
ECG
Xray
TT
Poor feeding, hypertension, syncope, nose bleeds,…
Systolic murmur irradiate to scapulars
Decreased pulse femoral/ and or L arm (if SCA comes off after coarctation)
LV/LA overload
Cardiomegaly , pulmonary edema, digit 3 (dilation pre, and stenosis post), rib notching secondary to reverse flow in intercostals.
TT surgical repair ideally!
if arterial HT, UL:LL mmhg >20mmHg.
Also exists: balloon, stent
