Congenital heart defects Flashcards Preview

CAM201 Clinical Skills > Congenital heart defects > Flashcards

Flashcards in Congenital heart defects Deck (32):
1

Teratogen

Any agent or substance which can cause malformation of an embryo or birth defects. 

2

Critical period of heart development

From about day 20 to 50.

However, deviation from normal pattern of development at any one time may produce one or more cardiovascular defects. 

3

Clinical features of congenital heart defects

  • Vary from asymptomatic through full spectrum to incompatible with life. 
  • Susceptible to infective endocarditis. 

Common symptoms

  • Breathlessness
  • Failure to attain normal growth or development

Clinical signs (Vary with anatomical lesions)

  • Clubbing
  • Cyanosis
  • Murmurs, thrills
  • Cardiomegaly
  • Radio-femoral delay

4

Classification of congenital heart disease

Embryological origin of classification

  • Abnormalities of position
  • Abnormalities of interatrial septum
  • Abnormalities of interventricular septum
  • Abnormalities in the division of the truncus arteriosus
  • Abnormal transformation of aortic arches 
  • Persistence of fetal circulation

Clinical classification

  • Cyanotic
  • Acyanotic

5

Abnormalities of position

  • Dextrocardia (isolated)
  • Dextrocardia (situs inversus)

6

Isolated dextrocardia symptoms

Often associated with other (severe) cardiac anomalies (e.g. transposition of great vessels, single ventricle). 

 

7

Situs inversus symptoms

Usually none. 

8

Abnormalities of interatrial septum

Atrial septal defect

  • Secundum type (most common)
  • Primum type 
  • Patent foramen ovale

9

Clinical presentation of ASD

Female: Male = 2:1

Symptoms

  • Often asymptomatic for many years
  • Dyspnoea, chest infections, cardiac failure, arrhythmias (especially AF)
  • Eisenmenger's syndrome (rarely)

Clinical signs

  • Fixed splitting of S2
  • Systolic flow murmur over pulmonary valve (often no murmur)
  • Secundum type - often associated valve abnormalities/murmurs

Management

  • Surgical repair
  • Cardiac catheterisation - implantable closure device

10

Abnormalities of interventircular septum

  • VSD most common CHD
  • Membranous VSD
  • Muscular VSD

11

Clinical presentation of VSD

Symptoms

  • May be asymptomatic if small
  • Tachypnoea, indrawing of lower ribs on spiration
  • Cardiac failure (4-6 weeks)
  • Eisenmenger's syndrome

Signs

  • Harsh pansystolic murmur, maximal at LSE
  • Murmur often louder when defect is small
  • Third or fourth heart sound
  • Often palpable systolic thrill

12

VSD management

  • Cardiac failure treated medically with digoxin and diuretics
  • Persistent failure is indicated for surgical closure (percutaneous closure devices). 

13

Abnormalities in the division of the truncus arteriosus

  • Persistent truncus arteriosus
  • Complete transposition of the great vessels
  • Pulmonary valve anomalies
  • Tetralogy of the fallot

14

Tetralogy of the fallot

  1. Pulmonary stenosis (outflow obstruction)
  2. R ventricular hypertrophy
  3. Over-riding aorta
  4. VSD

15

Abnormalities in the division of the truncus arteriosus clinical features and management

  • All severe
  • Cyanosis characteristically develops shortly after birth
  • Dyspnoea/apnoea
  • Clubbing

Management

  • Early surgical intervention

16

Abnormal transformation of aortic arches

  • Coarctation of the aorta
  • Double aortic arch

17

Coartctation of the aorta clinical features and management

Male: female = 2:1

Symptoms: depends on site of coarctation

Signs:

  • Radio-femoral delay (radio-radial delay)
  • Weak femoral pulse
  • Midsystolic murmur over praecordium and back
  • Upper limb HTN
  • Upper body may be better developed than lower body

Management:

  • Surgical correction
  • Balloon dilation

18

Main problem with double aortic arch

Main syptoms: problem with swallowing or regurgitation

19

Persistence of fetal circulation

  • PDA
  • PFO (see ASD)

20

PDA clinical presentation

Symptoms

  • Often asymptomatic in infancy
  • Dyspnoea
  • Progressive symptoms of cardiac failure

Signs

  • Collapsing pulse
  • Continuous loud 'machinery' murmur maximal at first left intercostal space
  • Progressive signs of cardiac failure
  • Eissenmenger's Syndrome - late

Management

  • Cardiac catheterisation - implantable occlusive device

21

Acyanotic CHD

  1. VSD
  2. ASD
  3. PDA
  4. Coarctationo of the aorta

22

Cyanotic CHD

  1. Tetralogy of Fallot
  2. Transposition of Great Vessels
  3. Persistent Truncus Arteriosis

 

23

Eisenmenger's syndrome

Pulmonary HTN and reversal of left to right shunt to right to left shunt.

Chronic left-to-right shunting through congenital heart defect (e.g. VSD, PDA). Produces severe pulmonary HTN. 

Because deoxygenated blood mied in systemic circulation --> cyanosis. 

24

Clinical features of Eisenmenger's syndrome

Symptoms

  • Dyspnoea
  • Featigue

Signs

  • Cyanosis
  • Clubbing
  • Loud P2
  • Polycythaemia --> stroke

Management

  • Heart - lung transplant usually required 

25

Causes of congenital heart defects

Genetic/chromosomal syndromes (20%)

  • ​Down syndrome
  • Turner syndrome
  • Trisomy 13 (Patau syndrome)
  • Marfan syndrome

Drugs/chemicals

  • Retinoic acid
  • Alcohol (foetal alcohol syndrome)

Infections

  • Rubella

Other (the vast majority)

26

What type of CHD does down syndrome cause?

Endocardial cushion defects (ASD, VSD, atrioventricular canal defects). 

27

What type of CHD does Turner syndrome cause?

Coarctation of the aorta

Bicuspid aortic valve 

28

What type of CHD does trisomy 13 cause?

ASD, VSD. 

Patent ductus arteriosis - PDA. 

Dextrocardia (isolated)``

29

What type of CHD does Marfan's cause?

Aortic and mitral valve abnoramalities. 

Aortic dissection

30

CHD in retinoic acid

Septal defects most common. 

31

CHD and alcohol

VSD, ASD

32

CHD in rubella

PDA