Congenital Heart Defects

Question 1

When do congenital defects generally present?

Answer 1

Up to 8 weeks after birth usually, either antenatally, soon after birth or at the various check ups

Question 2

What is the differential for cyanosis in newborns?

Answer 2

Cardiac disease, respiratory disease and persistent pulmonary hypertension of the newborn

Question 3

True or Fasle: Cardiac babies tend to be blue with little or no respiratory distress

Answer 3

True

Question 4

Transposition of the Great Arteries

Answer 4

Aorta comes off the right ventricle, instead of pulmonary artery - so no mixing of the systems at all or oxygenation of aorta blood

Question 5

Duct dependent lesions

Answer 5

Any condition in which the pulmonary or systemic circulation is dependent on the patency of the ductus arteriosus. Want to detect these antenatally, because if not detected earlier, present with circulatory collapse when the duct closes

Question 6

How do duct dependent lesion typically present?

Answer 6

• 3-5 day old infant suddenly pale, tachypnoeic and distressed, rapidly more unwell
• Clinical signs include pallor, prolonged capillary refill time (CRT), poor or absent pulses, hepatomegaly, crepitations, increased work of breathing

Question 7

What is the treatment of duct dependent lesions?

Answer 7

• ABC – support airway and breathing as necessary
• Prostaglandin E2 to open duct
• Multisystem supportive treatment
• Transfer to cardiac surgical centre for definitive management

Question 8

What are the underlying causes of cardiac failure often?

Answer 8

Moderate to large left to right shunts e.g. VSD

Question 9

What are the clinical signs of cardiac failure in newborns?

Answer 9

• Failure to thrive
• Slow / reduced feeding (feeding is the most strenuous things babies do)
• Breathlessness (especially when feeding)
• Sweatiness
• Hepatomegaly
• Crepitations