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Congenital heart defects Flashcards

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1
Q

What are the groups of causes of CHDs?

A

Genetic

Environmental

Maternal infections

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2
Q

What are three genetic conditions that give CHDs? Which CHDs do they each give?

A

Down’s syndrome - atrioventriclar septal defect

Turner’s syndrome - coarctation of aorta

DiGeorge syndrome - tetralogy of fallot

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3
Q

What are the environmental causes of CHDs?

A

Teratogens e.g. drugs, alcohol

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4
Q

What are two examples of maternal infections that cause CHDs?

A

Rubella

Toxoplasmosis

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5
Q

What are the categories of CHDs?

A

Acyanotic

Cyanotic

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6
Q

What are the defects involved in acyanotic CHDs?

A

Stenosis, obstruction

Or opening

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7
Q

What is the direction of blood flow across openings in acyanotic CHDs?

A

Left-to-right shunts

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8
Q

How are left-to-right shunts acyanotic?

A

Oxygenated blood from lungs is travelling back to the lungs

no deoxygenated blood travelling to body

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9
Q

Why does blood move from the left side of the heart to the right side of the heart in left-to-right shunts?

A

Left side of heart is at higher pressure than right side

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10
Q

What are seven examples of acyanotic CHDs?

A

Atrial septal defect

Ventricular septal defect

Patent ductus arteriosus

Aortic stenosis

Coarctation of aorta

Mitral stenosis

Pulmonary stenosis

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11
Q

What is an atrial septal defect (ASD)?

A

Persistent opening in interatrial septum after birth

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12
Q

What is the most common site of an ASD?

A

Foreamen ovale

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13
Q

What are ASDs caused by?

A

Septum primum being resorbed too much
or
Septumum secundum being too short

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14
Q

What does the amount of blood moving through an ASD depend on?

A

Size of opening

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15
Q

What does the RV experience with ASDs? Why?

A

Volume overload

due to extra blood entering RA from LA, then RV

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16
Q

How does the RV respond to volume overload?

A

Dilates

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17
Q

What can dilation of the RV lead to?

A

Right-sided heart failure

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18
Q

What happens to blood flow in the pulmonary circulation with an ASD?

A

Increased blood flow through pulmonary circulation

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19
Q

What can increased pulmonary blood flow in an ASD lead to?

A

Pulmonary hypertension

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20
Q

What are VSDs?

A

Abnormal opening in ventricular septum

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21
Q

Where are VSDs most common?

A

Membranous portion of ventricular septum

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22
Q

How does the LV respond to volume overload?

A

Dilates

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23
Q

What does dilation of the LV lead to?

A

Left sided heart failure

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24
Q

What does the LV experience with VSDs? Why?

A

Volume overload

increased blood flow in RV, pulmonary circulation, LA, then LV

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25
What may increased blood flow through the pulmonary circulation with a VSD lead to?
Pulmonary hypertension
26
What is a patent ductus arteriosus (PDA)?
Ductus arteriosus fails to close after birth | persistent communication between pulmonary artery and descending aorta
27
What does the pulmonary circulation experience with PDA?
Volume overload
28
What may volume overload in the pulmonary circulaton with PDA lead to?
Pulmonary hypertension
29
What is the cause of congenital aortic valve stenosis?
Bicuspid form of valve instead of tricuspid | narrower opening
30
How does congenital aortic stenosis affect blood flow?
Increases resistance to blood flow out of the LV
31
In what direction does blood shunt in PDA? Why?
From aorta to pulmonary artery | aorta is at higher pressure than pulmonary artery
31
What do the LA and LV experience with PDA?
Volume overload
33
How does pulmonic stenosis affect blood flow?
Increases resistance to blood flow out of RV
34
What happens to the RV with pulmonic stenosis? Why?
RV has to contract harder to generate higher pressure to push blood through pulmonic stenosis RV hypertrophies
35
What is coarctation of the aorta?
Narrowing of aortic lumen
36
What are the causes of pulmonic stenosis?
Pulmonary valve stenosis Pulmonary artery narrowing
37
What happens to the LV with coarctation of aorta? Why?
LV has to contract harder to generate higher pressures to pump blood into aorta LV hypertrophies
38
What forms around the aorta with coarctation of aorta? Why?
Collateral arteries | to bypass the narrowing
39
What type of shunt do cyanotic CHDs involve?
Right-to-left shunts
40
What do right-to-left shunts require? Why?
Opening - for blood to pass through from right side of heart to left side Distal obstruction - to give increased resistance to blood flow out of RV, so blood moves from RV to LV instead
41
Why are right-to-left shunts cyanotic?
Deoxygenated blood from body is entering systemic circulation instead of to the lungs
42
What is cyanosis?
Blue-purple discolouration of skin and mucous membranes
43
What is the cause of cyanosis?
High levels of deoxygenated Hb in the blood
44
What are five examples of cyanotic CHDs?
Tetralogy of Fallot Transposition of great arteries Tricuspid atresia Pulmonary atresia Hypoplastic left heart syndrome
45
What are the four defects in Tetralogy of Fallot?
VSD Over-riding aorta Pulmonic stenosis RV hypertrophy
46
What is the effect of the over-riding aorta in tetralogy of fallot?
Deoxygenated blood from RV enters aorta | enters systemic circulation
47
What is the effect of pulmonic stenosis in tetralogy of fallot?
Increased resistance to blood flow out of RV
48
What causes RV hypertrophy in tetralogy of fallot?
RV has to contract harder to generate higher pressuers to pump blood through pulmonic stenosis
49
What does the amount of blood shunting from the RV to the LV depend on in tetralogy of fallot?
The size of the VSD The extent of the pulmonic stenosis
50
What is transposition of the great arteries?
Aorta arises from RV | Pulmonary artery arises from LV
51
How does transposition of the great arteries affect blood flow?
Have two separate circuits of blood flow | rather than two circuits in series
52
What the two separate circuits of blood flow with transposition of the great arteries?
``` LA - oxygenated blood LV - oxygenated blood Pulmonary artery - oxygenated blood Pulmonary veins - oxygenated blood LA - oxygenated blood ``` ``` RA - deoxygenated blood RV - deoxygenated blood Aorta - deoxygenated blood Vena cavae - deoxygenated blood RA - deoxygenated blood ```
53
Why does a foetus with transposition of the great arteries survive till birth?
Due to the shunts in foetal circulation - foramen ovale - ductus arteriosus Form communication between the two circuits of blood flow
54
Why is transposition of the great arteries problematic after birth?
Shunts close | loss of communication between two circuits of blood flow
55
When might transposition of the great arteries not be as much of a problem after birth?
Shunts remain open e.g. patent foramen ovale PDA
56
What is tricuspid atresia?
Complete absence of tricuspid valve
57
How does tricuspid atresia affect blood flow?
No blood flow into RV
58
How does tricuspid atresia affect the RV? Why?
RV is hypoplastic - underdeveloped or absent | because it didn't have any blood to contract against
59
What is required for a foetus with tricuspid atresia to survive? Why?
ASD allows blood flow from RA to LA VSD allows blood flow from LV to RV to pulmonary artery to lungs to be oxygenated
60
Why does blood flow from RA to LA with tricuspid atresia?
Blood cannot flow into RV | only route for blood flow is into LA
61
Why does blood flow from the LV to RV with tricuspid atresia?
RV isn't receiving any blood from RA | LV is at higher pressure than RV
62
What is an alternative to the VSD with tricuspid atresia?
PDA
63
How is tricuspid atresia cyanotic?
Deoxygenated blood moves from RA to LA to LV to aorta and systemic circulation, some of it
64
What is pulmonary atresia?
Sealed pulmonary valve
65
How does pulmonary atresia affect blood flow?
No blood flow into pulmonary trunk
66
What is required for a foetus with pulonary atresia to survive? Why?
ASD Allows blood flow from RA to LA PDA Allows blood flow from aorta to pulmonary artery
67
Why does blood flow from RA to LA with pulmonary atresia?
Increased resistance to blood flow out of RV, into RV | Less resistance to blood flow into LA
68
Why does blood shunt from the aorta to the pulmonary trunk with pulmonary atresia?
Because pulmonary artery isn't recieving any blood aorta is at higher pressure than pulmonary artery blood flows down the pressure gradient
69
Why is cyanosis seen with pulmonary atresia?
Because deoxygenated blood is going from RA to LA to LV to aorta and systemic circulation, some of it
70
What is hypoplastic left heart syndrome (HLHS)?
LV and ascending aorta are under-developed | aortic and mitral valves are stenosed or sealed
71
What is essential for a foetus with HLHS to survive?
ASD allows blood flow from LA to RA PDA allows blood flow from pulmonary trunk to aorta
72
Why does blood flow from LA to RA with HLHS?
Blood cannot flow into LV | only route for blood flow is into RA
73
Why does blood flow from pulmonary artery into aorta with HLHS?
Because aorta isn't receiving any blood | pulmonary artery is at higher pressure than aorta
74
What is the role of the RV with HLHS?
Support systemic circulation
75
Why is cyanosis seen with HLHS?
Mixing of oxygenated and deoxygenated blood in RA oxygenated from LA deoxygenated from venae cavae enter RV, pulmonary trunk and aorta
76
What happens to the LV with congenital aortic stenosis? Why?
LV has to contract harder to generate more pressure to push blood through stenosed valve LV hypertrophies
76
How does coarctation of the aorta affect blood flow?
Increases resistance to blood flow in the aorta | increases aortic pressure, afterload

Cardiovascular System (22 decks)

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