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Systemic Disease in Dentistry > Congenital Heart Disease > Flashcards

Congenital Heart Disease Flashcards

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1
Q

What is congenital heart disease?

A

A structural abnormality of the heart or intra-thoracic great vessels that is present at birth and of functional importance

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2
Q

Describe the prevalence of CHD

A

8-9 per 1000 live births and 10-20% of still births and miscarriages

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3
Q

Describe the 4 stages at which CHD is identified

A
  1. Foetus
  2. Neonate
  3. Child
  4. Adult
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4
Q

Describe 3 ways in which CHD may present in a newborn

A
  1. Cyanosis
  2. Congestive cardiac failure
  3. Cardiac murmur
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5
Q

What are 4 associations of CHD in a newborn?

A
  1. Chromosomal defects
  2. Syndromes
  3. Extracardiac defects
  4. Teratogens
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6
Q

What is a common teratogen which may cause CHD in a newborn?

A

Sodium valproate

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7
Q

What are 3 categories of cyanotic congenital heart disease?

A
  1. Abnormal connections
  2. Right to left shunts
  3. Abnormal mixing
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8
Q

What is the most common abnormal connections which may cause cyanotic CHD?

A

Transposition of great arteries

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9
Q

Describe simple transposition of great arteries leading to cyanotic CHD

A

Aorta is connected to the right ventricle and the pulmonary artery is connected to the left ventricle meaning blood in the aorta is deoxygenated

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10
Q

Describe the treatment of transposition of the great arteries

A
  • Infants present as very cyanotic and only survive if there is mixing of blood
  • Stabilised initially using prostaglandin
  • Arterial switch repair is carried out usually within 2 weeks
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11
Q

What is a common condition which causes right to left shunts of blood in the heart?

A

Tetralogy of Fallot

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12
Q

Describe Tetralogy of Fallot

A
  • Lesion occurs between left and right ventricles
  • Narrowing of pulmonary valve
  • Aorta shifts more rightward
  • Hypertrophy of right ventricle
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13
Q

What condition can lead to abnormal mixing of blood in cyanotic CHD?

A

Univentricular heart

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14
Q

What are 3 associations with a univentricular heart?

A
  1. Pulmonary stenosis
  2. Subaortic stenosis
  3. Coarctation of aorta
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15
Q

Name 3 symptoms of heart failure in adults

A
  1. Swollen ankles
  2. Peripheral oedema
  3. Cracking in the lungs
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16
Q

Name 3 symptoms of heart failure in infants

A
  1. Tachypnoea (breathlessness)
  2. Tachycardia
  3. Hepatomegaly
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17
Q

What is hepatomegaly?

A

Increased size of liver

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18
Q

Describe 2 causes of heart failure in infancy

A
  1. Left to right shunts

2. Obstructive lesions of left heart

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19
Q

Name 4 types of left to right shunts

Study These Flashcards
A
  1. Ventricular Septal Defect
  2. Atrioventricular Septal Defect
  3. Atrial Septal Defect
  4. Patent Ductus Arteriosus
20
Q

What is the most common left to right shunt in:

a) the normal population
b) children with downs syndrome

Study These Flashcards
A

a) Ventricular Septal Defect

b) Atrioventricular Septal Defect

21
Q

Describe a ventricular septal defect

Study These Flashcards
A

There is a defect between the ventricles, causing blood to flow to area of least resistance which causes left to right shunt

22
Q

What is the main symptom of atrial septal defects?

Study These Flashcards
A

Breathlessness

23
Q

What are 2 associations with atrial septal defects?

Study These Flashcards
A
  1. Mitral regurgitation (primum type)

2. Partial anomalous pulmonary venous drainage (S.V. type)

24
Q

What is coarctation of aorta?

Study These Flashcards
A

A fibrous ridge of tissue encroaches into the lumen of aorta which prevents blood flow through the vessel

25
Name 3 associations of coarctation of aorta
1. Bicuspid aortic valve 2. Ventricular septal defect 3. Subaortic stenosis
26
Describe the classic sign of coarctation of the aorta
Hypertension in the upper body and lower tension in the lower body
27
Describe aortic stenosis
Narrowing of the aortic valve which causes hypertrophy of the left ventricle, leaving it more susceptible to arrhythmias
28
What are 3 associations of aortic stenosis?
1. Mitral valve abnormalities 2. Coarctation of aorta 3. Left ventricular hypoplasia
29
What are 2 categories of asymptomatic heart murmurs in childhood?
1. Innocent cardiac murmur | 2. Asymptomatic CHD
30
What is the definition of an innocent cardiac murmur?
Any murmur produced by a normal cardiovascular system under normal resting conditions
31
Describe the characteristics of an innocent cardiac murmur
- No symptoms - Normal heart sounds - No added sounds - Normal ECG / chest x-ray
32
Name 4 prosthetic materials used in cardiac surgery
1. Dacron (patch closure of VSD) 2. Gortex (shunts and conduits) 3. Prosthetic valves (aortic and mitral) 4. Pacemaker leads
33
What is the primary interventional procedure in paediatric cardiology with regards to CHD?
Device closure
34
Name an example of a device which may be used to close atrial septal defect
ASD Amplatzer Device
35
Describe the characteristics of infective endocarditis
- Rare in childhood - Vast majority have underlying heart disease - Serious potential cause of morbidity and mortality
36
Name 4 lesions in the heart which are commonly complicated by endocarditis
1. Ventricular Septal Defects 2. Aortic stenosis or incompetence 3. Tetralogy of Fallot 4. Patent Ductus Arteriosus
37
Why does infective endocarditis tend to be more commonly seen in smaller ventricular septal defects?
Smaller defects cause an increased velocity of flow which causes the endothelium to become more damaged
38
What are the 3 main types of microorganisms involved in infective endocarditis?
1. Streptococci (viridans more than enterococci) 2. Staphylococcus Aureus 3. Staphylococcus Epidermis
39
Describe the diagnosis of endocarditis
- Isolation of infecting organism from blood culture is important - Two to three blood cultures over 24 hour period usually adequate - Echocardiography
40
If blood cultures are negative during the diagnosis of potential endocarditis what may be considered?
Candida infection
41
Describe 5 clinical features of endocarditis
1. Fever 2. General malaise 3. Splenomegaly 4. Heart failure 5. Blood present in urine
42
Why is echocardiography useful in the diagnosis of endocarditis?
It demonstrates the vegetations attached to affected valves in most cases
43
Describe the treatment of endocarditis caused by Streptococcus Viridans
Combination of penicillin and gentamycin given intravenously
44
Describe the treatment of endocarditis caused by Streptococcus Faecalis
Combination of amoxycillin and gentamycin is used
45
Describe the treatment of endocarditis caused by staphylococcal infection
Flucloxacillin and gentamycin
46
Describe the treatment of endocarditis caused by candida infection
It is difficult to treat and may require a combination of amphotericin and flucytosine

Systemic Disease in Dentistry (22 decks)

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