Congenital heart disease Flashcards
VSD
Symptoms, incidence, time of presentation, examination, investigations, management
Symptoms:
- small: asymptomatic, normal growth
- moderate: poor feeding, FTT, SOB
- large: poor feeding FTT, SOB, sweaty & pale with feeds.
Most common congenital heart lesion - 15-20%
Associated with T21
Time of presentation:
- Antenatal at 16-18 weeks
- 6-8 week check
- CHF after 4-6 weeks
- persistent pulmonary HTN of newborn by 6-12 months
Examination:
- palpate thrill
- hepatomegaly in HF
- pan-systolic murmur loudest at LLSB
- loud P2 - pulmonary HTN
Investigations:
- Echo
- ECG: LVH, RVH
Management:
< 5mm - spontaneous closure 30-40%
Moderate/severe - diuretics, optimise weight gain for surgery & surgery before 12 months
ASD:
Symptoms, time of presentation, incidence, examination, investigations, management
Symptoms: asymptomatic/recurrent chest infections
2nd most common acyanotic heart lesion - 5-10%
Timing of presentation:
- incidental murmur - mean age 4.5y
- symptoms - arrhythmia, SOB before 40y
Examination:
- may have no auscultatory findings in infant
- Ejection systolic murmur loudest at ULSB
- widely fixed splitting of S2 (delayed closure of PV due to L–> R shunt)
Investigations:
- Echo
- ECG: incomplete RBBB
Management:
<8mm - spontaneous closure
-Repair of larger defects
PDA:
Symptoms, incidence, timing of presentation, examination, investigations, management
Symptoms:
- small: asymptomatic
- moderate: CHF with FTT.
- large: poor feeding, FTT, recurrent LRTI
5-10% of all CHD
Common in preterm infants
Timing of presentation:
- symptoms 3-5 days after birth with duct begins to close.
Examination:
- hepatomegaly in HF.
- bounding pulses + wide pulse pressure
- continuous machinery murmur at ULSB (best heard below clavicle)
- thrill at ULSB
Investigations:
- Echo
Management:
-pre-term - good chance of spontaneous closure.
- term - less likely to close
- medial: indomethacin/ibuprofen (not effective in term infants)
- surgery when > 5kg
Coarctation of aorta: outflow obstruction:
Incidence, timing of presentation, examination, investigation, management
5% of all CHD
Associated with Turner’s syndrome
Timing of presentation:
3-5 days after birth when duct begins to close as blood can no longer bypass obstruction
Examination:
- high systolic BP
- absent femoral pulses
- cold extremities, especially feet
- hepatomegaly if in HF
- murmur at back between scapulae
Investigations:
- Echo
Management:
- Medical: continuous infusion of prostaglandin E1 ti keep PDA open, dobutamine/dopamine to improve heart contractility
- surgery
Tetralogy of Fallot:
Pathophysiology, symptoms, incidence, timing of presentation, examination, investigation, management
1) VSD
2) Overriding aorta
3) Pulmonary stenosis
4) RVH
Symptoms: cyanosis, poor feeding, sweating during feeds.
7-10% of all CHD
Timing of presentation - day 3-4 when PDA begins to close.
Examination:
- cyanotic ‘tet’ spells (increased RV to LV shunt due to pulmonary stenosis)
- Crescendo-decrescendo murmur with hard ejection systolic quality heard loudest over upper left sternal angle with posterior radiation
Investigations
-Echo
- CXR - boot-shaped heart with R aortic arch
- ECG - RA enlargement, RVH
Management:
-medical - prostaglandin infusion to keep PDA open, treat HF, Abx prophylaxis
- surgical
Transposition of great arteries
Symptoms: cyanosis, poor feeding, sweating during feeds
3% of all CHD
Timing of presentation: day 3-5 when PDA closes
Examination: cyanosis, tachypnoea, murmur.
Investigations:
- Echo
- CXR - egg on string appearance
Management: surgery
Innocent murmurs:
Types, incidence, 10 features
Types:
1) Still’s murmur: soft murmur of LLSB in children
2) Venous hum: continuous murmur loudest over clavicles due to venous return from H&N, varies with position
3) Turbulent flow in pulmonary artery bifurcation: soft ESM
25% of full-term neonates
10 ‘S’
Soft
Systolic
Short
S1 and S2 normal
Symptomless
Special test normal
Standing/sitting - vary with position
Sternal depression
