Congenital Heart Disease (3)

Question 0

What is a left to right shunt?

Answer 0

• Blood from left heart is returned to lungs instead of body
• Increased lung blood flow
• By itself it isn’t damaging

Question 1

What can be the causes of congenital heart disease?

Answer 1

• Genetics: Downs/Turners
• Environmental: teratogenicity from drugs/alcohol
• Maternal infections: Rubella, toxoplasmosis

Question 2

What are the four main types of acyanoitc congenital heart disease?

Answer 2

• Acyanotic:
• Left to right shunts: ASD, VSD, PDA
• Obstructive lesions: aortic stenosis: hypoplasia
• Pulmonary stenosis: valve, outflow, branch
• Coarctation of aorta, mitral stenosis

Question 3

What are the four types of cyanotic congenital heart disease?(complex right to left shunts)

Answer 3

• Tetralogy of fallot (VSD/pulmonary stenosis)
• Transposition of great arteries
• Total anomalous pulmonary venous damage
• Univentricular heart

Question 4

What are the four types of shunts?

Answer 4

• Atrial
• Ventricular
• Atrio-ventricular
• Ventricular-pulmonary

Question 5

What is ASD?

Answer 5

• Atrial septal defects:
• Increased pulmonary blood flow
• RV volume overload
• Pulmonary hypertension is rare
• Eventual right heart failure

Question 6

What is VSD?

Answer 6

• Ventricular septal defects:
• Left to right shunt
• LV volume overload
• Pulmonary venous congestion
• Eventual pulmonary hypertension

Question 7

What is tetralogy of fallot?

Answer 7

• Pulmonary stenosis
• Ventricular septal defect
• Right ventricular hypertrophy
• Over-riding aorta

Question 8

What is tricuspid atresia?

Answer 8

• No right ventricle inlet
• Right to left atrial shunt of entire venous return
• Blood flow to lungs via VSD

Question 9

What is hypoplastic left heart?

Answer 9

• Left ventricle is underdeveloped
• Ascending aorta is very small
• Right ventricle supports systemic circulation
• Obligatory right to left shunt

Question 10

What is transposition of the great arteries?

Answer 10

• Right ventricle is connected to aorta
• Left ventricle is connected to pulmonary artery
• Not viable unless 2 circuits communicate via atrial/ventricular/ducktail shunts

Question 11

What is a univentricular heart?

Answer 11

• One ventricle
• Less control of blood flow to lungs/systemic
• Same pressure to both
• Possible deoxygenated blood to body

Question 12

What is a pulmonary atresia?

Answer 12

• No right ventricle outlet
• Right to left atrial shunt of entire venous return
• Blood flow to lungs via PDA

Question 13

What is the typical history of ASD?

Answer 13

• Asymptomatic late in adulthood
• Late onset arrhythmia
• Right heart failure

Question 14

What is the typical history of VSD?

Answer 14

• Unless is very small, presents in infancy with left heart failure
• Untreated can lead to in-operable pulmonary hypertension

Question 15

What is the typical history of coarctation?

Answer 15

• Neonatal variety: associated with PDA, right to left shunt
• Adult variety: complicated by renal hypertension, left ventricle hypertrophy often associated with aortic valve stenosis

Question 16

What is the typical history of tetralogy of fallot?

Answer 16

• Present in infancy/early childhood with cyanotic spells

- Mild cases are compatible with adulthood

Question 17

What are the typical histories for the following:

• Transposition of great arteries
• Hypoplastic left heart
• Pre-ductile coarctation
• Pulmonary atresia

Answer 17

• Presenting as neonatal emergencies

- Due to restricted blood flow