Congenital Heart Disease

Question 1

List 3 Acyanotic Cardiac Lesions.

Answer 1

• Ventricular Septal Defects (VSD)
• Atrial septal defects (ASD)
• Patent ductus arteriosus (PDA)

Question 2

List 2 features of acyanotic cardiac lesions.

Answer 2

1. Left to right shunting
   (mixing of oxygenated blood with deoxygenated blood)
2. Increased pulmonary blood flow
   (risk of pulmonary hypertension. Untreated acyanotic heart disease can lead to Eisenmenger syndrome)

Question 3

Which type of murmur is heard in acyanotic cardiac disease if the lesion is above the level of the nipple?

Answer 3

Ejection systolic murmur.

Question 4

Which type of murmur is heard in acyanotic cardiac disease if the lesion is below the level of the nipple?

Answer 4

Pan-systolic murmurs.

Question 5

What syndrome can untreated acyanotic heart disease lead to?

Answer 5

Eisenmenger Syndrome

Question 6

A child has a small ventricular septal defect. What symptoms might they have?

Answer 6

• May be asymptomatic

- Normal growth.

Question 7

A child has a moderate ventricular septal defect. What symptoms might they have?

Answer 7

• Poor feeding
• Failure to thrive
• Short of Breath

Question 8

A child has a large ventricular septal defect. What symptoms might they have?

Answer 8

• Poor feeding
• Failure to thrive (falls below centiles)
• SOB
• Sweaty and pale with feeds

Question 9

Describe the Epidemiology of Ventricular Septal Defects.

Answer 9

• Most common congenital heart lesion (15-20%)

- Associated with Down’s syndrome

Question 10

A child has a ventricular septal defect. When are they likely to present?

Answer 10

• Antenatal diagnosis at 16 - 18 weeks

- Presentation at 6 - 8 weeks

Question 11

A child has congestive heart failure as a result of a congenital ventricular septal defect. When is this likely to present?

Answer 11

Typically presents after 4 - 6 weeks.

Question 12

A child has a ventricular septal defect that is not identified or treated. What condition might this lead to and when will the condition establish itself?

Answer 12

• Persistent pulmonary hypertension of the newborn (PPHN)

- May become established by 6 - 12 months

Question 13

How would you manage a small ventricular septal defect?

Answer 13

If less than 5mm, defect may close spontaneously, with no repair required.

Question 14

How would you manage a moderate ventricular septal defect?

Answer 14

• Diuretic therapy (Furosemide + Spironolactone)

- Feeding with high caloric feeds (Infantrini)

Question 15

How would you manage a large ventricular septal defect/

Answer 15

• Diuretic + Feeding with high caloric feeds
• Optimise weight gain for surgery
• Schedule surgery before 12 months to prevent PPHN (Persistent Pulmonary Hypertension of the Newborn).

Question 16

Describe the symptoms seen in a child with an Atrial Septal Defect

Answer 16

• Typically asymptomatic

- Some children will have recurrent chest infections.

Question 17

Describe the epidemiology of ASD (Atrial Septal Defect).

Answer 17

• Second most common acyanotic heart lesion (5-10%).

Question 18

At what age would a child present with an atrial septal defect?

Answer 18

Mean age of diagnosis is 4.5s from an incidental finding of murmur.

Question 19

When would a symptomatic person present with an Atrial Septal Defect?

Answer 19

Symptomatic presentation is usually before age of 40yrs with arrhythmias and dyspnoea

Question 20

Describe the clinical features seen in Atrial Septal Defects.

Answer 20

• May have no auscultatory findings in infants (asymptomatic).

Question 21

What might you hear on auscultation of a Atrial Septal Defect?

Answer 21

• Ejection systolic murmur heard loudest at the upper-left sternal border