Congenital Heart Diseases

Question 1

what is the most common congenital heart disease

Answer 1

biscupid aortic valve

Question 2

what can you develop from bicuspid aortic valve

Answer 2

aortic stenosis +- aortic regurg predisposing to IE/SBE +- aortic dilatation/dissection

Question 3

what may accelerate complications in biscuspid aortic valve

Answer 3

intense exercise

Question 4

can bicuspid valves go undetected at birth

Answer 4

yes, can work well at birth

Question 5

what is atrial septal defect

Answer 5

a hole connects the atria

Question 6

what are the most common defects for ASD

Answer 6

ostium secundum- high in the septum

Question 7

what defects are associated with AV abnomalies (ASD)

Answer 7

ostium primum (opposing endocardial cushions- where the atrial and ventricular septi meet, and the mitral and ventricular valves meet)

Question 8

which defect presents early out of ostium primum and secundum

Answer 8

primum presents early, secundum can be asymptomatic until adulthood. L-R shunt depends on compliance R and L ventricles. left ventricle decr with age

Question 9

associated symptoms with ASD

Answer 9

pulm hypertension, cyanosis, arrhythmia, haemoptysis, chest pain

Question 10

signs ASD

Answer 10

incr JVP, AF, split S2, pulm ejection systolic murmur. pulm or tricusp regurg from pulm hypertension.

Question 11

complications ASD

Answer 11

reversal L-R shunt- Eisenmengers complex- pulm hypertension reverses the shunt leading to cyanosis. paradoxical emboli- vein-artery via ASD rare

Question 12

ECG for ASD ostium primum

Answer 12

RBBB with left axis deviaton and prolonged PR interval.

Question 13

how is left axis deviation diagnosed on ECG

Answer 13

+ve on lead I and aVL. -ve on lead II and aVF.

Question 14

how is right axis deviation diagnosed on ECG

Answer 14

+ve on leads III and aVF. -ve on leads I and aVL.

Question 15

ECG for ASD secundum

Answer 15

RBBB with right axis deviation

Question 16

what is the treatment for ASD

Answer 16

in children closure recommended before 10 years old. in adults if symptomatic or if pulm to systemic blood flow ratios >1.5:1. transcatheter closure more common than surgery now

Question 17

which is more common atrial or ventricular septal defect

Answer 17

atrial

Question 18

what is ventricular septal defect

Answer 18

hole connects ventricles

Question 19

causes of VSD

Answer 19

congenital, acquired- post MI

Question 20

symptoms of VSD

Answer 20

severe heart failure in infancy, or asymptomatic and detected incidentally in later life

Question 21

signs of VSD

Answer 21

smaller holes give louder murmurs. harsh pansystolic murmur, systolic thrill +- left parasternal heave. larger holes associated with signs pulmonary hypertension

Question 22

complications VSD

Answer 22

AR, infundibular stenosis, IE/SBE (subacute bacterial endocarditis, pulmonary hypertension, Eisenmengers complex

Question 23

what is the ECG like in small VSD

Answer 23

normal

Question 24

ECG in moderate VSD

Answer 24

LAD + LVH

Question 25

ECG in large VSD

Answer 25

LVH + RVH

Question 26

what is the CXR like in large VSD

Answer 26

cardiomegaly, large pulmonary arteries, marked pulmonary plethora (enlargement of the pulmonary arteries)

Question 27

treatment of VSD

Answer 27

medical at first as may close spontaneously. indications for surgical closure- failed medical therapy, symptomatic VSD, shunt >3:1, SBE/IE. endovascular closure possible

Question 28

what is coarctation of the aorta

Answer 28

congenital narrowing of descending aorta, usually just distal to origin of left subclavian artery.

Question 29

is coarctation of aorta more common in boys or girls

Answer 29

boys

Question 30

associations of aortic coarctation

Answer 30

bicuspid aortic valve, Turners syndrome (in females)

Question 31

signs of aortic coarcation

Answer 31

radiofemoral delay (fem later), weak femoral pulse, incr BP, scapular bruit, systolic murmur

Question 32

complications aortic coarctation

Answer 32

heart failure, infective endocarditis

Question 33

tests for coarctation

Answer 33

CXR shows rib notching

Question 34

treatment of coarctation

Answer 34

surgery, balloon dilatation +- stenting

Question 35

pulmonary stenosis can occur when

Answer 35

alone or with other lesions

Question 36

what is Fallots tetralogy

Answer 36

1. VSD. 2. pulmonary stenosis. 3. RVH. 4. aorta overriding VSD

Question 37

what is the most common cyanotic congenital heart disorder

Answer 37

tetralogy of fallot

Question 38

occasionally there can be a pentad of Fallot what is the additional condition

Answer 38

ASD

Question 39

presentation of Fallots tetralogy children

Answer 39

depends on degree of pulmonary stenosis.when hypoxic toddler may become restless agitated cry. may squat- increases peripheral vascular resistance decreases degree R to L shunt. failure to thrive clubbing

Question 40

presentation fallots adults

Answer 40

often asymptomatic. cyanosis common. late symptoms- dyspnoea, palps, RV failure, syncope, sudden death

Question 41

what does ECG show with fallots

Answer 41

RVH and RBBB

Question 42

what is the classic hallmark of fallots on CXR

Answer 42

classic boot shaped heart

Question 43

management fallots

Answer 43

give O2. child in knee chest position. morphine for sedation, long term B blockers, endocarditis prophylaxis, surgery