L4: Acyanotic Heart Diseases - VSD

Question 1

Types of Acyanotic Congenital Heart Diseases

Answer 1

Question 2

Incidence of VSD

Answer 2

Accounts for 25 - 30% of congenital heart diseases

Question 3

Anatomy of Ventricular Septum

Answer 3

Question 4

Types of VSD

Answer 4

Question 4

Types of VSD

• Most Common Type

Answer 4

Peri-membranous (or membranous)

Question 5

Physiologic Consequences of VSD

Question 6

Physiologic Consequences of VSD

• Size of VSD

Answer 6

Question 7

Physiologic Consequences of VSD

• Difference between SVR & PVR

Answer 7

Question 8

Large VSD

Answer 8

Question 9

Clinical Course of VSD

Answer 9

Question 10

Clinical Course of VSD

• Small VSD

Answer 10

Patients with small VSDs rarely have symptoms related to the defect

Question 11

Clinical Course of VSD

• Large VSD

Answer 11

Question 12

As pulmonary vascular disease gradually develops ……

Answer 12

symptoms of Left to Right shunt

Question 13

Symptoms of Small VSD

Answer 13

Asymptomatic
- The murmur is usually found during a routine physical examination

Question 14

Signs of Small VSD

Answer 14

Question 15

Signs of Small VSD

• Heart Sounds
• Thrill
• Murmur

Answer 15

Question 16

Signs of Small VSD

• Site of Murmur

Answer 16

Left parasternal area (LLSB)

Question 17

Signs of Small VSD

• Characters of Murmur

Answer 17

Loud, harsh, or blowing

Question 18

Signs of Small VSD

• Radiation of Murmur

Answer 18

No area of selective propagation
- May be propagated all over the precordium

Question 19

Signs of Small VSD

• Timing of Murmur

Answer 19

Pansystolic

Question 20

CP of Moderate VSD

Answer 20

As small VSD plus:

• Apical mid diastolic murmur (Relative Mitral Stenosis)
• P2 —–> Slightly accentuated

Question 21

Symptoms of Large VSD

Answer 21

Question 22

Signs of Large VSD

Answer 22

Question 23

Signs of Large VSD

• General

Answer 23

In cases of Eisenmenger syndrome —–> Cyanosis, clubbing

Question 24

Signs of **Large VSD** - Insperction & Palpation (Precordial Bulge)

Answer 24

(Prominence of the left precordium is common)

Question 25

Signs of **Large VSD** - Pericordial Activity

Answer 25

(Volume overload)

Question 26

Signs of **Large VSD** - Apex

Answer 26

Question 27

Signs of **Large VSD** - Pulsation

Answer 27

Left parasternal pulsation

Question 28

Signs of **Large VSD** - Thrill

Answer 28

Systolic

Question 29

Signs of **Large VSD** - Heart Sounds

Answer 29

Accentuated P, with narrow splitting "pulmonary hypertension"

Question 30

Signs of **Large VSD** - Murmur

Answer 30

- Less harsh & more blowing (as no significant pressure gradient). - Murmur of relative Mitral stenosis

Question 31

Why isolated large VSD is not a cause of heart failure in neonates?

Answer 31

- As the normal postnatal delay in fall of pulmonary vascular resistance limits the magnitude of Lt ----> Rt shunt in the neonatal period - Delayed the occurrence of symptoms of heart failure till the 4 - 6 weeks after birth

Question 32

Investigations for **VSD**

Answer 32

Question 33

Investigations for **VSD** - Chest X-Ray

Answer 33

Question 34

Investigations for **VSD** - ECG

Answer 34

Question 35

Investigations for **VSD** - ECHO

Answer 35

Question 36

Investigations for **VSD** - Cardiac Catheterization

Answer 36

Question 37

TTT of **VSD**

Answer 37

Question 38

TTT of **VSD** - Small & Moderate

Answer 38

Question 39

TTT of **VSD** - Catheter

Answer 39

Question 40

TTT of **VSD** - Catheter (Medical)

Answer 40

Question 41

TTT of **VSD** - Catheter (Surgical)

Answer 41

Question 42

Prophylaxis against **IE** in **Small VSD & Large secundum ASD**

Answer 42

Question 43

Natural History of **VSD**

Answer 43

Question 44

Natural History of **VSD** - Spontaneous Closure

Answer 44

Question 45

Natural History of **VSD** - Pulmonary vascular obstructive disease

Answer 45

Question 46

Natural History of **VSD** - Development of Aortic Incompetence

Answer 46

Question 47

Natural History of **VSD** - Infective Endocarditis

Answer 47

Question 48

Natural History of **VSD** - Development of infundibular pulmonary stenosis

Answer 48

Question 49

Natural History of **VSD** - Premature death

Answer 49