This or That - Conjenital Heart Defects

Question 1

Most common congenital anatomical defect

Heart or Bowel

Answer 1

Heart

0.8%

Question 2

Bigger association

Maternal DM or Maternal Rubella Infection

Answer 2

Rubella

Rubella - 30-35%
DM - 2%
SLE - 35%

Question 3

Complete heart block

SLE or Foetal Alcohol

Answer 3

SLE

anti-Ro and anti-La

Question 4

Innocent Murmur hallmarks

Heard at apex or left sternal edge

Answer 4

Left sternal edge

Hallmarks: (4Ss)

• aSymptomatic
• Soft blowing murmur
• Systolic
• left Sternal edge

Also:

Normal heart sounds with no added sounds, no heaves or thrills, no radiation.

Heard on anaemia or febrile illness due to increased blood flow

Question 5

1 week old baby presents with breathlessness, poor feeding and failure to thrive. Has a gallop rhythm.

Left to right shunt or outflow obstruction

Answer 5

Outflow obstruction

Left to right shunt will more likely show itself in infancy

Question 6

ECG shows partial RBBB. ESM in upper left sternal edge, split S2. Pt asymptomatic

ASD or VSD

Answer 6

ASD

Secundum ASD (80% of ASDs)

Mx: Catheter device closure at 2-5 years

Question 7

Large pansystolic murmur at lower left sternal edge, Pt asymptomatic

Small VSD or Large VSD

Answer 7

Small VSD

Large VSD would present with HF after 1 week as defect is bigger than aortic valve. As defect is large, murmur will be soft or not there at all.

Small VSD will resolve spontaneously by itself

Large VSD - treat the HF (diuretics, captopril, calories) then have surgery at 3-6 months

Question 8

Continuous murmur at upper left sternal edge, pulse is bounding. Pt is asymptomatic

PDA or ASD

Answer 8

PDA

Murmur is continuous instead of ESM.

For PDA, surgery at 1 year

Question 9

Cyanotic infant. Hyperoxia test shows O2 remains low.

Right to left shunt OR Lung Disease

Answer 9

Right to left shunt

If PaO2 >20, it is not a heart problem. Must use blood gas as O2 sats are not accurate at this point.

Question 10

Cyanosis, ESM at lower left sternal edge

VSD or Tetralogy of Fallot

Answer 10

Tetralogy of Fallot

Signs: Clubbing, harsh ESM at left sternal edge
CXR: small heart, boot shaped
ECG: RVH when older

Mx

Neonate: Shunt with artificial tube between subclavian and pulmonary artery - increase pulmonary blood flow

Surgery at 6 months
- Close VSD and relieve right ventricular outflow obstruction

Until then, manage symptoms medically

Cyanotic episodes:

• Usually self limiting but require treatment if last longer than 15 minutes
• Analgesia (morphine)
• IV Propanolol - vasoconstrictor and relieves obstruction at pulmonary artery
• Fluids
• Bicarb for acidosis - poor CO2 clearance
• Oxygen

Question 11

Normal birth and no complications on 1st day of life. 2nd day, sudden onset of cyanosis. No murmurs or added sounds.

Tetralogy or Transposition of Great Arteries

Answer 11

Transposition of Great Arteries

as PDA closes, there is no longer any mixing, leading to the sudden onset cyanosis.

CXR: Egg on side appearance - heart appears globular due to right atrial hypertrophy

Mx

• Immediately, give prostaglandin infusion - reopen PDA
• Balloon atrial septostomy - create an ASD
• Definitive: Arterial Switch Procedure