Ventricular Septal Defect Flashcards
(20 cards)
Ventricular Septal Defect presentation
This patient has developed sudden shortness of breath.
Examine his heart.
Clinical signs of Ventricular septal defect
- Thrill at the lower left sternal edge
- Auscultation:
- -> Systolic murmur well localized at the left sternal edge with no radiation.
- -> No Audible A2.
- -> Loudness does not correlate with size (Maladie de Roger: loud murmur due to high-flow velocity through a small VSD).
- -> If Eisenmenger’s develops the murmur often disappears as the gradient diminishes. - Other associated lesions: AR, PDA (10%), Fallot’s tetralogy and coarctation
- Pulmonary hypertension: loud P2 and RV heave + cyanosis and clubbing (Eisenmenger’s)
- Endocarditis
Auscultation in VSD
- Systolic murmur well localized at the left sternal edge with no radiation.
- No Audible A2.
- Loudness does not correlate with size (Maladie de Roger: loud murmur due to high-ow velocity through a small VSD).
- If Eisenmenger’s develops the murmur often disappears as the gradient diminishes.
Causes of VSD
- Congenital
2. Acquired (traumatic, post‐operative or post‐MI)
Investigation for VSD
- ECG: conduction defect: BBB
- CXR: pulmonary plethora
- TTE/TOE: site, size, shunt calculation and associated lesions
- Cardiac catheterization: consideration of closure
Management of VSD
Surgical (pericardial patch) or percutaneous (Amplatzer® device) closure of haemodynamically significant defects.
Associations with VSD
- Fallot’s tetralogy
- Coarctation
- Patent ductus arteriosus (PDA)
Fallot’s tetralogy
- Right ventricular hypertrophy
- Overriding aorta
- VSD
- Pulmonary stenosis
Blalock–Taussig (BT) shunts
- Partially corrects the Fallot’s abnormality by anastomosing the subclavian artery to the pulmonary artery
- Absent radial pulse and scar
causes of an absent radial pulse
• Acute: ETA
- Embolism,
- Trauma, e.g. radial artery sheath
- Aortic dissection,
• Chronic: ABCT
- Atherosclerosis,
- Blalock-Taussig (BT) Shunts
- Coarctation,
- Takayasu’s arteritis (‘pulseless disease’),
Coarctation of Aorta
A congenital narrowing of the aortic arch that is usually distal to the left subclavian artery.
Clinical signs of Coarctation of Aorta
- Hypertension in right ± left arm (coarctation usually occurs between left common carotid and left subclavian arteries)
- Prominent upper body pulses, absent/weak femoral pulses, radiofemoral delay
- Heaving pressure loaded apex
- Auscultation:
- -> continuous murmur from the coarctation and collaterals radiating through to the back.
- -> There is a loud A2.
- -> There may be murmurs from associated lesions
Auscultation in Coarctation of Aorta
- continuous murmur from the coarctation and collaterals radiating through to the back.
- There is a loud A2.
- There may be murmurs from associated lesions
Associations of Coarctation of Aorta
- Cardiac: VSD, bicuspid aortic valve and PDA
2. Non‐cardiac: Turner’s syndrome and Berry aneurysms
Investigation of Coarctation of Aorta
- ECG: LVH and RBBB
2. CXR: rib notching, double aortic knuckle (post stenotic dilatation)
Management of Coarctation of Aorta
- Percutaneous: endovascular aortic repair (EVAR)
- Surgical: Dacron patch aortoplasty
- Long‐term anti‐hypertensive therapy
- Long‐term follow‐up/surveillance with MRA: late aneurysms and recoarctation
Patent ductus arteriosus (PDA)
Continuity between the aorta and pulmonary trunk with left to right shunt
Risk factor: rubella
Clinical signs Patent ductus arteriosus (PDA)
- . Collapsing pulse
- Thrill second left inter‐space
- Thrusting apex beat
- Auscultation: loud continuous ‘machinery murmur’ loudest below the left clavicle in systole
Complications of Patent ductus arteriosus (PDA)
- Eisenmenger’s syndrome (5%)
2. Endocarditis
Management of Patent ductus arteriosus (PDA)
Closed surgically or percutaneously
