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Understanding Congenital Heart Disease
Dec 2, 2024
Congenital Heart Disease Lecture Notes
Overview
Congenital heart disease: group of conditions present at birth with structural heart abnormalities.
Most common birth defects.
Three main types:
Left to Right Shunting (Acyanotic):
Blood moves from left to right side of heart, does not usually cause cyanosis.
Right to Left Shunting (Cyanotic):
Deoxygenated blood moves to the left side, causes cyanosis.
Obstructive Defects:
Restrictions in blood flow pathways.
Heart Circulation Basics
Normal blood flow: Right atrium → Right ventricle → Pulmonary artery → Lungs → Pulmonary veins → Left atrium → Left ventricle → Aorta.
Pressure dynamics: Higher on left vs. right side.
Left to Right Shunting
Ventricular Septal Defect (VSD)
Most common congenital heart defect (20%).
Different types based on location: Outlet, Inlet, Perimembranous, Muscular.
Small VSDs often asymptomatic; larger can cause pulmonary hypertension, Eisenmenger syndrome.
Diagnosed with echocardiography.
Treatment can range from observation to surgical closure.
Atrial Septal Defect (ASD)
10% of congenital heart defects, more common in females.
Types: Sinus venosus, Ostium primum, Ostium secundum, Unroofed coronary sinus.
Small ASDs asymptomatic until adulthood.
Can cause atrial arrhythmias, heart failure.
Patent Ductus Arteriosus (PDA)
Connection between aorta and pulmonary artery remains open post-birth.
More common in premature infants.
Causes pulmonary hypertension, right heart strain.
Treatment: NSAIDs or surgery.
Right to Left Shunting (Cyanotic)
Tetralogy of Fallot
Includes four defects: VSD, Pulmonary stenosis, Right ventricular hypertrophy, Overriding aorta.
Symptoms: Cyanosis, poor growth, "Tet spells" (agitation and cyanosis).
Definitive treatment is surgical.
Transposition of the Great Arteries
Aorta and pulmonary artery are swapped.
Requires immediate intervention; prostaglandins and surgery.
Epstein's Anomaly
Malformed tricuspid valve, can lead to right to left shunting.
Symptoms vary widely.
Associated with lithium use during pregnancy.
Treatment often requires surgery.
Obstructive Defects
Aortic Coarctation
Narrowing of the aorta, usually near the ductus arteriosus.
Often associated with bicuspid aortic valve and Turner syndrome.
Treatment options include surgery or balloon dilation.
Additional Notes
Certain defects can allow emboli to cross from venous to arterial system (risk of stroke).
Diagnostics: Echocardiography is the gold standard, supplemented by CT/MRI as needed.
Management includes medical therapy, catheter interventions, and surgical repair.
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