CONGENITAL HEART DISEASE
PATHOPHYSIOLOGY
DEFINITION
is a defect in the structure of the heart and great vessels which is present at birth.
INCIDENCE AND ETIOLOGY
About 8/1000 live births. Sexes are equally affected 90% of children born with heart defects now survive to adulthood. Maternal infection (Rubella) associated with PDA , Pulmonary valve/artery stenosis , ASD. Maternal exposure to drugs and toxins (alcohol) associated with septal defects
CLASSIFICATION
1. Non-cyanotic / Acyanotic
(Left To Right Shunt)
all Ds in their names Ventricular septal defect (VSD) Atrial septal defect (ASD) Patent ductus arteriosus (PDA) Aortic stenosis Pulmonic stenosis Coarctation of aorta Atrioventricular canal (endocardial cushion defect)
2. CYANOTIC (blue discoloration caused by a
relative lack of oxygen) right to left shunt all Ts in their names Tetralogy of Fallot
Tricuspid atresia
Transposition of great vessels Truncus arteriosus Ebstein anomaly Pulmonary atresia
NONCYANOTIC /ACYANOTIC
Ventricular Septic Defect
A ventricular septal defect (VSD) is a hole in the wall (septum) that separates the hearts two lower chambers (ventricles).
Causes: A VSD may be associated with the following conditions:
fetal alcohol syndrome Down syndrome and other autosomal trisomies renal anomalies patent ductus arteriosus and coarctation of the aorta prematurity.
Signs and Symptoms:
Shortness of breath Fast breathing Hard breathing Paleness Failure to gain weight Fast heart rate Sweating while feeding Frequent respiratory infection
Pathophysiology
the ventricular septum fails to close completely by the eighth week of gestation pulmonary vasculature gradually relaxes, between 4 and 8 weeks after birth right ventricular pressure decreases,allowing blood to shunt from the left to the right ventricle
large VSD shunts cause left atrial and left ventricular hypertrophy
biventricular heart failure and cyanosis (from reversal of the shunt direction) occur
Fixed pulmonaryhypertension may occur much later in life with right-to-left shunting (Eisenmenger's syndrome),
causing cyanosis andclubbing of the nail beds.
Diagnostic Exam:
Chest X-ray ECG Echocardiogram Cardiac catheterization Pulse oximetry
Treatment :
Surgical repair. Catheter procedure Hybrid procedure
ATRIAL SEPTAL DEFECT
an opening between
the left and right atria
allows the blood to
flow from left to right, resulting in ineffective pumping of the heart, thus increasing the
risk of heart failure
Causes: UNKNOWN Signs and symptoms:
Heart murmur, a whooshing sound that can be heard through a stethoscope Shortness of breath, especially when exercising Fatigue Swelling of legs, feet or abdomen Heart palpitations or skipped beats Frequent lung infections Stroke Bluish skin color
Pathophysiology
Result to right heart volume overload
Left Atrium
Right Atrium
Right Atrium enlarges
In adults , irreversible pulmonary artery hpn
Cyanosis
Diagnostic Exam
Electrocardiogram Cardiac catheterization Coronary angiography Doppler study of heart ECG Heart MRI Transesophageal echocardiography (TEE)
Patent Ductus Arteriosus (PDA)
is a congenital heart defect in which the ductus arteriosus, a vascular structure between the pulmonary artery and the aorta that normally closes shortly after birth, remains open.
Patent ductus arteriosus (PDA) is an uncommon clinical finding in adult primary care patients.
Symptoms:
shortness of breath heart palpitations. high risk for bacterial endocarditis, an infection of the lining of the heart, valves, or arteries; an enlarged heart (cardiomyopathy); pulmonary hypertension (high blood pressure in the lungs); congestive heart failure; and death.
Diagnostic Exam in Adults:
Echocardiogram electrocardiogram (ECG) Pulse oximetry
Treatment :
Closure of the defect is generally recommended An open surgical procedure Video-assisted thoracic surgical (VATS) repair Transcatheter occlusion
Aortic Stenosis
is a disease of the heart valves in which the opening of the aortic valve is narrowed The aortic valve is the valve between the left ventricle of the heart and the aorta, which is the largest artery in the body and carries the entire output of blood
Signs and Symptoms: Angina Syncope
