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Ventricular septal defects (VSDs) (Complications (Eisenmenger's…
Ventricular septal
defects (VSDs)
Definition
Congenital structural disorder
of the heart with connection
between the L and R ventricles
Epidemiology
Account for 30% congenital
heart disease
Pathophysiology
Defect
Hole anywhere in AV septum
Mechanism
L-R shunt due to higher pressure of LV
Mixing of ox and deox blood
Causes increased pulmonary vascular pressure,
increasing pulmonary resistance over time and
risk of reversal of shunt to R-L (Eisenmenger's)
Types
Small: <3mm (smaller than aortic valve) - commonest Large: >3mm (bigger than aortic valve)
Aetiology
Congenital
Vascular
Post-MI
Clinical
presentation
Asymptomatic
(small VSDs)
Breathlessness
(large VSDs)
Recurrent chest infections
large VSDs)
Diagnosis
Examination
Cardio
Tachypnoea, tachycardia, signs of HF, thrill (all large VSD)
Murmur: pansystolic at LLSE (loud=small VSD; soft=large VSD)
may have apical middiastolic (large VSD)
Quiet P2 (small VSD), loud P2 (large VSD)
Investigations
Bloods
FBC, U+E, LFTs
Imaging
CXR: normal (small VSD); cardiomegaly,
enlarged pulm arteries, pulm vasc markings,
pulmonary oedema (large VSD)
ECHO Doppler: anatomy and function of defect
Bedside
Obs (sats, RR, HR, BP, temp)
ECG: normal in small VSD; biventricular hypertrophy if large
History
FH
Heart defects
DH
Current meds, allergies
PMH
Development and milestions
Vaccinations
Known medical conditions
POH
Antenatal: growth, bloods, complications
Perinatal: gestation, delivery, weight, complications
Postnatal: complications
PC/HPC
Asymptomatic, breathless, chest infections
SH
Living arrangements
Management
Conservative
Information, advice, support
Dental hygiene (reduce IE risk)
Watchful waiting (small VSDs; murmur dissapears, normal ECHO)
Surgical
Surgical correction
Indication: large defects by 3-6m; symptomatic
MOA: central sternotomy and correction
or endovascular closure
Medical
Diuretics
Indication: HF and <3-6m
E.g. furosemide
ACEi
Indication: HF <3-6m
E.g. captopril
Complications
Eisenmenger's syndrome
Large VSD only
Heart failure
Large VSD only
Pulmonary HTN
Large VSD only
Paradoxical emboli
DVT to LV then stroke
Infective endocarditis
Valve disorders
Mainly AR
Prognosis
Small VSDs often close
by themselves over time