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Atrioventricular septal defect (AVSD) (Diagnosis (History (PMH Growth…
Atrioventricular
septal defect (AVSD)
Definition
Congenital structural heart
disorder with connections
between atria and ventricles
Epidemiology
Common in Down's syndrome
Pathophysiology
Defect
Single five leaflet valve between atria and ventricles
across entire AV junction, tends to be leaky
Defect in the middle of the heart
Mechanism
Mixing of blood, L-R shunt
Increased pulmonary pressure causes pulmonary HTN
Clinical
presentation
Cyanosis
Breathlessness
Diagnosis
Examination
Cardio
Cyanosis (birth)
Signs of HF (neonate)
Investigations
Bloods
Cap blood gas, FBC, U+E, LFT
Imaging
CXR: nil
ECHO: diagnostic
Bedside
Obs (sats, RR, HR, BP, temp)
ECG: nil
History
PMH
Growth and development
Known conditions
DH
Meds, allergies
POH
Antenatal: maternal age, scans, bloods, growth, complications
Perinatal: gestation, delivery, weight, complications
Postnatal: complications
FH
Down syndrome, heart defects
Cosanguinuity
PC/HPC
Cyanotic and breathless
SH
Living arrangements
Management
Medical
Diuretics
Indication: HF
E.g. furosemide
ACEi
Indication: HF
E.g. captopril
Surgical
Surgical repair
Indication: 3-6m
MOA: repair of defect
Conservative
Information, advice, support
Referral to cardio/paeds ASAP
Complications
Pulmonary HTN
Eisenmenger's syndrome
Heart failure
Screening
Antenatal screening programme
Foetal anomaly scan
Neonatal examination
Routine ECHOs in baby with Down's syndrome