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CR - Congenital heart disease (Left-Right shunts (VSD (incomplete closure…
CR - Congenital heart disease
intro
most arise from faulty embryogenesis during wk 3-8 gestation (when major CV structures form)
main known causes are sporadic genetic abnormalities
3 main categories
Left-Right shunts
abnormal communication allowing flow of blood from left (systemic) to right (pul) side
increased pul blood flow, not associated initially with cyanosis
eventually increased flow vols + pressures, RVH + pul vasc prolif -> pul vasc resistance
shunt reversal - EISENMENGER'S SYNDROME
ASD
may not be detected until adulthood
abnormal fixed opening in atrial septum
allows communication of blood in left + right atria
generally well-tolerated - irreversible pul hypertension unusual
may be a source of systemic emboli
VSD
incomplete closure of ventricular septum
commonest form of congenital cardiac anomaly
only 20-30% of cases isolated (most associated with other congenital cardiac anomalies)
consequences depend of size of defect + associated anomalies
most involve membranous part of septum
irreversible pul vasc disease develops in all
large uncorrected defects will result in shunt reversal
Patent ductus arteriosus
in foetal circulation the ductus arteriosus shunts blood from pul art to aorta, bypassing the lungs
continuous harsh murmur
if isolated generally closes in infancy
Right-Left Shunt
cyanotic congenital heart disease
cyanosis + hypoxaemia due to mixture of poorly oxygenated venous blood with arterial blood
compensatory polycythaemia
paradoxical embolism
obstruction
e.g. coarctation of aorta
narrowing
causes hypertension + LVH (heart must work harder to pump blood through construction)