Congenital heart disease

Bicuspid aortic valve

• Function well at birth and go undetected
• Eventually develop AS and or AR

Atrial septal defect

• Ostium secundum defects are the most common
• Ostium primum defects are associated with AV valve anomalies
• Secundum ASDs may not present until adulthood
• Left to right shunting may precipitate heart failure
• There may be pulmonary hypertension, cyanosis, arrhythmia, haemoptysis and chest pain
• Signs;
  • AF
  • Raised JVP
  • Fixed split S2
  • Pulmonary ejection systolic murmur
  • Pulmonary hypertension may cause pulmonary or tricuspid regurgitation
• Complications
  • Reversal of the left to right shunt (Eisenmenger’s complex)
  • Paradoxical embolisation

VSD

• Can be congenital (2 in 1000 births) or post-MI
• May present with severe heart failure in infancy or remain asymptomatic until detected in later life
• Signs
  • Harsh pansystolic murmur heard over the left sternal edge with a systolic thrill and left parasternal heave
  • Larger holes may be associated with pulmonary hypertension

Coartation of the aorta

• Congenital narrowing of the aorta usually occurring just distal to the origin of the left subclavian artery
• Associated with biscuspid aortic valve and Turner’s syndrome
• Signs
  • Radio-femoral delay, weak femoral pulse, raised BP, scapular bruit, systolic murmur best heard over left scapula
• Complications
  • Heart failure
  • Infective endocarditis
• Tests
  • ECG shows rib notching