Congenital Heart

Diseases
{ Acyanotic
Differential Diagnosis:
o Ventricular Septal Defect
o Atrial Septal Defect
o Patent Ductus Arteriosis
o Aortic stenosis
o Pulmnoary stenosis
o Coaraction of aorta
VENTRICULAR SEPTAL DEFECT
VSDs are the most commonly occurring type of congenital acyanotic heart
disease

DEFECT- in the septum that divides the 2 lower chambers of the heart,
resulting in communication between the ventricular
cavities.

CLASSIFICATION-
2 types- Muscular and Membranous
SYMPTOMS-
Small VSD: Asyptomatic mostly
Large VSD: Heart Failure, breathlessness, failure to thrive (failure to gain
weight and poor growth) and Recurrent chest infections

CLINICAL FINDINGS-
Pansystolic murmur heard best at the lower left sternal border
S1 is masked by the murmur
S3 can be heard
VENTRICULAR SEPTAL DEFECT
CHEST XRAY-
Cardiomegaly
En;arged Pulmonary arteries
Enhanced vascular markings

ECG FINDINGS-
Biventricular hypertrophy and signs of pulmonary hypertension, right
ventricular hypertrophy
ATRIAL SEPTAL DEFECT
ASD_ third most common heart disease
DEFECT- Due to failure of septal growth or excessive reabsorption of tissue.

CLASSIFICATION-
Secundum ASD
Primum ASD
Sinus venosus defect

SYMPTOMS-
Mostly aymptomatic, breathlessness, tiredness on exertion, Recurrent
chest infections/wheeze, fatigue, sweating, palpitations, Heart failure,
Arrhythmias
CLINICAL FINDINGS-
A fixed and widely split 2nd heart sound -An ejection systolic murmur heard at
upper left sternal edge
S1 normal
ATRIAL SEPTAL DEFECT
CHEST XRAY-
Usually normal
Cardiomegaly
Enlarged pulmonary arteries
Increased pulmonary vascular markings

ECG FINDINGS-
Right bundle branch block
Right axis deviation
PATENT DUCTUS ARTERIOSIS
DEFECT-
The ductus arteriosus allows blood to flow from the pulmonary artery to the
aorta during fetal life. This changes to the opposite after birth, it normally
closes shortly after birth. Failure of the normal closure of it by a month post
term is due to a defect in the constrictor mechanism of the duct.

SYMPTOMS-
Shortness of breath
Congested breathing
Poor feeding and weight gain
Sweating
Tachypnea
Bounding pulse

CLINICAL FINDINGS-
Continuous machinery murmur beneath the left clavicle
Widened pulse pressure
collapsing or bounding pulse 
PATENT DUCTUS ARTERIOSIS
CHEST XRAY-
Usually normal 

ECG FINDINGS-- Usually normal unless the PDA is large and symptomatic
{ AORTIC STENOSIS
{ PULMONARY STENOSIS
DEFECT
 DEFECT 

 narrowing of the orifice

 Deformed cusps, opens
incompletely during
between the left ventricle
systole, obstruction to right
&the aorta, congenital ventricular outflow,
malformation increased systemic
pressure and stress leading
to right ventricular
hypertrophy
 Right to left shunt via
foramen ovale

AORTIC STENOSIS VS.

PULMONARY STENOSIS
{ {
AORTIC STENOSIS PULMONARY STENOSIS

 SYMPTOMS  SYMPTOMS
 Many pts are  Hepatomegaly, peripheral
asymptomatic Exertional edema,
dyspnea, dizziness,
fainting, angina pectoris,
low pulse pressure

AORTIC STENOSIS VS.

PULMONARY STENOSIS
{ {
AORTIC STENOSIS
 CLINICAL FINDINGS
 Single second heart sound
 ESM at right upper sternal
border radiating to apex
and carotids
 Carotid thrill on palpation
AORTIC STENOSIS VS.
PULMONARY STENOSIS
PULMONARY STENOSIS
 CLINICAL FINDINGS
 Pulmonary ejection click
after S1 in left upper sternal
border and normal S2,
relatively short low to
medium pitched SEM over
pulmonic area radiating to
both lung fields
{ {
AORTIC STENOSIS PULMONARY STENOSIS

 CHEST XRAY  CHEST XRAY

 Prominent Ascending  Poststentoic dilation of
aorta, may have valve pulmonary artery, normal
calcification. to increased heart size and
decreased pulmonary
vascularity.

AORTIC STENOSIS VS.

PULMONARY STENOSIS
{ {
AORTIC STENOSIS PULMONARY STENOSIS

 ECG FINDINGS  ECG FINDINGS

 ECG left ventricular  right ventricular
hypertrophy and strain hypertrophy, tall spiked T
waves , right atrial
enlargement

AORTIC STENOSIS VS.

PULMONARY STENOSIS
COARCTATION OF AORTA
DEFECT-
During development of the aortic arch, the area near the insertion of the
ductus arteriosus fails to develop correctly, resulting in a narrowing of the
aortic lumen.

SYMPTOMS-
Timing of presentation depends primarily on the severity of obstruction
and associated cardiac defects.
Shock, Congestive heart failure, Leg discomfort with exercise, Headache,
Epistaxis.

CLINICAL FINDINGS-
The femoral pulses are weaker and delayed compared with the radial
pulses.
The blood pressure in the lower extremities is lower than that in the upper
extremities
The murmur of coarctation is typically best heard in the left interscapular
area of the back.
COARCTATION OF AORTA
CHEST XRAY-
Often normal, though cardiomegaly and increased vascular markings may
be present in children with heart failure
posteroanterior radiograph a “figure three” sign is seen

ECG FINDINGS-
Left ventricular hypertrophy