1. Clinical Approach to Congenital
Heart Disease
Ahmad Hariz
071303074
Group D2

2. Epidemiology
• 8/1000 live born children have significant
cardiac malformations
• 1 in 10 stillborn infants have a cardiac
anomalies

3. Acyanotic Heart Disease
• Defined as:
– A congenital disorder manifested with left to right
shunting and obstructive lesions.
– Clinical signs are not always apparent at
birth, they manifest anytime during infancy or
early childhood.

4. • Incidence & classification
– Left to right shunt
• Ventricular septal defect – 30%
• Patent Ductus Arteriosus – 12%
• Atrial Septal Defect – 7%

5. – Outflow obstruction
• Pulmonary stenosis – 7%
• Aortic stenosis – 5%
• Coarctation of aorta – 5%

6. Ventricular septal defect
Incidence and Pathophysiology:
●VSDs account for approximately 25% of all CHDs.
●VSD is the most common congenital cardiac lesion
and is often accompanied by other cardiac
defects.
●The lesion consists of an abnormal opening
between the right and left ventricles which may
vary in size from a miniscule hole to complete
absence of the septum, resulting in a common
ventricle.

7. Ventricular septal defect

8. Ventricular septal defect
 Manifestations:
●Signs and symptoms vary with the size of the
defect and the presence of associated cardiac
lesions. Clinical symptoms are usually not seen at
birth because of continued high pulmonary
vascular resistance in the newborn. Infants with
moderate to large defects will become
symptomatic within the first few weeks of life.
●Children with small defects will remain
asymptomatic.

9. Ventricular septal defect
• Clinical manifestations
– Tachypnea, dyspnea
– Poor growth
– Palpable thrills
– Systolic murmur at left lower sternal border
– Shortness of breath
– Failure to gain weight
– Fast heart rate
– Pounding heart
– Frequent respiratory infections

10. Ventricular septal defect
• Complications
– Congestive heart failure.
– Growth failure, especially in infancy.
– Bacterial endocarditis
– Irregular heartbeat or rhythm
– Pulmonary artery hypertension

11. Patent ductus arteriosus
• Pathophysiology
– It is normally closed shortly after birth in term
infant
– In PDA, it failed to close by a month post
term, due to defect in the constriction mechanism
– The flow of blood is from aorta to pulmonary
artery

12. Patent ductus arteriosus

13. Patent ductus arteriosus
• Clinical features
– Symptoms depends on amount of extra blood
flow to lungs
– Usually asymptomatic in small PDA
– CHF symptoms in moderate to large shunt
– On physical examination:
• Widened pulse pressure
• Collapsing/ bounding pulse

14. Patent ductus arteriosus
• Differential cyanosis (cyanosis of lower limb but upper
limb pink)
– Upper limb supplied by brachiocephalic trunk and left
subclavian artery (before PDA junction)
• Left infraclvicular/upper left sternal edge continous
murmur

15. Atrial septal defect
Incidence and Pathophysiology:
● ASD accounts for approximately 10% of all CHDs. It is seen more
frequently in females than males.
● The lesion consists of an abnormal opening between the atria
Types of Lesions:
1. Ostium Secundum – located at the middle of the atrial septum
(fossa ovalis), the most common type.
2. Ostium Primum – located low in the atrial septum, results from a
defect in endocardial tissue formation and is often associated with a
left mitral valve malformation.
3. Sinus Venosus – which is located high in the septum close to the SVC

16. Atrial septal defect

17. Atrial septal defect
Manifestations:
Most infants and children are asymptomatic but over
years to decades may experience:
1. Fatigue and SOB
2. Palpitations or atrial dysrhythmias – result of atrial
enlargement
3. Recurrent respiratory infections can occur when there
is a large amount of pulmonary blood flow
4. Systolic murmur is produced by increased blood flow
across the pulmonary valve.

18. Atrial septal defect
5. Diastolic murmur is present with large shunts
6. Stroke or major organ damage can occur
because of embolization of thrombus, air or
other materials – PARADOXIMAL EMBOLISM
7. Tachypnea, tachycardia and enlarged liver
from heart failure

19. Aortic stenosis
• Aortic valve leaflets are partly fused
together, giving restrictive exit from left
ventricle
• Often associated with mitral stenosis and
coarctation of aorta

20. Aortic stenosis

21. Aortic stenosis
• Clinical features
– Mild to moderate cause no symptoms
– Severe : causes easy fatigue, exertional chest pain
and syncope
– Systolic ejection murmur, maximum at upper right
sternal edge, radiating to neck

22. Aortic stenosis
– Small volume, slow rising pulse
– Carotid thrills
– Apical ejection click (if valvular stenosis)

23. Pulmonary stenosis
• Pulmonary valve leaflets partly fused
together, giving restrictive exit from right
ventricle

24. Pulmonary stenosis

25. Pulmonary stenosis
• Clinical features
– Most are asymptomatic
– Moderate to severe
• Exertional dyspnea and easily fatigability
– Severe stenosis
• Cyanosis

26. Pulmonary stenosis
– Ejection systolic murmur in upper left sternal
edge, thrill may present
– Soft or absent P2
– Valvular stenosis will result in a click

27. Coarctation of aorta
• During the development of aortic arch, area
near the insertion of ductus arteriosus failed
to develop correctly
• Results in narrowing of aortic lumen
• Always juxtaductal in position

28. Coarctation of aorta

29. • Clinical features
– Asymptomatic
– Always systemic hypertension in right arm
– Ejection systolic murmur at upper sternal edge
– Collaterals at the back
– Radio femoral delay
• Due to blood bypassing the obstruction via collateral
vessels