Cardiovascular changes at birth Flashcards

1
Q

A day after delivery, a premature infant is examined by a neonatal specialist. With her stethoscope, she hears a harsh blowing murmur throughout the cardiac cycle, more intense when the heart is ejecting blood (ventricular systole) and less intense when the ventricle is filling (ventricular diastole).

A

A patent ductus arteriosus

(contd.)
The murmur of a PDA is cause by turbulent blood flow from the aorta to the pulmonary artery. There is a always a pressure gradient between them, though somewhat greater in systole than in diastole, so the murmur is heard throughout the cardiac cycle and is described as a “machinery murmur”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what carries oxygenated blood from placenta to foetus

A

umbilical vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what carries deoxygenated blood back to the placenta from the foetus

A

2 umbilical arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what does the ductus arteriosus connect to

A

aorta and pulmonary artery - keeps blood away from lungs filled with amniotic fluid
provides outlet flow so decreased resistance and increased flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what does the ductus venous allow

A

blood from placenta to bypass the liver as docent work fully yet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

function of foramen ovale

A

allows blood flow from right atrium into Left atrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In utero why is the pressure higher in the right atrium than the left ?

A

due to vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

where does blood flow from the IVC travel through

A

through foramen oval to left atrium then to left ventricle to the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is pulmonary vasoconstriction

A

reduced blood flow to the lungs diverts pulmonary artery through ducterious arterosus , RA increased pressure keeping it open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what can occur if baby is born hypoxic

A

COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

if the RA pressure is greater then LA what stays open

A

Foramen ovale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

pressure = flow x ?

A

resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

potential difference = current x

A

resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

does vasoconstriction increase resistance

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how is adequate O2 delivery to tissues achieved by

A

fetal HB
fetal circulation
polycythaemia (increased RBC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

when the first breath occurs what happens

A

PO2 rises and pulmonary vasodilation occurs as trying to grab oxygen
Placental circulation ceases stopping flow in the ductus venosus
because the baby has just been moved resistant goes up in the body circulation so pressure in left atrium rises so Foramen oval closes and venous blood goes to the lungs causing PO2 to rise
IVC flow now goes through the RV and pulmonary circulation
in the ductus arteriosus flow reverses and cease due to systemic flow incasing and aortic pressure increasing so eases flow on the pulmonary artery to lungs so no longer needed and end up with ligamentum arteriosus.

first breath needs to happen for this sequence to occur

17
Q

what prostaglandin keeps the DA patent in utero

A

PGE2

18
Q

What is the fetal response to hypoxia - bad

A

Tachypnoea - abnormal rapid breathing
Primary apnoea - foetus unconscious
gasping respiration - brainstem reflex of gasping
secondary apnoea - stimulation of NB spontaneous - cardiovascular collapse

19
Q

what is the long term fate of the three shunts
FO
DA
DV

A

FO- fuses fossa ovalis
DA- remanent ligamentum arteriosus
DV- remanent ligamentum venosum