Embryology and Congenital Defects Flashcards Preview

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Flashcards in Embryology and Congenital Defects Deck (36):
1

(probe) patent foramen ovale

20% of people
higher pressure on left side keeps membranous flap over foramen ovale
increase right pressure above left: opens foramen ovale
deoxygeneated blood skips lungs

2

Tetralogy of Fallot

right to left shunt
VSD, RVH, pulmonary stenosis, overriding aorta
cyanotic
tet spell: relieved by squatting
Sx: low saturation without respiratory distress, blacker than normal lungs, cyanosis, harsh systolic ejection murmur along the right upper sternal border, looks like boot

3

eisenmenger syndrome

chronic left-to-right shunt that causes progressive pulmonary HTN that eventually reverses the shunt

4

truncus arteriosus

ascending aorta and pulmonary trunk

5

bulbus cordis

smooth parts of ventricles

6

primitive atrium

trabeculated part of atria

7

primitive ventricle

trabeculated part of ventricles

8

primitive pulmonary vein

smooth part of LEFT atrium

9

left horn of sinus venosus

coronary sinus

10

right horn of sinus venosus

smooth part of RIGHT atrium (sinus venarum)

11

right common cardinal vein an right anterior cardinal vein

SVC

12

fetal erythropoiesis

yolk sac: 3-8 weeks
liver: 6 weeks- birth
spleen: 10-28 weeks
bone marrow: 18 weeks to adult

13

ductus arteriosus

ligamentum arteriosum

14

ductus venosus

ligamentum venosum

15

foramen ovale

fossa ovalis

16

notochord

nucleus pulposus

17

umbilical arteries

medial umbilical ligaments

18

umbilical vein

ligamentum teres hepatis in falciform ligament

19

allantois-> urachus (duct between bladder and umbilicus)

median umbilical ligament

20

right to left shunts

early cyanosis
req. urgent surgery or maintenance of PDA
start with T
1. tetralolgy of fallot
2. transposition of arteries
3. truncus arteriosus (persistent)
4. total anomalous pulmonary venous return (TAPVR)
5. tricsupid atresia
6. hypo plastic left heart

21

left to right shunts

late cyanosis
freq.: VSD>ASD>PDA
1. ventricular septal defect
2. atrial septal defect,
3. patent ductus arteriosus
4. pulmonic stenosis
5. aortic stenosis

22

persistent truncus arteriosus

right to left shunt
fails to divide into pulmonary trunk and aorta due to lack of aorticopulmonary septum formation
most patients have VSD too

23

transposition of great vessels

more common in first born, male, big normal looking babies
right to left shunt
failure of aorticopulmonary trunk to spiral: aorta leaves RV and pulmonary trunk leaves LV
MUST have another defect that allows mixing of blood to survive: VSD, PDA, ASD, patent foramen ovale
Sx: cyanotic, reverse cyanosis, egg on a string CXR, LOW O2 saturation: RIGHT HAND LOWER THAN RIGHT FOOT (get some saturation due to a patent foramen oval that eventually will close)

24

tricuspid atresia

right to left shunt
absence of tricuspid valve and hypo plastic rRV
NEED both ASD and VSD to survive

25

total anomalous pulmonary venous return (TAPVR)

right to left shunt
pulmonary veins drain right heart into circulation
associated with ASD and sometimes PDA to maintain CO
CXR heart in a SNOW STORM

26

ventricular septal defect (VSD)

left to right shunt
MOST common
usually membranous part of septum
ASYMPTOMATIC AT BIRTH and may remain asymptomatic for life
larger lesions: LV overload and HF
Sx: HF (growth delay and feeding intolerance), high RR and HR, head bobbing, sweats and falls asleep when feeds, low freq. holosytolic murmur across precordium (blood going from left ventricle to right), diastolic murmur in left axilla (mitral have more blood in left atrium), crackles in lungs, liver slightly large, S2 hard to hear
left heart dilatation
Small VSD: large systolic pressure difference between ventricles: high freq. holosystolic murmur

27

atrial septal defect (ASD)

left to right shunt
loud S, wide fixed split S2
Sx: none to HF
types: ostium secundum defect (most common), ostium primum defect (other defects often found), sinus venosus defect, common atrium
ADULT S2 SPLIT
complication: emolism
Tx: cath lab disc

28

patent ductus arteriosus (PDA)

left to right shunt (fetal: right to left (normal then changes when lung pressure decreases at birth)
machine like murmur
Signs: CONTINOUS MURMUR: through systolic and diastolic
wide pulse pressure (diastolic drops), pulses bounding, tachycardia, low saturation of lower extremities, tachypnea, crackles in lungs (lung congestion), cardiomegaly
progressive RVH and or LVH and HF
untreated: late cyanosis of lower limbs
Tx: indomethacin
PDE will keep open
complications: less blood to organs: ischemia of intestines, intestinal necrosis, kidney insufficiency or failure; risk of endocarditis

29

coarctation of aorta

aortic narrowing near insertion of ductus arteriosus
associated with: bicuspid valve, Turner syndrome, other heart defects
Sx: HTN in upper extremeties and weak delayed pulse in lower extremities, collateral arteries erode ribs (notches on xray); cool mottled extremities, delayed capillary refill
pre-ductal: patent ductus arteries needed
post ductal: develop collateral circulation in utero

30

infant normal stats

HR: 140
Arm BP: 65/45
pulmonary artery BP: 25/10
O2 saturation: 96-98%

31

pulmonary HTN of newborn

pressure too high in lungs to get blood to body; common to have tricuspid regurgitation
tachycardia, tachypnea, cyanosis, hepatomegaly, crackles in lungs, loud P2, holosystolic murmur along midsternal border
can get aspiration from mechonium aspiration: abnormal pulmonary parenchyma on CXR
want: open PDA

32

innocent murmurs

venous hum: at clavicle looking straight ahead, blood going down SVC (goes away when turn head or press on it)
PPS: peripheral pulmonary stenosis
Still's murmur: something with the left ventricle: musical near lower left sternal border and apex

33

systolic murmurs

PS: pulmonary stenosis
AS: aortic stenosis
TR: tricuspid regurgitation
MR: mitral regurgitation
VSD: ventricular septal defect

34

diastolic murmurs

AI: aortic insufficiency
PI: aortic insufficiency
MS: mitral stenosis
TS: tricuspid stenosis

35

What heart problems might you see with DiGeorge?

conotruncal anomalies
Tetralogy of Fallot
truncus arteriousus
transposition of great vessels
Sx: hypocalcemia, immunodeficiencies, developmental issues (speech and feeding), high arching soft and hard palates

36

Ebstein's anomaly

anomaly of tricuspid valve
WALL to WALL heart