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OBGYN 2 > M12: FetalCardiac Abnormalities > Flashcards

M12: FetalCardiac Abnormalities Flashcards

(88 cards)

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1
Q

When does the heart begin to develop, when is it fully formed

A

5 wks

10 wks

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2
Q

Describe how the heart develops… when do the chambers of the heart develop

A

Paired heart tubes fuse to form a single heart

B/w 6-8 wks

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3
Q

When is a heart beat detected

A

5-6 wks

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4
Q

Describe the pathway of blood starting from the placenta

A

Placenta > umbilical vein > Lt portal vein > ductus venosus and some through the hepatic veins > IVC > RA > foramen of ovale > LA > LV > AO > iliacs > hypogastric A > umbilical A > placenta

Some blood also goes from the RA to the RV, through the PA, to the lungs, PV and to the left heart.

OR from the RV blood can go through the PA and ductus arteriosus to the AO

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5
Q

Do the umbilical V or A carry O2 rich blood

A

Veins

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6
Q

Number of umbilical artery and vein

A

2 arteries

1 vein

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7
Q

Most of the blood that does enter the RV will pass through which structure

A

The ductus arteriosus b/c blood is getting oxygenated from mom

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8
Q

What does the ductus venosus connect?

Ductus arteriosus?

A

DV: connects LPV to IVC

DA: PA to AO

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9
Q

indications for fetal echo

A

abnormal findings
fam HX of congenital heart disease
previous prog w/ cardiac abnormality
maternal disease associated w/ heart defects (type 1 diabetes)

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10
Q

1 reason for fetal echo

A

type 1 maternal diabetes

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11
Q

other findings associated w/ heart defects

A 
2 vessel cord
CDH
omphalocele
thick nuchal fold or NT (> 3.5 mm will do echo)
hydrops
chromo abnorm
bradycardia
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12
Q

what % of T21 babies have heart defects

A

50%

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13
Q

fetal echo routine

which are done at detailed, which are fetal echo only

A 
detailed:
find situs w/ stomach and heart
4CH
LVOT/RVOT
3 Vv

echo only:
AO arch and ductal arch
short axis of ventricles and atria
SVC/IVC (long horn view)
pulmonary veins
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14
Q

which chamber of the heart is most anterior

A

RV

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15
Q

how should the RVOT and LVOT cross

A

90 degrees

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16
Q

size of the structures in 3 vV

A

PA>AO>SVC

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17
Q

appearance of the AO arch and ductus venosus

A

AO: candy cane w/ great vessels

DA: hockey stick, no branches

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18
Q

in which views may you do doppler in a fetal echo

A

inflow
outflow
ductus arteriosus
foramen ovale

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19
Q

how do we do Mmode of the heart

why

A

insinuating through both the atria and ventricles

to rule out arrhythmias and heart block

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20
Q

when in wks is a fetal echo best performed

A

20 or 22 2ks to term

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21
Q

4CH view R/O what amount of cardiac defects

how about if we included outflows?

A

1/3

2/3

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22
Q

norm HR

what is considered bradycardia
tachy?

A

120-160… up to 180 in first trimester

Brady: <100 bpm
tachy: > 200 bpm (reduced SV)

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23
Q

what usually causes Bradycardia in fetuses

A

heart block

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24
Q

how is tachycardia of the fetus treated

A

digoxin to mom… moms heart will respond also

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25
most common arrhythmia in a fetus are they worrisome
PACs not usually
26
describe an ASD why is it hard to diagnose
partial or complete absence of the IAS due to norm foramen ovale
27
how large should the foramen of ovale be
no larger than the AO root
28
how do you want the septum placed on the screen when looking for an ASD
horizontal
29
describe a VSD
partial or complete absence of the IVS, usually associated w/ other cardiac anomalies MOST COMMON CARDIAC ANOMALY
30
best view to asses a VSD
subcostal/horizontal 4 CH and short axis of ventricles is best
31
prognosis for VSD
good, many close on their own if they're small
32
how does blood move through the Foramen ovale
from RA to LA in the fetus
33
when does an atrioventricular septal defect (AVSD) occur describe the abnormality
when the endocardial cushions fail to fuse early in embryology 1 common valve w/ 5 leaflets (combo of TV and MV)
34
describe the anatomy of the heart ear in embryology
starts as a common ventricle and common atria that communicate through the AV canal
35
another name for a AVSD
AV canal | endocardial cushion defect
36
what % of fetuses w/ T21 have an AVSD
50%
37
describe ebstein's anomaly US appearance
apical displacement of the TV into the RV large RA apical displacement of TV sm/dysplastic RV
38
ebstein's anomaly is associated w/ which other anomalies
hydrops | pulmonary stenosis
39
ebstein's anomaly is associated w/ the ingestion of which medication
lithium
40
why does a hypoplastic Right ventricle occur
secondary to pulmonary atresia w/ no VSD.. theres no blood flow getting into the RV which makes it small
41
Us appearance of hypoplastic Right ventricle
difficult to see inner chamber and sm or absent pulmonary artery
42
why does a hypoplastic left ventricle occur US appearance
due to decreased flow into or out of the LV sm LV AO stenosis or atresia MV atresia
43
hypoplastic left ventricle is associated w/ which other anomalies
``` coarctation of the AO endocardial fibroelastosis (EFE) as preg progresses ```
44
RVOT, LVOT ratio
1:1
45
describe endocardial fibroelastosis (EFE) cause
myocardium is replaced by collagen and elastic tissue which causes decreased cardiac function and congestive HF muscle hypertrophy
46
when is endocardial fibroelastosis (EFE) seen
w/ hypoplastic heart syndromes
47
US appearance of endocardial fibroelastosis (EFE)
thick, echogenic myocardium
48
in general, what causes hypoplastic heart syndromes
lack of blood flow into or out of either of the ventricles, which doesn't allow them to develop normally
49
4 abnormalities w/ tetralogy of fallot
VSD AO overriding ventricular septum (too big) hypertrophy of RV pulmonary stenosis
50
describe truncus arteriosis
single large vessel arising from the base of the heart (PA and AO start as one didnt separate)
51
the single vessel w/ truncus arteriosis supplies which vessels/circulation
coronary arteries pulmonary circulation systemic circulation
52
US appearance of truncus arteriosis
VSD larger overriding AO pulm A origins will vary off the AO
53
will you have a separate ductal and AO arch w/ truncus arteriosis
no, only one vessel
54
describe double outlet RV common anomaly w/ this condition
when the Ao & PA both arise form the RV VSD
55
double outlet RV is associated w/ what maternal factors
maternal diabetes | alcohol abue
56
describe transposition of the great vessels
when the AO arises from the RV and the PA arises from the LV and both outflow vessels are parallel/dont cross at 90 degrees
57
2 types of transposition of the great vessels
complete/D loop: D for dextro corrected/L loop: L for levo
58
describe a D loop/complete transposition
closed circuit where blood flows from RA to RV not compatible with life
59
US appearance of D loop/complete transposition
great vessels parallel instead of crossing maybe VSD
60
describe the direction/flow of blood w/ a complete transposition
De02 > RV > AO > body/head 02 > LV > PA > lungs
61
describe a L loop/corrected transposition what to look for to identify the RV
when the RV is attached to the LA moderator band
62
is pulmonary and systemic circulation normal with corrected transposition
yes
63
US appearance of corrected transposition
parallel great vessels | morphologic RV to LA
64
can people w/ corrected transposition be asymp when might they start to show symptoms
yes mid life, they might show signs of heart failure b/c the RV can't cope w/ the pressure
65
describe the morphology of the PA and AO w/ corrected transposition
PA comes off the LV and de02 goes to lungs AO off the RV and 02 goes to body... basically the LV and the RV switch spots and everything else is normal
66
describe coarctation of the AO
narrowing of the AO lumen, usually at the isthmus (area b/w the Lt subcla A and the descending AO)
67
US appearance of coarctation of the AO
prominent RV sm LV (not enough flow into/out of the LV and AO) narrowing of the AO
68
coarctation of the AO is associated w/ which conditions
AVSD VSD maternal diabetes
69
when does coarctation of the AO often occur
after birth due to tissue from the ductus arteriosus entering the AO as it seals off
70
2 locations for coarctation of the AO
pre ductal and post ductal
71
most common cardiac tumor
Rhabdomyoma (cardiac hamartoma)
72
US appearance of Rhabdomyoma
solid echogenic tumors usually on the ventricular septum... may obstruct outflows
73
DDX for Rhabdomyoma
cardiac fibroma hemangioma myxoma teratoma
74
describe cardiomyopathy
muscle damage that results in altered cardiac function
75
causes of cardiomyopathy
viral infection bacterial infection metabolic disease maternal type 1 diabetes
76
what is ectopic cordis associated w/ which condition
heart outside the chest cavity pentalogy of central
77
describe cardiosplenic syndromes which organs are affected
symmetrical development of normally asymmetric organs or organ systems.... fetus either has 2 left sides or 2 right sides liver lungs stomach heart
78
another name for cardiosplenic syndrome
isomerism situ ambiguous heterotaxia
79
describe polysplenia US appearance
bilateral left sidedness... ``` multiple spleens (polysplenia) LA isomerism (2 LAs) 2 left lungs midline liver IVC interruption dextro or mesocardia ```
80
what happens to the IVC w/ polysplenia
IVC doesnt course through the liver and the HV empty into the RA... the renal and subhepatic segments drain into the azygous veins which drain into the IVC
81
describe dextro and mesocardia
dextrocardia: heart points to R side mesocardia: heart in the middle of the chest
82
is Lt or RT isomerism better
LT
83
other names for bilateral right sidedness
asplenia | ivenmark's syndrome
84
describe the anomalies of asplenia
``` no spleen right atrial isomerism (2 RAs) 2 right lungs midline liver bilateral SVC ```
85
possible heat defects seen w/ cardiosplenic syndromes. asplenia/right isomerism
- transposition of great arteries - pulm stenosis or atresia - total anomalous pulmonary venous return (2 RA, normal LA) - complete heart block heart defect are much worse w/ asplenia -AVSD is common w/ asplenia
86
which defects are associated w/ heterotaxia
almost any heart defects can be associated w/ it
87
diagnosing cardiosplenic syndrome on US
hard to diagnose clues may be: - interrupted IVC - large azygous vein - abnormal liver, stomach or heart position
88
which type of transposition is more common
D loop/complete

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