Test 5 Flashcards
(93 cards)
1
Q
most common congenital infection
A
cytomegalovirus
2
Q
how does CMV spread? 4
A
direct contact
exposure to secretions
blood transfusions
vertical transmission (via placenta) to fetus
3
Q
risk of transmission of CMV to fetus
A
40%
75-80% if occurs in 3rd tri
4
Q
CMV is the most common infectious cause of ______ 3
A
mental retardation
deafness
visual impairment
5
Q
symptoms of CMV and presentation ~4
A
5-15% symptomatic at birth
mortality up to 30% in 2 yrs
neurologic issues 80%
hearing loss 10-15%
85-95% asymptomatic at birth
neurologic issues in 30% w/in a year
6
Q
assumed fetal infection with CMV in documented maternal infection if ________ occur 5
A
progressive IUGR microcephaly hepato/spleno-megaly cerebral/visceral calcifications hydrops
7
Q
US findings in CMV 9
A
ventriculomegaly calcifications - non shadowing microcephaly cerebellar/CM abnormalities intraparenchyal cystic changes hepatosplenomegaly cardiomyopathy non immune hydrops IUGR
8
Q
CMV recommended imaging and percentages
A
MRI 92%
US 38%
9
Q
diagnosis of CMV and when its detected
A
amnio
5-7 weeks after infection
10
Q
follow up for suspected/confirmed CMV
A
serial US 2-4 weeks to track IUGR, Anemia (MCA) and hydrops
11
Q
parvovirus
A
fetal infection with human parvovirus B19
12
Q
incidence of parvovirus transmission and loss rate
A
17-33%
8-17% fetal loss when
13
Q
prognosis of parvovirus 2
A
normal development in survivors
neurodevelopmental delays in severe infections with transfusions
14
Q
US findings with parvovirus 7
A
anemia to hydrops to cardiac failure ascites - TMC placentomegaly poly echogenic bowel
15
Q
toxoplasmosis risk of congenital infection w/o treatment
A
20-50%
16
Q
long term effects/prognosis of toxo 4
A
asymptomatic at birth
blindness
epilepsy
intellectual impairment
17
Q
US findings of toxo 4
A
non shadowing intracranial calcifications
non shadowing intrahepatic calcifications
IUGR
ventriculomegaly
echogenic bowel
18
Q
prognosis for varicella 5
A
6% transmission at
19
Q
US findings for varicella 5
A
intrahepatic calcifications intracranial calcifications poly (from lack of swallowing) limb hypoplasia/contractures paradoxical diaphragmatic motion - unilateral paralysis
20
Q
when does heart tube start contracting and when is effective circulation formed
A
heart tube - 4th week
CRL 2mm
circulation at 5th week
21
Q
ductus arteriosus communication
A
b/w pulmonary artery and descending aorta
22
Q
risk factors for cardiac issues 6
A
IUGR abnormal amnio - trisomy abnormal heart rate cardiac arrhythmias GI anomalies renal anomalies
23
Q
maternal risk factors for cardiac disease 4
A
lupus
DM
teratogens
family hx of cardiac defect
24
Q
familial risk factors for cardiac disease 3
A
genetic syndromes
heart defect in previous child
congenital heart defect in parent
25
normal heart images 7
```
4 chamber
RVOT
LVOT
aortic arch
m-mode
axis
situs
```
26
what to look for in fetal heart 7
```
heart and stomach on same side
cardiac axis 45 +-20
size of heart (small chest vs big heart)
symmetric
PA slightly larger than Ao
Color for foramen ovale and septum
heart rate
```
27
4 chamber view components 9
```
apex pointed to left
right larger than left
foramen ovale flap to the left
moderator band in RV
assess MV and TV (TV lower)
pulmonary veins enter LA
right lower pulmonary vein not imaged
SVC & IVC enter RA
Interventricular septum
```
28
Things to consider of OFTs 3
size
width
position
29
LVOT and RVOT standard views
LVOT - long axis
| RVOT - short axis
30
normal heart position
levocardia
31
heart displaced further left than normal
levoposition
32
heart in right chest, apex to the right
dextrocardia
33
heart in right chest, apex medially or to the left
dextroposition
34
apex points midline
mesocardia
35
most common heart defect
ventricular septal defect VSD
36
VSDs account for ________
20% of congenital heart disease
37
VSD is associated with 2
cardiac abnormalities (50%)
>40% chromosome anomaly
20% of congenital heart disease
38
types of VSD
membranous
| muscular
39
membranous VSD
more common - 75%
| high up in ventricle - near crux
40
muscular VSD
10-15%
defect in muscular septum (anywhere)
large/small or single/many
41
prognosis of VSD 3
muscular more likely to close on their own
surgery for large defects
excellent prognosis when isolated
42
best way to image VSD 2
heart perpendicular to sound beam
| Color
43
AVSD names 3
atrioventricular septal defect
endocardial cushion defect
atrioventricular canal defect
44
AVSD definitieion
cardiac defect involving atrial and ventricular septum, AV valves and conducting system
45
AVSD is associated with _____ and percentages
```
t21 50%
20-30%
t13
t18
heterotaxy
```
46
prognosis for AVSD
95% 20 year survival rate with surgery
47
best diagnostic clue for AVSD +others 5
```
missing crux of heart
presence of ASD and VSD
AV valves at same level
look for ventricular symmetry (balanced vs unbalanced)
Color sees defect and regurg
```
48
ebstein anomaly
atipical displacement of septal and posterior tricuspid valve leaflets
lower in right ventricle
49
result of ebstein anomaly
atrialization of RV
50
prognosis for ebstein anomaly 4
in utero mortality 45%
absence of antegrade flow across pulmonary valve = lethal
surgery if heart failure and cyanosis
mild cases don't require surgery
51
best imaging clue of ebstein anomaly + others 6
```
right atrial enlargement
apical displacement of tricuspid valve
cardiomegaly
RA large while RV small
PA small from lack of flow
color to eval regurg through TV
```
52
hypoplastic left heart 4?
underdeveloped left side of heart (LA+LV) with MV or AV stenosis/atresia and hypoplasitc ascending Ao and coarctation
53
prognosis of hypoplastic left heart 8
```
20% IUFD
improving surgical techniques - >85% success
Long term survival unknown
6 year survival rate = 64%
Aneuploidy 15%
CHF
Pericardial effusions
hydrops
```
54
Aneuploidy with hypoplastic left heart 3
TMC turner's 13%
T13
R18
55
circulation in hypoplastic left heart 6
RV supplies pulmonic and systemic
pulmonary veins return blood to RA
Overload on RV leads to CHF leads to pericardial effusion leads to hydrops
56
hypoplastic left heart imaging 11
```
not symmetric 4 chamber
LV small/nonexistent
LV round instead of bulled shaped
RV dilated and wraps around LV
RV hypertropfied
Interatrial septum bowed left to right
LA hypertrophic
RA dilated
Ductus arteriosus dilated
ascending Ao small
Ao coarctation
```
57
ToF components
RVOT obstruction/stenosis
overriding aorta
VSD
RV hypertrophy
58
T or F
| 4 chamber view is normal in ____ cases of ToF
true
| 95%
59
size of pulmonary artery in ToF
narrow
60
TMC cyanotic congenital heart disease and percentage
ToF
| 7-10% of congenital heart disease
61
associations with ToF
chromosomal abnormality in 45%
62
prognosis of ToF 4+
depends on aneuploidy
isolated = excellent
>98 survival in liveborn
worse in absence of PV (32% mortality in 4 years and hydrops)
63
transposition of great arteries
Ao and PA switch
| OFT's run parallel
64
4 chamber view with TGA
normal
65
Associations and prognosis with TGA 4
VSD 45%
LVOT obstruction 25%
aneuploidy rare
long term prognosis 20+ with surgery 97%
66
only communication between right and left side in TGA
ductus arteriosus
| foramen ovale
67
blue baby
TGA
68
how do you recognize corrected TGA
evaluate right and left heart
| look for moderator band in right
69
anomalies associated with corrected TGA 3
VSD 60-80%
RVOT obstruction 30-60%
AV valve abnormalities - 90%
70
trucus arteriosus
single vessel truncus with 1-5 cusps arising from the heart giving rise to Ao and PA
71
imaging findings with truncus arteriosus/associated anomalies 8
```
single trunc giving rise to Ao and PA
single valve with 1-5 cusps
+- stenosis and regurg
VSD
interrupted Ao arch 10-19%
right sided ao arch 21-36%
extracardiac anomalies 21-30%
22q11 deletion 40%
```
72
prognosis of truncus arteriosus
depends on associated anomalies
| worse with interrupted ao arch
73
hypertrophic cardiomyopathy
primary disorder of cardiac muscle with tickened but non-dilated left ventricle and absence of other diasease capable of producing hypertrophy
74
causes of hypertrophic cardiomyopathy 7
```
44% idiopathic
41% genetic/metabolic:
noonan syndrome
DM
metabolic causes
fetal renal disease
TTTS receiver
```
75
prognosis of hypertrophic cardiomyopathy
18 % 1 year survival rate
| treat underlying cause
76
imaging of hypertrophic cardiomyopathy 2+
hypertrophy of myocardium
| asymmetric distribution but may be symmetric
77
irregular rhythm
ectopic or extra beat arising from site other than heart's pacemaker
78
likelihood of arrhythmia
1-2%
79
Most common cause/type of arrhythmia
PAC/PVC 90%
80
complication for PAC and occurance
supraventricular tachycardia 2-5%
81
cursor placement for M mode
over atria + ventricle
82
PAC 3
premature atrial contraction
compensatory paure of ventricles
normal rhythm resumes
83
PVC 3
premature ventricular contraction
noncompensatory pause
sinus node acts like nothing happened
84
SVT
supraventricular tachycardia
| tachycardia with origin above ventricles
85
rate of SVT
>200
86
how many of PAC's develop SVT
2-5%
87
prognosis for SVT 4
good if intermittent
hydrops with 50-75%
fetal demise 10%
ischemic brain injury with hydrops
88
bradyarrhythmia
slow heart rate >100 BPM
89
prognosis of bradyarrhythmia 3
increased mortality with >50 BPM and hydrops
if normal structures and no hydrops - 90% survival
poor prognosis with structural abnormality - 15% survival
90
benign transient bradycacrdia
vagal stimulation with transducer that returns to normal
91
complete heart block and cause
HR 60-80 BPM due to failed conduction from atria to ventricle
92
associations with complete heart block 2
50% cardiac malformations
| 50% autoimmune disease
93
complications of bradyarrhythmia 6
```
ventricular dilation
distortion of AV valve ring
tricuspid regurg
venous hypertension
hepatic congestion
hydrops
```
