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OB2 > Ch. 35 & 36 > Flashcards

Ch. 35 & 36 Flashcards

1
Q

Caudal region of the primitive heart

A

Sinus venosus

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2
Q

Primitive atrium develops into

A

Left and right atria

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3
Q

Primitive ventricle develops into the

A

Left ventricle

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4
Q

Bulbous cord is develops into the

A

Right ventricle

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5
Q

Truncus arteriosus dilates to form

A

Aortic sac from which the aortic arches arise

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6
Q

Sinus venosus initially this is a separate chamber that opens into the

A

Right atrium

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7
Q

Sinus venosus receives all blood returning to the heart from

A

Common cardinal veins
Vitelline veins
Umbilical veins

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8
Q

The left horn of the sinus becomes the

A

Coronary sinus

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9
Q

The right horn is incorporated into _, this forms the _

A

The wall of the right atrium

Smooth portion of the adult right atrial wall

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10
Q

The right half of the primitive atrium persists as the

A

Right auricle

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11
Q

Left atria is formed by

A

Incorporation of the primitive pulmonary vein

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12
Q

4 pulmonary veins eventually enter the _ from the _

A

Left atrium

lung

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13
Q

The smooth wall of the left atrium is formed from the _

A

Absorbed pulmonary vein

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14
Q

The left atrial appendage (_) is from the _

A

Left auricle

Primitive heart

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15
Q

Division of the 4CH occurs during _ of fetal development

A

4th & 5th weeks

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16
Q

Endocardium cushions develop in _ region of the heart

A

Atrioventricular

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17
Q

The cushion grows toward each other and fuse to divide the _

A

Atrioventricular canal into right and left canals

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18
Q

The foramen oval is an opening between

A

The free edge of the septum secundum

and the dorsal wall of the atrium

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19
Q

The left ventricle is formed from the

A

Primitive vein

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20
Q

The right ventricle is formed from

A

Bulbous cordis

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21
Q

The interventricular septum begins as

A

A ridge in the floor of the primitive ventricle and slowly grows toward the endocardial cushion

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22
Q

Foramen ovale allows communication from _ to the _

A

right atrium to the left atrium

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23
Q

Ductus arteriosus allows fetal circulation to bypass the _

A

Lungs

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24
Q

Ductus arteriosus allows communication from the _ to the _

A

Pulmonary trunk

Descending aorta

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25
Q

Ductus venosus allows fetal circulation to bypass

A

The liver

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26
Q

Ductus venosus: flow passes from _ through the ductus venosus to the _ and then _

A

Umbilical vein
IVC
Right atrium

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27
Q

After birth, fetal lungs begin to function. The omission of placenta circulation causes an immediate fall in _

A

Blood pressure in the newborns IVC and right atrium.

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28
Q

After birth, as lungs expand with air, there is a fall in _. This causes an increase in _

A

Pulmonary resistance

Pulmonary blood flow and progressive thinning of the wall of the pulmonary artery.

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29
Q

Pressure in the _ becomes higher than the _. This causes _

A

Left atrium
Right atrium
The foramen ovale to close

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30
Q

First shunt to close after birth

A

Foramen ovale

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31
Q

If the foramen ovale does not close after birth

A

Patent foramen ovale

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32
Q

The ductus arteriosus usually constricts _ after birth, once _

A

24-48hrs

Left sided pressure exceeds right sided pressure

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33
Q

There is a small shunt from the _ to the _ until _

A

Aorta
Pulmonary artery
The left and right sided pressures adjust to neonatal life

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34
Q

Ductus arteriosus turns into the _ in the neonate.

If communication persisist _

A

Ligamentum arteriosum

Patent ductus arteriosus

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35
Q

Umbilical arteries also constrict after birth to _

A

Prevent blood loss from the newborn

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36
Q

Umbilical vein may

A

Remain patent for some time after birth

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37
Q

Normal HR

A

120-160bpm

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38
Q

Bradycardia _bpm

A

<100

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39
Q

Tachycardia _bpm

A

> 200

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40
Q

Umbilical arteries go _

A

Around the bladder

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41
Q

Indicators for fetal echo

A 
IUGR
Cardiac arrhythmias
Abn. amnio
Abn. HR
Hydrops fetalis
Thickened NT
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42
Q

Extracardiac abnormalities are assoc. w/

A

Congenital heart block

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43
Q

Echo: maternal factors

A

Previous child with congenital heart disease
Parent with congenital heart disease
Maternal diseases affecting fetus (diabetes, lupus, drug/alc. use)

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44
Q

Echo: Fetal US landmarks

A

Fetal position
Fetal thorax
Apex of heart

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45
Q

Echo: When fetus is in a difficult position

A

Ask mother to change positions

Have mother go to the restroom

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46
Q

Normal cardiac study should include the following views

A

o4 chambers
oOutflow tracts [RVOT, LVOT]
oOblique long-axis view for aortic arch and ductus arteriosus

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47
Q

The most commonly acquired view of the fetal heart

A

4CH

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48
Q

4-chamber view anatomy

A 
▪Right atrium & ventricle [with moderator band]
▪Tricuspid valve
▪Left atrium & ventricle
▪Mitral valve
▪Interventricular septum
▪Interatrial septum
▪Foramen ovale
▪Pulmonary veins as they enter the left atrium
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49
Q

Moderator band can be used to locate the

A

Rt ventricle

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50
Q

Most anterior chamber

A

Rt ventricle

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51
Q

Most posterior chamber

A

Left atrium

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52
Q

The _ side of the heart is slightly larger in utero

A

Right

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53
Q

In utero the foramen ovale opens toward the _, as the pressure is slightly _ in the right atrium

A

Left atrium

Greater

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54
Q

After birth the pressure in the _ heart forces the foramen to close

A

Left

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55
Q

Failure of the foramen to close results in

A

defect in the atrial septum

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56
Q

_ valve is slightly inferior to the _ valve

A

Tricuspid

Mitral

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57
Q

The IVC and SVC can be seen entering the _

A

Right atrium

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58
Q

Junction of the interatrial and intraventricular septa, AV valves, and the 4 chambers

A

Crux

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59
Q

Five chamber view allows for the _

A

aortic flow to be recorded leaving the left ventricle

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60
Q

For 5CH, the transducer position is _

A

Slightly anterior to the 4CH

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61
Q

Criss-cross view, as the transducer is angled from the aorta slightly left

A

Pulmonary artery may be seen as it arises from the right ventricular outflow tract

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62
Q

Criss cross view: Pulmonary artery is normally _ and to the _ of the aorta

A

Anterior

Left

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63
Q

Criss cross view allows visualization of _

A

The normal relationship of the pulmonary artery and aorta to one another

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64
Q

Great vessels

A

Pulmonary artery and aorta

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65
Q

The “sweep” from the aorta to the pulmonary artery is called the_ view

A

Criss cross

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66
Q

LVOT: The origin of the aorta is identified arising from the

A

Left ventricle

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67
Q

Best view to obtain septal defects

A

LVOT

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68
Q

LVOT: Evaluate size of

A

▪Right & left ventricles
▪Right & left atriums
▪Thickness of interventricular septum
▪Continuity of interventricular septum

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69
Q

LVOT allows you to evaluate for _

A

A septal defect

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70
Q

LVOT: _ may not be detected with US

A

Small defects

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71
Q

Short axis view

A

RVOT

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72
Q

Long axis view

A

LVOT

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73
Q

For RVOT, from LVOT, rotate transducer _degrees in a _ direction

A

90

Cephalic

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74
Q

RVOT: Visualize the _ of the _ into the right and left pulmonary arteries

A

Bifurcation

Main pulmonary artery

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75
Q

RVOT: Demonstrates the normal relationship of the pulmonary artery as it lies _

A

Anterior and to the right of the aorta

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76
Q

Normally the RVOT and PA “drape” _ to the circular aorta

A

Anterior

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77
Q

Oblique view

A

Ductal/aortic views

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78
Q

Angulation of the transducer to oblique longitudinal plane provides visualization of this aortic anatomy:

A

Root of the aorta
Ascending aorta
Arch
Descending aorta

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79
Q

For oblique views, find the fetal spine in sagittal plane and angle _ to find the _ & _

A

Slightly inward toward the chest

Aortic & ductal arches

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80
Q

Aortic Arch: The three head and neck branch arteries arise from the perfect curve of the aortic arch as they

A

Ascend into the fetal head

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81
Q

3 head and neck branch arteries

A

Innominate (brachiocephalic)
Left common carotid
Left subclavian

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82
Q

Appearance of the aortic arch

A

Candy cane

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83
Q

Ductal Arch: Transducer is angled

A

inferior from the aortic arch

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84
Q

Ductal Arch: Arch type pattern represents

A

patent ductus arteriosus

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85
Q

Ductal arch: Ductus is slightly _ than the aortic arch

86
Q

Ductal arch appearance

A

Hockey stick

87
Q

Ductal arch: Does not have _ arising from its wall like the aortic arch

A

Head and neck vessels

88
Q

Ductal arch: SVC/IVC emptying into the _

A

Right atrium

89
Q

The most common types of congenital heart disease

A

Ventral septal defect
Atrial sseptal defects
Pulmonary stenosis

90
Q

Most common single cardiac anomaly

A

Ventral septal defect

91
Q

Influencing factors of congenital heart disease

A

Environmental
Chromosomal
Hereditary

92
Q

Fetal echo helps to establish the

A

presence and severity of the cardiac abnormality

93
Q

Indications for Sonographic detection of congenital heart disease

A 
CHRISTMAS
Concordance & contractility
Hydrops
Risk factors & rhythm
Incorrect size (LGA/SGA)
Symmetry
Tetralogy of Fallot, transposition, tricuspid atresia, truncus arteriosus
Masses & mobility
Aneuploidy
Situs
94
Q

Common occurrence of _ with congenital heart disease

A

Chromosomal abnormalities

95
Q

Majority of CHD have _

A

Trisomy 21

Followed by 13, 18, and Turners

96
Q

Certain cardiac abnormalities are more likely to be associated with chromosomal defects, such as

A 
Atrioventricular septal defect [ASD]
Tetralogy of Fallot
Double outlet right ventricle
Coarctation of the aorta
*Hypoplastic left heart
97
Q

Malformations of the _ side of the heart are rarely assoc. w/ karotypic abn.

98
Q

*Mother who had a child with _ heart abnormality has significantly higher risk of delivering another child with a form of _ heart disease

99
Q

Risk for heart disease _ with each pregnancy

A

Increases significantly

100
Q

*_is the most common severe congenital abnormality

A

Congenital heart disease

101
Q

CHD: _ of these are _

A

Half

Minor

102
Q

CHD: may be corrected with _

103
Q

CHD: Other half (not minor) is responsible for more than _ of the deaths from congenital abnormalities in childhood

104
Q

Prenatal Evaluation of Congenital Heart Disease: Several cardiac abnormalities may be detected with the _

A

4CH but many will be missed with only this view

105
Q

Dextrocardia: _ with the apex pointing to the _

A

Heart is in the right side

Right

106
Q

Dextrocardia is assoc. w/

A

Normal visceral situs

Situs inversus

107
Q

Dextroposition: Heart is in the _ with the apex pointing

A

Right side of the chest

Medially/left

108
Q

Dextroposition: Usually found with intrinsic factors such as

A

Diaphragmatic hernia or hypoplasia of the right lung

109
Q

Levocardia:

A

Both normal position of the heart in the left chest & when visceral/partial situs abnormalities are present

110
Q

Levocardia is assoc. w/

A

Normal situs

Situs inversus

111
Q

Levoposition

A

Heart is displaced further toward the left chest

112
Q

Levoposition is assoc. w/

A

Space occupying lesion that would shove the heart more towards the left (diaphragmatic hernia)

113
Q

Mesocardia

A

Cardiac apex is pointing toward the middle of the chest. Heart is usually more midline

114
Q

Mesocardia is assoc. w/

A

Extracardiac mass

Lung abnormalities

115
Q

Cardiomyopathy

A

Disease of myocardial tissue in the heart

116
Q

Causes of cardiomyopathy

A

▪Exposure to virus or bacteria leading to infection
▪Errors of metabolism
▪Endocardial fibroelastosis

117
Q

Myocarditis: characterized by

A

necrosis & destruction of myocardial cells and inflammatory infiltrate

118
Q

Viral cardiomyopathy AKA

A

Myocarditis

119
Q

All 4 chambers dilated and thinning of myocardial walls

A

Viral cardiomyopathy

120
Q

Myocarditis: Severely decreased cardiac functionleadingto

A

▪congestive heart failure

▪Bradycardia ▪Death

121
Q

Myocarditis prognosis

122
Q

Pericardial effusion

A

Abnormal collection of fluid surrounding the epicardial layer of the heart

123
Q

Pericardial effusion: in the 4CH view, *normal hypoechoic area in the peripheral part of the epicardial/pericardial interface should be

A

2mm or less

124
Q

Pericardial effusion:

*Separation of greater than _mm may be associated with _

125
Q

3 types of septal defect

A

Atrial septal defect [ASD]
Ventricular septal defect [VSD]
Atrioventricular septal defect [AVSD]

126
Q

Atrial Septal Defect creates a communication between the

A

Right and left atrium

127
Q

3 common forms of ASD

A

Osteum secundum
Osteum primum
Sinus venosus

128
Q

Osteum Secundum:
_ common
Defect in _

A

Most common, yet most difficult to see.

The central atrial septum near foramen ovale

129
Q

Osteum primum is assoc. w/

A

Trisomy 21

130
Q

Sinus venosus: Near the _

_ common

A

Entrance of the SVC to the right atrium

Least

131
Q

ASD is _ in utero, because _, unless _

A

not always diagnosed in utero
Foramen ovale
Part of the intra-atrial septum is missing

132
Q

Failure of the foramen ovale to close may cause

133
Q

Color flow helpful in detecting

134
Q

Most common congenital lesion of the heart

135
Q

VSD accounts for _% of all structural heart defects.

136
Q

VSD: Defects smaller than _ are not detected by ultrasound

137
Q

VSD prognosis

138
Q

VSD is assoc. w/

A

▪Tetralogy of Fallot
▪Single ventricle
▪Transposition of the great arteries
▪Endocardial cushion defect

139
Q

Atrioventricular septal defect AKA

A

Endocardial cushion defect and AV canal malformation

140
Q

Defect in the atrial & ventricular septum–failure of the common AV orifice to separate into mitral and tricuspid valves

A

Atrioventricular septal defect

141
Q

Atrioventricular septal defects are subdivideed into

A

Complete
Incomplete
Partial

142
Q

Atrioventricular septal defects are assoc. w/

A

Downs
Asplenia
Polysplenia

143
Q

Tricuspid atresia _ causing _

A

Interruption of the growth of tricuspid leaflets

Valve to be hypoplastic or atretic

144
Q

Tricuspid atresia: in the 4CH

A

Large dilated left ventricular cavity

Small, underdeveloped right ventricular cavity

Echogenic tricuspid annulus is seen with no valvular movement

Mitral valve is clearly the dominant atrioventricular valve

145
Q

Ebstein’s Anomaly

A

*Abnormal displacement of the septal leaflets of the tricuspid valve toward the apex of the right ventricle-(low insertion)

146
Q

Ebstein anomaly: _ is usually massively dilated

A

Right atrium

147
Q

Ebstein anomaly: abn. function of the right side of the heart is related to the following 3 factors:

A

Malformed tricuspid valve

Atrialized portion of the right ventricle

Reduced capacity of pumping portion of right ventricle

148
Q

Hypoplastic right heart

A

Right heart is underdeveloped

due to obstruction of RVOT secondary topulmonary stenosis

149
Q

Hypoplastic right heart: small _

A

RV, RA, and tricuspid valve

150
Q

Hypoplastic Left Heart Syndrome

A

Small hypertrophied left ventricle with aortic &/or mitral atresia

151
Q

Hypoplastic left heart is a _ condition

A

Autosomal recessive

152
Q

Hypoplastic left heart: Overload of _ may lead to_ with _

A

Right ventricle
Congestive heart failure
Pericardial effusions and hydrops

153
Q

Hypoplastic left heart: small left ventricle due to

A

Blood cannot fill LV to provide volume
Aortic stenosis
Mitral &/or aortic valve atresia

154
Q

Hypoplastic left heart is considered _ but prognosis has _

A

Lethal

improved with cardiac transplant

155
Q

*Most common form of cyanotic disease in infants & children

A

Tetralogy of Fallot

156
Q

Tetralogy of Fallot: severity varies according to

A

degree of pulmonary stenosis present

157
Q

Tetralogy of Fallot consists of 4 abn. (sonographically)

A

VSD
Over-riding aorta
Pulmonary stenosis
Right ventral hypertrophy

158
Q

Large septal defect with severe pulmonary stenosis

“Blue baby” at birth

A

Cyanotic disease

159
Q

Large septal defect with mild to moderate pulmonary stenosis

A

Acyanotic disease

160
Q

Tetralogy of Fallot is assoc. w/

A

Trisomy 13, 18, 21

other congenital cardiac malformations

161
Q

If aorta overrides over 50%

A

*Called double-outlet right ventricle

Means that both great vessels arise from the right side of the heart

162
Q

*Most common form of RVOT obstruction is _

A

Pulmonary valve stenosis

163
Q

Pulmonary stenosis: abn. cusps become

164
Q

Pulmonary stenosis: main pulmonary artery may be

A

Hypoplastic

165
Q

Pulm. stenosis: assoc. w/

A

other cardiac anomalies

166
Q

Pulm. stenosis is _ to diagnose

A

Very difficult

167
Q

*Transposition of the Great Arteries

A

Aorta is abnormally connected to the RV and the pulmonary artery is abnormally connected to the LV

168
Q

Transposition of great arteries: In fetal heart

A

no hemodynamic compromise is seen when the great arteries are transposed
BUT, after birth, the problem occurs due to inadequate mixing of oxygenated & deoxygenated blood

169
Q

Prognosis of transposition of great arteries

A

Good with surgical intervention

170
Q

Transposition of great arteries is assoc. w/

A

ASD

Anomalies of the atrioventricular valves Underdevelopment of the right or left ventricles

171
Q

Transposition of great arteries: _ is key in imaging the great arteries & their relationship

172
Q

Transposition of great arteries: RVOT, pulmonary artery & bifurcation should be seen _ to the aorta. In transposition this relationship _

A

anterior to the aorta

Is not present

173
Q

Transposition of great arteries: LVOT: Normal criss-cross pattern seen when sweeping from LVOT to RVOT With transposition this

A

is not possible

174
Q

Transposition of great arteries: LVOT: The great arteries are seen _ because

A

Parallel to each other

They both arise from the ventricles

175
Q

Truncus Arteriosus

A

*Heart lesion which only 1 great artery arises from the base of the heart

176
Q

Truncus arteriosus: from single great artery arises the

A

Pulmonary truck
Systemic arteries
Coronary arteries

177
Q

Truncus arteriosus is assoc. w/

A

Mitral atresia
Atrial septaldefect [ASD]
Univentricular heart
Aortic arch abnormalities

178
Q

Prognosis of truncus arteriosus _, fetal usually develops _

A

Poor
▪Congestive heart failure
▪Pericardial effusion
▪hydrops

179
Q

Ultrasound: Truncus arteriosus

A

Abnormal, large, single great vessel arising from the ventricle

180
Q

Coarctation of the Aorta

A

Shelf-like lesion in the isthmus of the arch.

Narrowing/kinking in the aorta

181
Q

Coarctation of aorta: Assoc. intracardiac malformations are present in _% of cases

182
Q

Cardiac malformations assoc. w/ coarctation of the aorta

A

▪Aortic stenosis
▪Aortic insufficiency ▪Septal defects ▪Transposition of great arteries
▪Truncus arteriosus
▪Double-outlet right ventricle

183
Q

Coarctation of the aorta is _ to diagnose in fetus. Blood flow may _. After delivery, _

A

Difficult
Still be flowing into the arch
This will be very evident

184
Q

Cardiac tumors are

A

Very unusual

185
Q

Most cardiac tumors are

A

Benign and isolated

186
Q

Most common cardiac tumor

A

Rhabdomyoma followed by teratoma

187
Q

Cardiac tumors: _ are malignant

188
Q

Rhabdomyoma tends to be

A

Multiple and involve the septum

189
Q

Rhabdomyoma is assoc w/

A

Tuberous sclerosis

190
Q

Rhabdomyoma: Fetus becomes _ when tumor_

A

Symptomatic

Becomes large enough to obstruct one of the outflow tracks

191
Q

Rhabdomyoma leads to

A

Congenital heart failure
Pericardial effusion
Hydrops
Death

192
Q

Rhabdomyoma: Prognosis depends on

A

Size
Location
Histologic type

193
Q

Rhabdmyoma is best seen in

194
Q

Single Ventricle

A

2 atrium _

1 ventricle

195
Q

Single ventricle: 1 ventricle receives

A

Both mitral and tricuspid valves. Both are patent

196
Q

Single ventricle: the right or left AV connection _

A

May be absent

197
Q

Single vent.: Great arteries _. Aorta arises above _

A

May be transposed

A small outlet chamber

198
Q

Single vent.: Pulmonary stenosis _

A

may or may not exist

199
Q

Ectopia Cordis

A

Abnormal development of the heart outside of the chest

200
Q

Ectopia cordis is assoc. w/

A 
Facial & skeletal deformities
Ventral wall defects[omphalocele]
CNS malformations [meningocele, cephalocele]
•Cardiac anomalies include:
Tetralogy of Fallot
Transposition of the great arteries
201
Q

Prognosis of ectopia cordis

202
Q

Premature Atrial & Ventricular Contractions: called

A

PAC’s and PVC’s

203
Q

Premature Atrial & Ventricular Contractions results from

A

An immature heart

204
Q

Premature Atrial & Ventricular Contractions

A

Ectopic premature contraction

205
Q

Premature Atrial & Ventricular Contractions: Atrium & ventricle may both experience

A

extrasystoles & ectopic beats

206
Q

Echogenic intracardiac focus

A

An echogenic structure in the heart that is bright as bone

207
Q

EIF: seen in the

A

Left ventricle of the heart

208
Q

EIF is thought to represent

A

calcification of the papillary muscle or chordae tendineae (puts pressure on valves to keep closed)

209
Q

EIF may be

A

Normal or linked with trisomy 21

210
Q

How would you tell EIF from the moderator band

A

EIF is on the left (MB on right)

EIF will be bright as bone

OB2 (7 decks)

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