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MIDS 187 > Ch 8 Normal Heart > Flashcards

Ch 8 Normal Heart Flashcards

1
Q

Blood starts to circulate within the embryo by how many weeks gest age?

A

5 weeks

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2
Q

The heart begins as a set of paired tubular structures known as what?

A

Cardiogenic cords

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3
Q

The cardiogenic cords begin to fuse on what day?

A

22nd day

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4
Q

What do the cardiogenic cords form after they fuse?

A

Forms the single heart tube

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5
Q

At approx what day does the endocardial cushions begin to develop + separate the atria from ventricles?

A

Day 27

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6
Q

What does the endocardial cushions separate?

A

Atria + ventricles

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7
Q

By what day post-conception are the mitral + tricuspid valves formed?

A

Day 33

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8
Q

B/w what days does the septum primum form?

A

25th-28th day post conception

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9
Q

What does the septum primum create an initial division b/w?

A

The right + left portions of the atrium

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10
Q

Once the septum secundum is formed, why does the foramen ovale remain?

A

Remains to allow the right to left shunting until birth

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11
Q

Where do the great vessels (AO/PAs) arise from?

A

The common vessel of the truncus arteriosis

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12
Q

Swellings in the truncus arteriosus form + twist around each other during what week? What does this form?

A

-7th week
-Forms the aorticopulmonary septum

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13
Q

The pulmonary channel is contiguous/touching the RV or LV?

A

RV

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14
Q

The systemic (aortic) channel is contiguous/touching the RV or LV?

A

LV

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15
Q

The AO + pulmonary arches arise from what? When does this occur?

A

-Series of primitive aortic arches
-B/w 19-30 days post conception

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16
Q

By the beginning of what week has the heart fully formed + placental circulation has begun?

A

Start of 8th week gestation

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17
Q

The majority of the blood from the umbilical vein is shunted into what?

A

The ductus venosus

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18
Q

What does the majority of the blood from the umbilical vein bypass + enter?

A

Bypasses the hepatic circulation + enters the IVC

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19
Q

Where does the remainder of blood flow through?

A

The hepatic circulation prior to entering into the IVC via hepatic veins

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20
Q

Blood enters the RA from what vessels?

A

IVC + SVC

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21
Q

How does oxygenated blood get into the LA from the RA?

A

Oxygenated blood is directed by the eustachian valve through the foramen ovale into the LA

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22
Q

The remained of blood in the RA (plus returning blood from SVC) pass through which valve to enter the RV?

A

TV

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23
Q

From the RV, blood passes through which valve into the PA?

A

PV

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24
Q

The majority of blood that enters the PA is diverted through what?

A

The ductus arteriosus into the AO + systemic circulation

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25
Q

Blood in the LA comes from 2 places, what are they?

A

-From pulmonary circulation
-Gets shunted through foramen ovale (from RA)

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26
Q

Blood in LA passes through what valve to get into LV?

A

MV

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27
Q

The highly oxygenated portion of blood is shunted mainly to what portion of the fetus?

A

The cranial portion

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28
Q

Highly oxygenated blood gets shunted mainly to the cranial portion of the fetus via what arteries?

A

Brachiocephalic arteries (which arise from the prox portion of the AO arch)

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29
Q

What are the brachiocephalic arteries?

A

Right subclavian artery + right carotid artery

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30
Q

The remainder of blood goes where after it reaches the cranial portion of the fetus?

A

Spreads to distal portion of fetus through abdominal AO

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31
Q

The remainder of blood goes where after it reaches the distal portion of the fetus?

A

Returns to the placental circulation through the umbilical arteries

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32
Q

Does the MCA + umbilical artery have opposite or the same dopplers in regards to diastolic flow?

A

Opposite (MCA wants low, UA wants high)

33
Q

Difference b/w MCA + umbilical artery dopplers?

A

MCA: higher peaks, lower diastolic flow
UA: lower peaks, higher diastolic flow

34
Q

The location + orientation of the heart can be evaluated once what is determined?

A

Fetal position

35
Q

The heart should occupy how much of the left side of the fetal chest?

A

The majority of it

36
Q

Should the apex normally point to the left or right?

A

Left

37
Q

What is the normal angle of the heart in degrees?

A

45 degrees to left of midline

(plus/minus 20 degrees)

38
Q

What is the term that represents a normal sided heart?

A

Levocardia

(levo = left side)

39
Q

What is dextrocardia?

A

When the heart is on the right side of chest, with apex also pointing to right

(fully flipped)

40
Q

What is dextroposition?

A

When the heart is on right side of chest, with apex pointing to left

(apex still in right position, but wrong side chest)

41
Q

What is mesocardia?

A

When heart is in middle portion of chest, with apex pointing along midline

(meso = middle)

42
Q

Dextroposition + mesocardia occur m/c due to what?

A

There being a mass lesion in the left chest

(ex. mass causes heart to shift over onto wrong side of chest)

43
Q

Is dextrocardia usually a congenital condition?

A

Yes

44
Q

List the heart protocol?

A

-4 ch view
-LVOT + RVOT
-SAX
-AO + ductal arch
-Bicaval
-3 vessel view
-Cine sweep from stomach to 3VV (with + w/o CD)
-Split screen/cine showing axis of heart relative to stomach

45
Q

Is the heart often a reason why moms comes back for a repeat u/s?

A

Yes!

46
Q

How is the apical 4 ch view obtained?

A

-From TRV image of fetal chest
-Apex points either directly towards or away from probe
-Ventricular + apical/atrial septa is parallel to probe
-Ensure valves are on the same level

47
Q

Should the RA + LA be approx equal size?

A

Yes!

48
Q

Does the RV or LV appear slightly larger?

A

RV (remember is opposite of adults)

49
Q

The MV + TV valves (AV valves) are located where?

A

B/w atria + ventricles

50
Q

What do we have to watch out for when imaging the 4 ch view in regards to the ventricular septum?

A

-Watch out for drop out (as the septum is parallel to the beam)
-Ensure septum is continuous w/o any disruption

51
Q

What should the atrial septum contain in fetuses?

A

The normal opening of the foramen ovale

52
Q

What is the foramen ovale?

A

-Hole in b/w RA + LA
-Foraminal flap should be seen opening into the LA

53
Q

Are the 2 superior pulmonary arteries or veins seen entering into the LA in the 4 ch view?

A

Veins

54
Q

How do we angle the probe to get LVOT?

A

Angle towards the fetal right shoulder from the 4 ch view

55
Q

If a VSD is present, how would it appear in LVOT?

A

As a break in the continuity of the IVS

56
Q

Is PLAX in adults the same view as LVOT in fetuses?

A

Yes!

57
Q

How do we angle the probe to get RVOT?

A

Angle further toward the fetal right shoulder while in LVOT

58
Q

Should RVOT + LVOT cross when switching/angling back and forth b/w them?

A

Yes!! Should show AO crossing anteriorly to the PA

59
Q

How do we angle the probe to get SAX?

A

Angle slightly towards fetal left shoulder

60
Q

Is PSAX - AoV level in adults the same as SAX in fetuses?

A

Yes!

61
Q

What structures are seen in SAX?

A

-AO appears as central circular structure
(encircled by surrounding PA)

-RA, RV + PA seen

-AoV, PV + TV seen

-Size of AO + PA can be directly compared here

62
Q

How do we angle the probe to get the AO arch?

A

Angle from left shoulder to right hemithorax while in a longitudinal/SAG view of fetus

63
Q

How can we distinguish the AO arch from the ductal arch?

A

-By identifying the head + neck vessels
-Ductal arch is more caudal

64
Q

AO arch has what appearance?

A

Candy cane

65
Q

Ductal arch has what appearance?

A

Hockey stick

(think dudes = play hockey = ductal)

66
Q

How do we angle the probe to get the ductal arch?

A

Remaining in longitudinal/SAG view from the AO arch, but rotating back to a straighter anterior-posterior view

67
Q

What structures are seen in the ductal arch?

A

PA (top) , ductus arteriosus (middle) + descending AO (bottom)

68
Q

What 3 vessels come off the Ao arch?

A

-Left subclavian artery
-Left common carotid artery
-Brachiocephalic trunk

69
Q

How do we angle the probe to get the 3 vessel view?

A

Apical 4 ch view obtained, then probe is moved cephalad

70
Q

List the structures in the 3VV?

A

From midline to lateral: acronym PASS
-PA
-AO
-SVC

(can compare size of AO to PA here)

71
Q

Why does the PA appear more elongated in the 3VV compared to the AO + SVC?

A

B/c the PA is being imaged at the level of the ductus arteriosus

72
Q

What is the ductus arteriosus?

A

-A blood vessel that connects the fetal PA to the AO, it closes after birth
-It allows oxygenated blood to bypass pulmonary circulation + go right into AO, since the lungs aren’t being used yet

73
Q

How can we obtain the bicaval view?

A

Go oblique, SAG view through heart

74
Q

What structures are seen in the bicaval view?

A

-SVC entering RA superiorly
-IVC entering RA inferiorly

(make sure we image IVC and not accidentally AO)

75
Q

What is SAX short for?

A

Short Axis

76
Q

The smallest vessel on the 3V view is the?

A

SVC

77
Q

The heart should point 45 degrees to the left, +/- this many degrees?

A

20 degrees

78
Q

Levocardia is defined as?

A

A normal heart

MIDS 187 (19 decks)

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