EVALUATION OF THE CARDIOVASCULAR SYSTEM AND VITAL SIGNS

Question 1

Fetal heart develops b/w ________ weeks of gestation even before conception is perceived.

Answer 1

3-8

Question 2

1st cardiac pulsation appears by _____ week of pregnancy.

Answer 2

3rd

Question 3

The Critical period for the development of normal cardiovascular structures and cardiac defects is the ____ trimester of pregnancy.

Answer 3

1st

Question 4

The Critical window period (latent interval) between exposure to risk factors and occurrence of CHD is ____________ and ______________.

Answer 4

3 months before

3 months after conception.

Question 5

The primitive fetal heart is a ___________ tube with _____directional blood flow and ______ stages are involved in the development of the heart, the vascular system and conduction pathway.

Answer 5

straight vertical valveless

uni; six

Question 6

Embryology of Cardiogenesis (Stages)

Six primary events result in the development of a normal heart and CHD will develop if steps 3, 4, 5 and 6 are compromised.
 Step 1: _____________
 Step 2: _____________
 Step 3: _____________
 Step 4: _____________
 Step 5: Formation of the cardiac _____________ and _____________ SYSTEMS
 Step 6: Development of _____________ and vascular system of the rest of the body.

Answer 6

 Step 1: MIGRATION
 Step 2: FUSION
 Step 3: LOOPING
 Step 4: SEPTATION
 Step 5: Formation of the cardiac ELECTRICAL CONDUCTION and VASCULAR SYSTEMS
 Step 6: Development of AORTIC VASCULAR ARCHES and vascular system of the rest of the body.

Question 7

Embryology of Cardiogenesis (Stages)

 Step 1: MIGRATION and organization of __________ from streaks of primitive mesodermal tissues into a pair of ____________ on the __________.

 Step 2: FUSION of _________ forms a primitive _________;

 Step 3: LOOPING of the primitive ______ leads to formation of the primitive
____________ & correct positioning of the heart in the left chest (levocardia)

 Step 4: SEPTATION of the primitive cardiac loop leads to formation of the _______ and partitioning of the primitive heart chambers.
 Step 5: Formation of the cardiac ELECTRICAL CONDUCTION and VASCULAR SYSTEMS
 Step 6: Development of AORTIC VASCULAR ARCHES and vascular system of the rest of the body.

Answer 7

pre-cardiac cells; cardiac crescent; myocardial plate

two cardiac crescents; vertical heart tube

vertical tube; cardiac chambers

five septae

Question 8

The Fetal Circulation and Role in CHD

 ________ system pumps blood into the ________ circulation.
 ____________ /___________ lungs (collapsed); vasoconstricted pulmonary
arterioles and high PVR.

 _____________ blood (65-75% ) but sufficient to maintain growth.

 (Upper or lower?) body receives better oxygenated blood than (upper or lower?) body parts

Answer 8

Parallel; systemic

Non-functioning; ventilating

Hypoxaemic

Upper; lower

Question 9

The Fetal Circulation and Role in CHD

 Four shunts: list them

 The fetal circulation ameliorates the effects of most but not all CHDs through the ____________ and ______________ .

 Exceptions include CHDs that can lead to _________ and _________ . (complete AVCD/ECD with severe TR, Ebsteins anomaly with severe TR, absent PV or severe PV regurgitation;Tricuspid atresia with absent Foramen ovale)

Answer 9

Foramen ovale (intracardiac); Ductus arteriosus, Ductus venosus and Placenta (extaracrdiac)

ductus arteriosus and foramen ovale

right heart failure and hydrops fetalis

Question 10

PAEDIATRIC AGE CATEGORIES

• Birth(Newborn): ———-\———-
• Infancy(Infant): _______-________
• Pre-toddler: _______-________
• Toddler: _______-________
• Earlychildhood/Preschool(Preschooler): _______-________
• Middle childhood/School age (Pre-teens): _______-________
• Earlyadolescence/Teens(Adolescent): _______-________
• Late adolescence _______-________ (Young adult)

Answer 10

28days/4weeks

28days-12months

12months-2years

2-3 years

2-5years

6-11 years

12-18years

19-21 years

Question 11

Specific History to Explore/Emphasize in
Cardiovascular Disease
Newborn and Infant
•_________ history and ________
• Maternal history of _______ or ______
• Exposure to ________ agents associated with cardiac defects
•____________ at birth or with crying
• Feeding and activity levels
•________ problems
• Poor growth
• Family history of congenital or acquired heart disease
• Family history of genetic abnormalities/syndromes
• Heart murmur

Answer 11

Gestational; Birthweight

diabetes mellitus or Rubella

teratogenic; Blueness (Cyanosis)

Respiratory

Question 12

Specific History to Explore/Emphasize in
Cardiovascular Disease
Older Child
• Gestational history and Birthweight
• Maternal history of diabetes mellitus or Rubella
• Exposure to teratogenic agents associated with cardiac defects
• Blueness (Cyanosis) at birth or with crying
• Feeding and activity levels
• Respiratory problems
• ________ and _______
• ____________ on exertion
Poor growth
•__________ swelling
•_____________
•Family history of __________ in close relations

Answer 12

Spells and Seizures

Shortness of breath

Joint swelling

Palpitations

sudden death

Question 13

Specific History to Explore/Emphasize in
Cardiovascular Disease
Adolescent
• Gestational history and Birthweight
• Maternal history of diabetes mellitus or Rubella
• Exposure to teratogenic agents associated with cardiac defects
• Blueness (Cyanosis) at birth or with crying
• Feeding and activity levels
• Respiratory problems
• ________ and _______
• ____________ on exertion
Poor growth
•__________; __________
•_____________
•_______ with or after exercises
•Family history of __________ in close relations
•__________________

Answer 13

Spells and Seizures

Shortness of breath

Syncope; chest pain

Palpitations ;Dizziness
sudden death; alcohol or drug use or abuse