Exam 1 CV Flashcards
1
Q
what tissue type is the heart mostly derived from
A
mesoderm
2
Q
when does heart development start
A
end of 3rd week
3
Q
when does the fetal heart start beating
A
during 4th week (22 days)
4
Q
when does fetal blood start circulating
A
during 3rd week
5
Q
when is the “critical period of development” for fetus
A
days 20-50 after fertilization
6
Q
where does heart tube development begin
A
clusters of angiogenic cells in the cardiogenic plate that coalesce to form R and L endocardial tubes..these tubes then fuse together
7
Q
when do the R and L endocardial tubes fuse
A
21 days
8
Q
what are primitive partitions of chambers (and valves) called
A
endocardial cushions
9
Q
name sections of primitive heart (before looping) from inferior to superior
A
sinus venosus, primitive atrium, primitive ventricle (inlet), bulbus cordis (outlet), truncus arteriosus
10
Q
in which direction does looping proceed
A
to the right
11
Q
what is abnormal looping associated with
A
isomeric cardiac lesions
12
Q
when is the cardiac loop complete
A
by day 28
13
Q
what is dextrocardia the result of
A
looping goes left instead of right
14
Q
what is dextrocardia sometimes associated with
A
situs inversus (all organs are on opposite side)
15
Q
when does septation occur
A
during second month
16
Q
what is the role of the septum primum
A
reduces bloodflow from right atrium to left atrium by closing the foramen primum
17
Q
what happens when foramen primum is closed
A
apoptosis occurs in the septum primum and the foramen secundum is formed so that oxygenated blood can be delivered to left atrium
18
Q
what is the purpose of the septum secundum
A
it overlaps the foramen secundum in order to provide a one-way valve from right atrium to left atrium so that blood only flows in that direction (foramen ovale)
19
Q
where does oxygenated blood travel from placenta
A
across foramen ovale to left atrium and out aorta; and to pulmonary vasculature
20
Q
what are the endocardial cushion defects
A
ASD, VSD, tetralogy of fallot, transposition of great vessels
21
Q
when does ventricular septation begin
A
42 days
22
Q
how are AV valves formed
A
endocardial cushions get resorbed and invagination and dehiscence of myocardium form valves and tensor apparatus
23
Q
how are semilunar valves formed
A
ingrowth from truncal wall
24
Q
what are the “2 big issues” of the developing fetal vascular system
A
developing lungs must be bypassed, and proliferating tissue has increased oxygen demand
25
how does oxygenated blood enter fetal circulation
umbilical vein
26
what is the main collecting chamber for blood in fetal heart
sinus venosus
27
how does blood exit fetal heart
pumped through aortic arches before passing through paired dorsal aortae
28
how are fetal tissues supplied with blood
efferent segmental arteries
29
how is mixed blood returned to placenta for oxygenation
via umbilical arteries (endpoint of dorsal aortae)
30
how is blood drained from developing tissues
via cardinal veins
31
where is deoxygenated blood mixed and returned to circulation
sinus venosus
32
what supplies blood to yolk sac
vitelline arteries
33
what do vitelline arteries become
mesenteric arteries
34
what supplies foregut derivatives
celiac artery
35
what supplies midgut derivatives
SMA
36
what supplies hindgut derivatives
IMA
37
what do the vitelline veins become
IVC, superior mesenteric vein, hepatic vein
38
when is umbilical cord formed
week 5
39
what vessels does the umbilical cord contain
2 arteries and 1 vein
40
what is Wharton's jelly
loose, proteoglycan-rich matrix that embeds the umbilical vessels
41
what are the arterial system defects
PDA, coarctation, double aortic arch, vascular rings
42
what are the venous system defects
double IVC or SVC, absence of IVC or SVC
43
when is the heart and circulatory system fully functional
16 weeks
44
3 major features of fetal circulation
maternal circulation operates via placenta and provides bloodflow to fetus
foramen ovale allows blood to shunt from right atrium to left atrium
ductus arteriosus allows deoxygenated blood to flow from pulmonary artery to aorta and to body
45
what is the purpose of the ductus arteriosus
to prevent circulatory overload in lungs and to allow the RV to strengthen
46
what is the ductus venosus
fetal blood vessel that connects umbilical vein to IVC that carries mostly oxygenated blood
47
oxygen saturation of placental blood
80%
48
what happens where the ductus venosus meets the IVC
oxygenated blood from the ductus venosus mixes with deoxygenated blood from the body and the mixture travels through the IVC to the right atrium
49
course of the umbilical vein
travels along anterior abdominal wall to liver (50% of blood enters liver, 50% bypasses liver via ductus venosus)
50
course of blood through fetal heart
most blood entering the right atrium gets shunted to left atrium via foramen ovale but a small portion enters pulmonary circulation (limited by high resistance in pulm. circulation) in order to perfuse lungs
51
places in fetal circulation where oxygenated and deoxygenated blood mix
liver, IVC, RA, LA, entrance of ductus arteriosus into descending aorta
52
circulatory changes at birth
initial inflation of lungs reduces resistance of pulmonary bloodflow, which increases pulmonary bloodflow and therefore bloodflow into RA/RV. There is also decreased bloodflow across foramen ovale as well as increased LA pressure and decreased RA pressure, causing foramen ovale to close
53
what is the most common malignancy of childhood
ALL
54
what is the most common lab finding in ALL
neutropenia with decreases in at least 2 cell lines
55
what is the most common presentation of beta thalassemia major
normal at birth with symptoms presenting during the first year: anemia, poor growth, skeletal changes, hepatosplenomegaly
56
what anemias present in a newborn
hemolytic, maternal factors, prematurity
57
what anemias present in an infant/toddler
IDA, nutritional, blood loss, leukemia, hemolytic
58
what anemias present in a child
IDA, nutritional, blood loss, leukemia, malabsorption
59
what anemias present in a teenager
blood loss, malabsorption
60
when does HSP present
age 2-7 (boys)
61
when does vWB present
early childhood
62
when does ALL present
age 2-10
63
what is beta thalassemia
point mutation in chromosome 11 causes deficiency of beta hemoglobin chains
64
inheritance of beta thalassemia
autosomal recessive (heterozygous = minor/asymptomatic, homozygous = intermedia or major)
65
consequences of beta thalassemia
hemolytic anemia (pallor, fatigue, SOB), jaundice, secondary hemochromatosis (arrhythmias, pericarditis, DM, hypothyroid), chipmunk facies, crew-cut appearance on x-ray hepatosplenomegaly,
66
why is presentation of beta thalassemia not until 3-6 months
fetal hemoglobin is still produced
67
beta-thalassemia blood smear
microcytic hypochromic anemia with target cells
68
beta thalassemia CBC/iron
anemia with high serum iron, ferritin, transferrin
69
beta thalassemia confirmatory testing
hemoglobin electrophoresis (Low HbA, increased HbF/HbA2)
70
beta thalassemia treatment
blood transfusions with iron chelation, splenectomy
71
sickle cell inheritance
autosomal recessive
72
what causes sickle cell crisis
acidosis, hypoxia, dehydration
73
consequences of sickle cell crisis
vaso-occlusion, hemolysis (intravascular and extravascular)
74
left-to-right shunt conditions are ___
acyanotic
75
left-to-right shunt conditions
ASD, VSD, PDA
76
right-to-left shunt conditions are ___
cyanotic
77
right-to-left shunt conditions
tetralogy of fallot, transposition of great arteries
78
obstructive stenotic lesion
coarctation of aorta
79
the most important clinical feature of left-to-right shut conditions is
respiratory distress
80
murmur of ASD
systolic at L upper sternal border, mid-diastolic at left lower sternal border
81
S1/S2 of ASD
wide split S2, fixed
82
physical finding of ASD
RV heave
83
ASD symptoms
usually asymptomatic
84
chest XR ASD
cardiomegaly, enlarged RA/pulmonary arteries, increased vascular markings
85
EKG ASD
RVH, right axis deviation
86
ASD treatment
potentially catheterization repair after 3 y/o
87
small VSD
asymptomatic with loud murmur
88
VSD symptoms
poor growth, poor exercise tolerance, pulmonary infections
89
VSD murmur
pansystolic, harsh at lower left sternal border with possible thrill
90
large VSD murmur
diastolic at apex
91
chest XR VSD
can be normal, or: LVH, RVH, LAH, pulm arteries enlarged, increased vascular markings
92
EKG VSD
normal or LVH/LAH
93
VSD treatment
ACE inhibitors, diuretics, nutrition until catheterization repair at < 1 y/o
94
PDA small defect
asymptomatic
95
PDA ssx
poor growth, decreased exercise tolerance, pulmonary infections
96
PDA murmur
continuous, machine-like LUSB
97
PDA pulses
bounding
98
PDA CXR
normal, or full pulm arteries silhouette with increased vascular markings
99
PDA EKG
normal or LVH, and poss. RVH
100
treatment for PDA in premature infants
IV indomethacin and diuretics
101
surgical correction for PDA age
symptomatic < 6 months, asymptomatic 6-12 months
102
most important feature of right-left shunt is
cyanosis
103
elements of tetralogy of fallot
RV outlet obstruction (pulmonary stenosis), overriding aorta, large VSD, RV hypertrophy
104
symptoms of tetralogy of fallot are determined by:
degree of pulmonary stenosis
105
symptoms of tetralogy of fallot with mild PS
mild SOB on exertion, mild fatigue, minimal cyanosis
106
ssx of tetralogy with severe PS
deeply cyanotic (w/o SOB), tet spells
107
onset of tet spells
resltess/agitated/crying
108
progression of tet spells
squatting, hyperpnea, increasing cyanosis, loss of murmur
109
severe tet spells
LOC, seizures, death, hemiparesis
110
tetralogy heart sounds
pulmonary stenosis murmur, single S2, RV impulse left sternal border
111
CXR tetralogy
boot-shaped heart, enlarged heart with upturned apex from RVH, absent main pulm. artery silhouette
112
EKG tetralogy
right axis deviation, RVH
113
treatment of tetralogy
surgical repair
114
sequelae post-treatment of tetralogy
after many years, symptoms may return. Exercise restrictions, endocarditis prophylaxis, antiarrhythmics, further surgeries, pacemaker
115
treatment of tet spell
1. increase venous return (knee-chest), 2. increase systemic vascular tone (phenylephrine), 3. increased fluid volume (IV) 4. decrease pulm vascular tone and increase venous return to RA (oxygen, morphine, correct acidosis)
116
newborn treatment of tetralogy
PGE1 to maintain patency of PDA
117
ssx of coarctation
upper extremity BP>lower extremity BP, CHF symptoms, systolic murmur, cyanosis in infant, absent or diminished LE pulses
118
CXR coarctation
rib notching and figure 3 sign
119
murmur of coarctation
blowing systolic that radiates to back, scapula or axilla
120
coarctation treatment
PGE1 and surgical correction
121
2nd most common form of congenital cyanotic heart disease
Transposition
122
transposition characteristics
tachypnea develops over time, no improvement in cyanosis with O2, cyanosis without SOB, single S2, loud systolic murmur
123
CXR transposition
narrow superior mediastinum, increased pulm vascularity, "egg on a spoon"
124
EKG transposition
RVH, right axis deviation
125
transposition treatment
PGE1 and repair within 2 weeks
126
innocent pediatrics murmurs
stills murmur, cervical venous hum, innocent pulmonary flow murmur
127
characteristics of still's murmur
systolic, LLSB, "musical" "vibratory," school-aged child, diminishes with sitting, standing, inspiration
128
most common innocent murmur
still's murmur
129
pulmonary flow murmur cause
normal bloodflow across pulmonary valve
130
pulmonary flow murmur characteristics
systolic, LUSB, low-pitched, older children, diminishes with sitting, standing, inspiration
131
venous hum murmur characteristics
only heart in sitting position. Continuous, right infraclavicular, low-pitched, machinery-like, any age, disappears when supine or pressure on JV
132
characteristics of suspicious murmurs
diastolic, holosystolic, loud (3 or higher), harsh, wide/fixed S2 split, clicks, snaps, rubs, remains when supine or pressure on JV
133
murmur of ASD characteristics
systolic, LUSB or LLSB, grade 1-3, RV heave with fixed split S2
134
murmur of VSD characteristics
middiastolic, pansystolic, LLSB or apex, can be loud with poss. thrill
135
murmur of PDA characteristics
continuous, machine like, persists when supine
136
tetralogy murmur characteristics
pansystolic, LUSB or mid LSB, harsh, loud, crescendo-decrescendo, single S2, right heave, thrill, possible click
137
what is the most common pediatric cardiomyopathy
dilated
138
dilated cardiomyopathy ekg
ST-depression and inverted T-waves
139
dilated cardiomyopathy treatment
reduce afterload, diuretics, thrombolytics, antiarrhythmics, treat underlying causes, transplat
140
most common cause of sudden cardiac death in young people
hypertrophic cardiomyopathy
141
treatment of hypertrophic cardiomyopathy
decrease LV outflow obstruction, decrease O2 demand, decrease heart rate, exercise restriction, surgery
142
etiology of long QT syndrome
usually congenital
143
consequences of long QT syndrome
palpitations, bradycardia, syncope, seizures, SIDS, sudden death
144
diagnosis of long QT syndrome
ECG/holter monitor
145
treatment of long QT syndrome
beta blockers (propranolol/nadolol), exercise restriction, correct underlying causes
146
most important part of cardiac physical exam
observation
147
what to use to feel pulsations
fingertips
148
what to use to feel thrills
base of fingers
149
what to use to feel heaves
base of hand
150
hepatomegaly in neonate size
at or over 3.5 cm
151
hepatomegaly in child size
at or over 2 cm
152
splenomegaly size
over 2 cm
