Fetal Heart Flashcards
What is a normal fetal HR? (doesn’t say a specific GA)
120-160 or 180 bpm
Which heart chamber is closest to the spine?
LA
Where is the foramen ovale located?
LA
Which valve is closer to the apex of the heart?
Tricuspid
What can a 3VV enable the diagnosis of?
coarctation of the aorta right aortic arch double aortic arch (tetralogy of fallot) absence of a great artery truncus arteriosus transposition of the great arteries
What are 4 findings that are associated with Tetralogy of Fallot?
VSD
misplaced aorta
pulmonary valve stenosis
thickened muscle wall
What is the transposition of the great arteries?
aorta-right ventricle
PA-left ventricle (4-7% of heart defects)
simple transposition can be successfully treated with arterial switch operation within the first week of live
What is truncus arteriosus almost always associated with?
VSD
What is truncus arteriosus?
single trunk supplies both the pulmonary and systemic circulation
does not cause hemodynamic problem in uterus, but is a major problem postnatally (80% death rate in first year)
In the 3VV and trachea view, should the trv aortic arch and ductal arch be similar sizes? If not, which one should be larger?
Same size
Which sagittal view looks like a candy cane?
aortic arch
Which sagittal view looks like a hockey stick?
ductal arch view
ductus arteriosus
What is the leading cause of infant mortality?
congenital heart disease
incidence of 4-13 per 1000 live births
What are indications for a fetal echo? (11)
abnormal heart on screening hydrops polyhydramnios fetal arrhythmia chromosomal anomalies family hx maternal disease (diabeetus) teratogen exposure inc NT monitoring for intrauterine therapy monitoring for persistant tachyarrhytmia, hydrops
What sets the rhythm of the heart?
natural pacemaker of the heart called sinoatrial (or sinus) node
Where is the sinoatrial node located?
wall of RA
When is irregular rhythm most common?
3rd trimester
Most irregular rhythms are due to what?
premature atrial contractions (PAC’s)
Irregular rhythm is the most common arrthymia. True or false
true
Occasional skipped beats can be associated with an increased risk of heart disease. True or false
false
If a fetus has arrhythmia’s, when are they expected to disappear?
spontaneously near term or shortly after birth
Fetal bradycardia is a HR of
<100 bpm (sustained)
Mild bradycardia is transiently observed in the ___ trimester.
2nd
Sustained bradycardia required timely evaluation for a possible _____ ______.
heart block
interference w/ the transfer of the electrical nerve impulses (conduction) that regulates the normal, rhythmic, pumping action of heart muscle
What can be an indicator of 3rd trimester fetal distress?
repetitive heart rate decelerations
Which arrhythmia has the most liklihood to be associated with a structural heart abnormality?
bradycardia
What’s the most frequently associated structural defect seen with bradycardia?
atrioventricular canal defect
In tachycardia, HR is?
> 180bpm
What is tachycardia associated with?
congestive heart failure and hydrops
Levocardia:
normal cardiac position
Dextrocardia:
bulk of heart is in the anterior right chest and cardiac axis is reversed
Dextroposition:
heart is displaced to the right side by maintains normal apical axis
81% mortality rate
Ectopia Cordis:
heart is located outside the thoracic cavity
results in the failure of fusion of the lateral body fold in the thoracic region
Ectopia cordis is classified into 4 types, what are they and which one is most common
thoracic 60%
abdominal 30%
thoracic abdominal 7%
cervical 3%
Thoracic ectopia cordis
heart is displaced from thoracic cavity through a sternal/anterior chest wall defect
Abdominal ectopia cordis
heart is displaced into the abdomen through a diaphragmatic defect
Thoracic abdominal ectopia cordis
heart is displaced from the chest through a defect in the lower sternum with an associated diaphragmatic or ventral abdominal wall defect
Cervical ectopia cordis
heart is displaced in the neck area
Ectopia cordis can be associated with Pentalogy of Cantrell. What is that?
condition characterized by a sternal cleft, ventral diaphragmatic hernia, omphalocele, intracardiac anomalies and ectopia cordis.
prognosis is poor
Atrial Septal Defects (ASD):
results from an error in the amount of tissue reabsorbed or deposited in the interatrial septum
Ventricular septal defect (VSD):
most common cardiac anomaly that’s associated with chromosomal abnormality and diabetes mellitus
high recurrence rate
Which septal defect has a high association with teratogen exposure
ventricular
Atrioventricular septal defect is also called:
endocardial cushion defect
AVSD:
defect in the lower position of the atrial septum and upper portion of the ventricular septum
AVSD’s are most commonly associated with
Tri 21
What are the types of AVSD
complete, partial transitional
Complete AVSD:
defects in all structures formed by the endocardial cushions. Valves remain undivided or “common”
Partial/Incomplete AVSD:
part of the ventricular septum formed by the endocardial cushions has filled in
mitral and tricuspid valves are divided into 2 distinct valves
primarily in the atrial septum and mitral valve
Partial/Incomplete AVSD is also referred to as
ostium primum atrial septal defect
usually associated with a cleft that may cause the valve to leak
Transitional type AVSD:
similar to complete, but leaflets of the common AV valve are stuck to the ventricular septum
this divides the valve into 2 valves and closes most of the hole between ventricles
