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Joeli lectures > General cardiac circulation and murmurs > Flashcards

General cardiac circulation and murmurs Flashcards

1
Q

when does a fetal heart beat begin?

A

4th week of gestation

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2
Q

4 major functions of placenta

A

gas exchange (lungs)
nutrition (GI tract, liver, kidneys)
waste removal (liver, kidneys)
fluid and electrolyte balance (kidneys)

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3
Q

function of shunts in fetal circulation

A

blood bypasses certain areas to make oxygen and nutrition delivery and waste removal more efficient

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4
Q

Placenta (circulatory shunt)

A

blood from iliac arteries form paired umbilical arteries
shunts blood away from lower extremities and GI and into the placenta
deoxygenated blood

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5
Q

Ductus venosus (circulatory shunt)

A

shunts blood from umbilical vein to the IVC directly, bypassing the liver
placenta –> umbilical vein –> ductus venosus –> IVC –> right atrium
oxygenated blood

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6
Q

foramen ovale (circulatory shunt)

A

shunts blood from right atrium to left atrium
~1/2 of blood that comes from IVC crosses the right-to-left shunt
allows oxygenated blood to bypass the lungs to be used in systemic circulation (placenta does oxygen transfer so doesn’t need to go to lungs)

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7
Q

Ductus arteriosus (circulatory shunt)

A

shunts blood from pulmonary artery to aorta
right-to-left shunt
remains open due to relaxation facilitated by PROSTAGLANDINS
large portion of blood entering pulmonary artery shunts to aorta > 80%

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8
Q

In cardiac septa development, what can lead to ASD

A

septa primum, septa secundum, foramen secundum

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9
Q

in cardiac septa development, what can lead to VSD

A

membranous septum most commonly

could also be interventricular muscular septum

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10
Q

Anatomic changes

A

Ductus venosus –> ligamentum venosum
Umbilical arteries –> medial umbilical ligament/fold
Umbilical vein –> ligamentum teres (runs w falciform ligament)
Ductus arteriosus –> ligamentum arteriosum

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11
Q

Stenotic murmur

A

valves that should be open but are partially closed

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12
Q

regurgitation murmor

A

valves that should be closed but aren’t

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13
Q

what valves should be open during systole (ventricular contraction)?

A

pulmonary and aorta

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14
Q

what valves should be closed during systole (ventricular contraction)?

A

mitral and tricuspid

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15
Q

what valves should be open during diastole (ventricular relaxation)?

A

mitral and tricuspid

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16
Q

what valves should be closed during diastole (ventricular relaxation)?

A

pulmonary and aortic

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17
Q

Why is PDA a continuous murmur?

A

there is always some blood in that area (pulmonary and aorta)

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18
Q

Preload

A

end diastolic volume - volume of blood in the ventricles prior to ejection

19
Q

Afterload

A

resistance that must be overcome for ventricles to eject blood

20
Q

Pressures

A

LV pressure > RV pressure
Aortic pressure > Pulmonary artery pressure
LA pressure > RA pressure

21
Q

Valsalva

A

decreases venous return, decreases end diastolic volume, decreases stroke volume

22
Q

Valsalva effects on pulmonic and aortic stenosis

A

decrease in murmurs due to decrease in volume of flow from ventricles through valves

23
Q

valsalva effects on VSD sound

A

decrease in volume of flow leads to decrease of shunting

24
Q

Valsalva effects on hypertrophic cardiomyopathy

A

decrease end diastolic volume leads to decreased stretching leads to decrease in LV outflow tract size which leads to increased intensity of murmur

25
Q

Increase in venous return equals

A

increase in preload

26
Q

increase in SVR (systemic vascular resistance) equals

A

increase in afterload

27
Q

How does squatting affect mitral regurgitation

A

increase after load and preload which leads to an increase in back flow pressure which leads to an increase flow across regurgitant valve

28
Q

how does squatting affect VSD

A

increase preload and after load which leads to increased shunting

29
Q

how does squatting affect aortic regurgitation

A

increased after load which leads to increased regurgitation during diastole

30
Q

how does squatting affect hypertrophic cardiomyopathy

A

increased end diastolic volume which leads to stretching of the ventricle which causes a larger outflow tract which leads to decrease outflow stenosis

31
Q

What does inspiration/expiration NOT affect?

A

mitral valve prolapse and HOCM

32
Q

PDA murmur

A

continuous machinery like murmur at left upper sternal border through systole and diastole

33
Q

PDA complications

A

increased flow to lungs through pulmonary arteries leads to increased venous return to LA and LV which leads to increased heart workload

increased RV pressure over time

34
Q

Murmur of ASD

A

crescendo-decrescendo systolic ejection murmur
wide fixed splitting of S2

both are due to increased pressure/volume in pulmonic

35
Q

VSD murmur

A

loud, harsh, holosystolic murmur

systolic thrill left lower sternal border with radiation to neck

36
Q

why may a VSD not be audible on a neonate?

A

pressures are similar in a neonate

37
Q

VSD complications

A

shunting occurs during systole when RV is contracting
increased blood volume into pulmonary artery which leads to increased PVR which leads to increased venous return to LA and LV which causes hypertrophy of LV

38
Q

What will you see on chest x-ray on Eisenmenger?

A

enlarged pulmonary artery

39
Q

Murmur of coarctation of aorta

A

systolic ejection murmur due to rapid blood flow through narrowing

40
Q

coarctation of aorta on chest x-ray

A

3’s sign

rib notching

41
Q

4 main defects in tetralogy of fallot

A

VSD
pulmonary stenosis
overriding aorta
RV hypertrophy

42
Q

Chest x-ray tetralogy of fallot

A 
Boot shaped 
right aortic notch
upturned apex due to RVH
hyperinflation of lungs
decreased pulmonary vasculature
43
Q

pAtria > pVentricles –>

A

mitral and tricuspid are open during mid-late ventricular diastole

44
Q

pArterial < pVentricles –>

A

aorta and pulmonary valves are open during ventricular systole

Joeli lectures (18 decks)

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