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Echo 3 > M2: Cardiac Situs/Segmental Approach > Flashcards

M2: Cardiac Situs/Segmental Approach Flashcards

1
Q

define segments

A

describes the anatomical structures that the cardiovascular system is divided into for the purpose of evaluation….

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2
Q

which areas do segments refer to

A

includes the systemic, pulmonary veins, atria, ventricles and great arteries

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3
Q

define connections

what do they include

A

describes the anatomical sequence of structures

veno-atrial, atrial-ventricular, ventricle-arterial
venous to atria, atria to ventricle, ventricle to great arteries

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4
Q

define concordant

and discordant

A

describes the normal sequential relationship b/w the hearts chambers, valves and great vessels

abnormal sequential relationship b/w chambers, valves and great vessels

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5
Q

another term for concordant

A

appropriate

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6
Q

define commitment

A

describe the degree of abnormality of flow through valves into ventricles and great arteries… assigned based on the 50% rule… If more than 50% of a valve over rides a VSD its said to be committed

eg. a valve which overrides a large VSD is committed to more than 1 ventricle

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7
Q

define inlet/outlet abnormalities

A

inlet: anomalies of structure and flow into the ventricles
outlet: anomalies of structure and flow out of the ventricles

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8
Q

what is the segmental approach to CHD

A

systemic approach to define and characterize CHD, focuses on segments of the heart and connections b/w them - old system focused on associated abnormalities

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9
Q

3 steps to the the segmental approach to CHD

A
  1. visceral atrial situs + connections
  2. orientation of ventricles + connections
  3. orientation of great vessels + connections
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10
Q

describe step 1 of the segment approach to CHD

which view do you start with

A

refers to the position of the atria in relation to the nearby anatomy… identify which way the apex is pointing, identify atria and relate to surrounding structures

subcostal

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11
Q

describe cardiac situs for the atria

3 types

A
  1. situs solitus - morphological RA is to the Right side of the morph LA
  2. situs inversus - morphological RA is to the LEFT side of the morph LA
  3. situs ambiguous - cannot tell which atria is which
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12
Q

define morphological and functional

A

morphological - has morphologic features of that chamber

functional - functioning as a different chamber

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13
Q

describe cardiac situs for heart within the chest

which way is the apex pointing

A

dextroposition - most of the heart lies to the R of the sternum
mesoposition - most of the heart lies directly under the sternum
levoposition - most of the heart lies to the L of the sternum (NORMAL)

apex may still point to the L in any of these cases

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14
Q

describe cardiac situs for apical direction

A

dextrocardia - apex points to the R side of body
mesocardia - apex lies under sternum
levocardia - apex points to the L side of body (NORMAL)

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15
Q

how to identify and document dextrocardia

A

start w/ TRX subcostal sweep and look at direction of atria and vent, determine visceral situs, position patient according to which direction apex points.

label Rt chest for Dr

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16
Q

prevalence of dextrocardia

A

1:12000

17
Q

term used if all organs are mirrored

A

dextrocardia situs inversus totalis

18
Q

dextrocardia patients (heart only) are prone to which conditions

why

A

esophageal, bronchial or cardiopulmonary disorders such as lung infections, sinus infections and pneumonia… may have difficulty breathing, cyanosis, fatigue, failure to thrive

due to abnormal cilia in the lungs

19
Q

does isolated dextrocardia usually have symptoms

A

no

20
Q

dextrocardia patients (heart only) are at risk for which congenital cardiac anomalies

A

endocardial cushion defect
pulmonary stenosis
double outlet RV

21
Q

which venous segments need to be evaluated for abnormal connections

A

HPV, IVC, SVC, coronary sinus, pulmonary veins

22
Q

what are the 2. venous-atrial connections

A

systemic venous return - SVC IVC

pulmonary venous return - Pul veins

23
Q

defining features used for atrial assignment - RA

A 
Eustachian valve
IVC/SVC
coronary sinus
chiari network
RA appendage - pyramide shaped/pointed many pectinate muscles
24
Q

what is the Eustachian valve

A

remnant valve that directed 02 rich blood from the RA to the foramen ovale in the fetus

25
Q

defining features used for atrial assignment - LA

A

pulmonary veins

LAA - finger like shape, few pectinate muscles

26
Q

what might be required to definitively assign atrial

A

TEE

27
Q

how can you tell if there are concordant atrioventricular connections

A

look in A4CH at the crux of the heart, TV is always attached more apically then MV… TV always associated w/ RA and MV always wth LV

28
Q

defining features used for ventricular assignment - RV

A 
present shaped
TV ( 3 leaflets)
large apical trabeculations
multiple sm pap muscles
moderator band
septal leaflet apically displaced
29
Q

defining features used for ventricular assignment - LV

A 
bullet shape
MV (2 leaflets)
2 pap muscles
may have false tendons
inlet and outlet valves in continuity
30
Q

3 abnormal variations of AV connections

A
  1. bi-ventricular - one atria connected to both (2) ventricles
  2. uni-ventricular - both (2) atria connected to one ventricle
  3. common - atria connected to both ventricles through a single multi-leaflet structure
31
Q

what 3 things should you look for when assessing the concordance of the ventriculo-arterial connections

A
  • fibrous continuity b/w the AV and MV
  • look for over riding vessels
  • assess spatial relationship of AV/PV in SAX
32
Q

3 abnormal variations of VA connections

A
  1. Transposition of the Great Arteries - main PA arises from the LV and AO from the RV
  2. double outlet RH - both great arteries arise from RV or LV (RV usually)
  3. single outlet connection - truncus arteriosus - one great artery coming from the base of the heart
33
Q

define pulmonary and systemic ventricle when abnormal connections are present

A

pulmonary - whichever ventricle is pumping into the PA

systemic - whichever ventricle is pumping into the AO

Echo 3 (3 decks)

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