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Ob/Gyne 2 > Module 12 : Fetal Cardiac Abnormalities > Flashcards

Module 12 : Fetal Cardiac Abnormalities Flashcards

1
Q

when does fetal heart development begin and what happens during that time

A
  • 5 weeks

- paired heart tubes form and fuse into a dingle heart

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2
Q

at what weeks do the heart chambers begin to develop

A

6-8 weeks

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3
Q

at what week is the heart fully formed

A
  • 10 weeks
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4
Q

when can we start to detect fetal heart beat

A

5-6 weeks

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5
Q

how does the blood flow from the placenta to the umbilical arteries

A
  • placenta&raquo_space; umB v&raquo_space; left portal V&raquo_space; ductus venosus&raquo_space; IVC&raquo_space; rt atrium&raquo_space; foramen ovale&raquo_space; lt atrium&raquo_space; lt ventricle&raquo_space; aorta&raquo_space; iliac artery&raquo_space; hypogastric artery&raquo_space; umbilical artery&raquo_space; placenta
    OR
    rt atrium&raquo_space; rt ventricle&raquo_space; pulmonary artery&raquo_space; ductus arteriosus&raquo_space; descending aorta&raquo_space; hypogastric artery&raquo_space; umbilical artery
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6
Q

what are 4 clinical indications for a fetal echo

A
  • abnormal fetal findings from a previous ultrasound
  • family history of a congenital heart defect
  • previous pregnancy wth a cardia abnormality
  • maternal disease associated with heart defects
    + type 1 diabetes
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7
Q

what are 7 fetal findings associated with heart defects

A
  • 2 vessel cord
  • congenital diaphragmatic hernia
  • omphalocele
  • thick nuchal fold or NT
  • hydrops
  • chromosomal abnormalities
  • bradycardia
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8
Q

what is the full fetal echo routine

A
  • situs with stomach and 4 chamber heart
  • 4 chamber heart
  • outflow tracts
  • 3 vessel view
  • aortic and ductal arch
  • short axis of ventricles and atria
  • SVC and IVC
  • pulmonary veins
  • doppler (inflows, outflows, ductus arteriosis, foramen ovale)
  • m-mode through an atrium and ventricle to rule out arrhythmias
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9
Q

what are the 3 vessels in the 3 vessel view and what should be there respective sizes

A
  • pulmonary artery (biggest or same as AO)
  • aorta (bigger than SVC or same as PA)
  • SVC (smallest)
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10
Q

what are 2 differences between the aortic arch view and the ductal arch view

A
  • aortic arch = three branches and candy cane

- ductal arch = no branches and hockey stick

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11
Q

how many heart defects are ruled out with 4 chamber heart image and how many when 3 vessels are added

A
  • 1/3

- 2/3

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12
Q

between what weeks is fetal echo the best performed

A

20-22 weeks to term

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13
Q

what is a normal heart rate for a fetus

A

120-160 is normal

+ 180 bpm in 1st trimester

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14
Q

what is considered bradycardia in fetus

A
  • < 100bpm

- due to heart block

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15
Q

what is considered tachycardia in fetus

A
  • > 200 bpm
    + decrease stroke volume
    + treated with digoxin to the mother
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16
Q

what is the most common arrhythmia in fetus we see

A
  • PAC

- usually benign

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17
Q

what is an atrial septal defect

A
  • partial or complete absence of interatrial septum
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18
Q

is it easy or difficult to diagnose ASD on US and why

A
  • difficult

- due to foramen ovale

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19
Q

what should be the normal size of the foramen ovale

A
  • no larger than aortic root
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20
Q

what is the best view to asses IAS

A
  • fetal subcostal
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21
Q

what is a ventricular septal defect (VSD)

A
  • complete or partial abscess of ventricular septum
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22
Q

what is the most common cardiac anomaly

A
  • ventricular septal defect
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23
Q

how many VSDs are associated with other anomalies

A
  • 50%
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24
Q

what is the best view to asses VSDs

A
  • subcostal 4 chamber and short axis of ventricle
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25
Q

what is the prognosis of VSDs

A
  • good

- many resolve on their own

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26
Q

what causes an atrioventricular septal defect AVSD

A
  • when the endocardial cushions fail to fuse early in embryology
  • end result is 1 common valve with 5 leaflets
  • aka = AV canal or endocardial cushion defect
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27
Q

what is a common chromosomal abnormality that occurs with AVSD 50% of time

A
  • T21
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28
Q

what is ebsteins anomaly and what is common ly associated with it

A
  • apical displacement of the tricuspid valve into the right atrium
  • hydrops and pulmonary stenosis and lithium ingestion
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29
Q

ultrasound appearance of ebsteins anomaly

A
  • large right atrium
  • apical displacement of tricuspid valve
  • small right ventricle (dysplastic)
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30
Q

what is hypo plastic right ventricle

A
  • secondary to pulmonary atresia with no VSD

- extremely uncommon compared to hypo plastic left ventricle

31
Q

what is the ultrasound appearance of hypoplastic right ventricle

A
  • difficult to see in inner chamber

- small or absent pulmonary artery

32
Q

what causes hypoplastic left ventricle

A
  • due to decreased flow into or out of the left ventricle
33
Q

sonographic appearance of hypoplastic left ventricle

A
  • small left ventricle
  • aortic stenosis or atresia
  • mitral valve atresia
  • associated with coarctation of the aorta
  • endocardial fibroelastosis (EFE) often seen as pregnancy progresses
34
Q

what is endocardial fibroelastosis EFE

A
  • from muscle hypertrophy
  • myocardium is replaced by collagen and elastic tissue
  • seen with hypoplastic heart syndromes
35
Q

ultrasound appearance of EFE

A
  • very thick echogenic and focally thick myocardium
36
Q

what does EFE cause

A
  • decreased cardiac function and congestive heart failure
37
Q

What does tetralogy mean

A
  • 4
38
Q

What 4 things are wrong in tetralogy of fallot

A
  • VSD
  • aorta overriding ventricular septum
  • hypertrophy of right ventricle
  • pulmonary stenosis
39
Q

What view is important to check with tetralogy of fallot

A
  • 3 vessel view
40
Q

What is truncus arteriosus

A
  • single large vessel arising from the base of the heart
41
Q

What structures are supplied by a truncus arteriosus

A
  • coronary arteries
  • pulmonary
  • systemic circulation
42
Q

Ultrasound appearance of truncus arteriosus

A
  • VSD
  • larger overriding aorta
  • pulmonary artery origins will vary off the aorta
43
Q

What is a double outlet right ventricle e

A
  • aorta and pulmonary artery arise from the right ventricle e
  • various positions of the aorta related to the pulmonary artery
  • VSD is common
44
Q

What two things is double outlet right ventricle associated with

A
  • maternal diabetes

- alcohol abuse

45
Q

What is transposition fo the great vessels

A
  • aorta arises from right ventricle
  • pulmonary artery arises from left ventricle
  • outflow vessels are parallel
46
Q
  • what are the 2 types of transposition of great vessel
A
  • complete = D loop (D for dextro)

- corrected = L loop (L for levo)

47
Q

What is D loop transposition/ complete

A
  • closed circuit
  • right atrium to right ventricle
  • oxygenated blood wont go to the head or the body
48
Q

Ultrasound appearance of D loop transposition

A
  • great. Vessels are parallel rather than crossing

- VSD

49
Q

Where does deoxygenated blood go to with D loop transposition

A
  • RA&raquo_space; RV&raquo_space; Ao&raquo_space; body/head
50
Q

Where does oxygenated blood go with D loop transposition

A

LA&raquo_space; LV&raquo_space; pulmonary artery&raquo_space; lungs

51
Q

What is L loop transposition

A
  • right ventricle is attached to the left atrium

- normal pulmonary to systemic circulation (O2 gets to the right spots)

52
Q

What structure should we look for with L loop transposition

A
  • look for moderator band
53
Q

Utrasound appearance of L loop transposition

A
  • parallel great vessels

- morphological right ventricle to morphological left atrium

54
Q

Do patients present with symptoms and why

A
  • usually asymptomatic throughout life then begin to show signs later in life
  • right ventricle does not have the same pumping ability as left ventricle does
55
Q
  • what is coarctation of the aorta
A
  • narrowing of the aortic lumen

- usually at isthmus

56
Q

Where is the isthmus in the aortic arch

A
  • area between the lt subclavian artery and descending aorta
57
Q

Ultrasound appearance of coarctation of aorta

A
  • prominent right ventricle
  • small left ventricle
  • narrowing in the aorta
58
Q

What two other anomalies is associated with coarctation of the aorta and what increases chance of this anomaly

A
  • AVSD and VSD

- maternal diabetes

59
Q

Are cardiac tumors common or uncommon

A
  • very rare
60
Q

What is the most common cardiac tumors

A
  • rhabdomyoma

- cardiac hamartoma

61
Q

Ultrasound appearance of cardiac tumors

A
  • solid echogenic tumors usually of the ventricular septum

- may obstruct outflows

62
Q
  • what are 4 differentials of cardiac tumors
A
  • cardiac fibromyalgia
  • hemangioma
  • myxoma
  • teratoma
63
Q

What is cardiomyopathy and what does it result in

A
  • muscle damage

- altered cardiac function

64
Q

What 4 things cause cardiomyopathy

A
  • viral infection
  • bacterial infection
  • metabolic disease
  • maternal type 1 diabetes
65
Q

What is ecoptia cordis and what is it associated with

A
  • heart outside of chest cavity

- pentalogy of Cantrell

66
Q

What characteristic must be met in order to diagnose an echogenic intracardiac focus (EIF) and what chromosomal anomaly is it associated with

A
  • have to be as bright as bone

- associated with Down syndrome

67
Q

What are 3 other names for cardiosplenic syndromes

A
  • isomerism
  • situ ambiguous
  • heterotaxia
68
Q

What is a cardiosplenic syndrome and what are the affected organs

A
  • symmetric development of normally asymmetric organs or organ systems
  • liver, lungs, stomach, heart
  • fetus has either two left sides or two right sides
69
Q

What is polysplenia

A
  • bilateral left sidedness
    + multiple spleens
    + left atrial isomerism (2 left atria)
    + 2left lungs
  • midline liver
  • IVC interruption (no IVC through liver)
    + renal to subhepatic segment to azygous vein to SVC
  • hepatics empty into right atria
  • heart points to right or is meso cardia (midline)
70
Q

What is asplenia (ivenmarks syndrome)

A 
- bilateral right sidedness
  \+ no spleen 
  \+ right atrial isomerism 
  \+ 2 right lungs 
- midline liver
- bilateral SVC
71
Q

Are heart defects with cardiosplenic syndromes worse with rt or lt isomerism

A
  • rt isomerism (asplenia)
  • extremely high incidence fo AVSD with asplenia
  • almost any defect associated with heterotaxia
72
Q

What are 5 common associated defects with isomerism

A
  • transposition fo great arteries
  • pulmonary stenosis or atresia
  • common atrium
  • total anomalous pulmonary venous return with asplenia
  • complete heart block
73
Q

Is it easy or hard to diagnosi isomerism on Ultrasound and what are 3 clues to help diagnose

A
  • very hard
  • interrupted IVC
  • large azygous vein
  • abnormal liver, stomach or heart position

Ob/Gyne 2 (19 decks)

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