Pediatric Terminology Lecture #1 Flashcards
The first organ to form in embryology is
the heart
in how many days does the heart become fully functional? what does the heart consist of at this stage?
18 to 19 days FROM THE MESODERM and begins beating and pumping blood about day 21 or 22
the heart. consist of a pair of strands called cardiogenic cords that quickly form a hollow lumen and are referred to as endocardial tubes
The fusion of the endocardial tubes (day 22) differentiate into these 5 things
- truncus arteriosus
- bulbs cordis
- primitive ventricle
- primitive atrium
- sinus venosus
Embryology between how many days
20-40 days
Paired vascular tubes results in
a single tube
Vascular tubes:
1. Aortic arches form what?
2. sinus venous forms what?
3. cardiac loop forms what?
- aortic arches form the great vessels, carotid, and pulmonary arteries and the ductus arteriosus
- sinus venous: forms the IVC/SVC, pulmonary veins, coronary. sinus, and posterior portions of RA
- Cardiac loop: forms primitive atrium, ventricle and bulbus cordis
D-looping is to the ________ (direction)
RIGHT (anatomically correct)
It is normal folding. The right ventricle is rightward and anterior to the left ventricle…
RIGHT ventricle is on the RIGHT side
When looping is reversed, it is referred to as
L-Looping
LEFT ventricle is on the RIGHT side
development of the right atrium The right atrium develops from most of the _______ and part of the ________.
primitive atrium, sinus venosus
The left sinus horn becomes the
coronary sinus
The right sinus horn becomes the
inferior vena cava
In abnormal development of the left sinus horn, it does not become the coronary sinus but instead becomes the
Left Superior Vena Cava
The left atrium develops from a small part of the _______ (_______). THEN… this grows toward the primitive left atrium
primitive atrium (sinoatrial orifice)
Then, the common pulmonary vein grows toward the primitive left atrium
development of pulmonary veins the pulmonary veins begin as a _________ entering the LA. As the LA grows, it absorbs the _____________, absorbing all the way to the _____ branches.
single vein, single pulmonary vein, four
This tube, made from the bulbus cordis and truncus arteriosus and allowing outflow from the heart, needs to be split in order to form the _________ and _________.
aorta, pulmonary trunk
What happens around the 5th week in regards to septation of the outflow tracts? what separates them?
Around the 5th week, ridges appear in the truncus and conus cordis, as swelling grow together they twist around each other.
Fusion* separates truncus into aorta and main pulmonary
Failure of aortopulmonary septum to separation gives rise to persistent
truncus arteriosus
formation of aortic arches the aortic sac gives rise to a total of how many pairs of arteries?
six pairs
formation of aortic arches which pair disappears at a very early stage?
fifth pair
formation of aortic arches what does the first arch contribute to?
maxillary, hyoid. and stapedial arteries (same as 2nd)
formation of aortic arches what does the second arch contribute to?
maxillary, hyoid, and stapedial arteries (same as 1st)
formation of aortic arches. what does the 3rd arch form?
common carotid artery and part of the proximal internal carotid artery
formation of aortic arches what does the 4th arch form?
right arch forms right subclavian artery
left arch forms part of aortic arch
formation of aortic arches what does 5th arch form?
either never forms, or forms incompletely and regresses
formation of aortic arches what does 6th arch form?
right arch forms right pulmonary artery
left arch forms left pulmonary artery and ductus arteriosus
In utero, the fetus has a ________ systemic resistance and a _______ pulmonary resistance.
LOW SYSTEMIC RESISTANCE
HIGH pulmonary RESISTANCE
in fetal circulation, the shunts are all (what direction)
right to left
ductus arteriosus is right to left
foramen ovale is right to left
what happens with the first breath? (4)
- pulmonary artery pressures drop
- O2 levels in aorta rise
- closes the ductus arteriosus
- increased pulmonary blood flow raises the LA pressure closing the foramen vale
post natal (after birth) the systemic circulation is ______ and the pulmonic circulation is _____.
systemic is high
pulmonic is low
situs means
site or position
solitis means
usual or normal
situs solitus
normal position
inversus means
opposite or reverse of normal
situs ambiguous
uncertain, indeterminant, what the heck???
normal situs… the normal arrangement for the organs… what is left sided?
what is right sided?
left sided: spleen, pancreas, stomach, sigmoid colon
right sided: liver, cecum, appendix
right main bronchus is short, left is longer
what are a few things that can go wrong with abdominal situ ambiguous
the abdominal organs are abnormally symmetric and inconsistent
spleen may be absent, liver may be midline, both lungs may both have 2 or 3 lobes
situs ambiguous is associated with
HETEROTAXY
with heterotaxy syndrome, the incidence is _____ births with a male to female ratio of _______
1 in 10,000 births
male to female ratio of 2:1
what is heterodoxy syndrome
a condition in which the internal organs are abnormally arranged in the chest and abdomen
it’s a collection of disorders usu involving the following organ systems (heart, stomach/intestine, spleen and liver)
Asplenia is more _________ than polysplenia
common
2 kinds of heterotaxy:
- right atrial isomerism/asplenia
- left atrial isomerism/polysplenia
right atrial isomerism / asplenia
refers to BILATERAL structures both of which have morphologic right characteristics, such as morphological right atrial appendages, morphological right bronchi, and bilateral tri-lobed lungs. Could have problems with valves and septal defects, particularly pulm valve… may also have pulmonary venous connections. spleen may be absent and the liver and other organs on other side of body
left atrial isomerism / polysplenia
refers to bilateral structures both of which have morphological left characteristics such as morphological left atrial appendages, left bronchi, and bilateral bi-lobed lungs. may have septal defects as well as problems with valves and the electrical system. Some have complete heart block. No spleen or many small spleens.
3 positions of heart in thorax
levocardia (think “L” is left)
mesocardia (think “M” for middle)
dextrocardia (think “D” that’s my name and I’m always “right”)
what is cardiac malposition
abnormal location of the heart relative to the position (situs) of the abdominal viscera
out of the 3 heart positions in the thorax, which one is normal
levocardia
2 kinds of dextrocardia
primary and secondary
whats the difference between primary and secondary dextrocardia
primary - due to a congenital heart defect. In primary dextrocardia the apex usu. points to right
secondary - heart is pushed or pulled toward the right due to an extracardiac abnormality (emphysema, hernia) Apex may point to the left or right
atrial situs ambiguous… there is no_______. What else… any other involvements with vessels?
commonly there is ONE atria due to NO septum. IVC can be interrupted. Can be. bilateral SVC. Coronary sinus can be unroofed (meaning IVC drains into coronary sinus and may look like IVC/LA connection)
***can’t use pulm. veins to identify left atrium bc could. drain into something else
ventricular concordance, av concordance is.
normal
disconcordance is abnormal *study images
what is. the infundibulum
it is the connecting segment between the ventricles and the great arteries
smooth-walled portion of right ventricle directly below pulmonary valve
aorticopulmonary septum: division b between aorta and pulm trunk formed from the bulbar ridges
IVC is usu ______ and to the right of the _______
anterior, aorta
levocardia is normal heart position. true or false
true
The shunts are all ______ to _______ in utero
right to left
resting HR for EKG pediatrics
90-190 bpm
transdx for newborn, what frequency
7.5 Mhz or higher… 12 is ideal
- for comparison, teenage to adult is 2-2.5 MHz
atrial shunting can be best evaluated from what view(s)
subxiphoid (subcostal) long-axis or short-axis views of atrial septum (bicaval)
patency of IVC in what view
subcostal long axis
high left parasternal ductal view how to get
high parasternal about one rib space up from the PA view…. from PLAX view rotate transdx 30-45 degrees counterclockwise… this aligns beam with ductus for patent ductus arteriosus view
the pulmonary artery sits _____ and _____ to the aorta
anterior and to the left (anatomical)
in older adults over 60, what gland atop the heart is mostly replaced by fat
thymus
the left atrial appendage can often be mistaken for the
left upper pulmonary vein
the pulmonary veins are best evaluated in what view
a high left parasternal or suprasternal short axis view (crab view)
USU do not measure what function in children.
left ventricular
for linear measurements in children, where should you. measure for LV internal diameter
Short axis @ MV leaflet tips
As opposed to adults, parasternal long axis views are recommended instead
LA volumes measured at what part of cardiac cycle
end-systole before MV opens
Most. common spot for an aortic arch coarctation
aortic isthmus
Measurement. of arterial vessels should be made at what point. in cardiac cycle
during mid-systole or at their most expanded
endocarditis of Lupus involves typically what valves
MV and TV
Myocardial toxicity in it most severe form causes
potentially fatal CHF
Most frequently associated cardiac abnormality with muscular dystrophy is
cardiomyopathy either Duchenne (CM) or Becker’s (DM)
Lupus can manifest as these conditions of the heart
myocarditis
pericarditis
endocarditis
rheumatic fever commonly affects what valves and can cause what
AoV and MV
can cause myocarditis with impaired function
lutembacher syndrome is a combo of
mitral stenosis and left-to-right atrial shunt (can be. congenital or acquired)
other than the subcostal view, what other view is great to see the pulmonary veins
suprasternal
