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Pathology-Cardio > Principles of congential heart disease > Flashcards

Principles of congential heart disease Flashcards

1
Q

valves are

A

passive blockers of blood flow

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2
Q

principles of congenital heart disease

A 
fetal circulation
development of heart
determinants of flow
cyanosis
adaptations to abnormal flow
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3
Q

fetal circulation

A
  • one umbilical vein carrying oxygenated blood and 2 umbilical arteries returning de-oxygenated blood
  • flow into heart right to left
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4
Q

what does the PDA allow for?

A

some blood flow to lungs

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5
Q

what closes the ASD in fetal circulation?

A

natural valve mechanism closes ASD after birth with increases pressures on left

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6
Q

tardive cyanosis

A

when de-oxygenated blood is on the left side of heart because of high pressure on right side of heart-> cause cyanosis

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7
Q

when should congenital heart diseases be fixed before?

A

do it before get irreversible pulmonary HTN

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8
Q

things that cause early cyanosis (flow from right to left)

A

all start with a T

  • tricuspid atresia
  • tetralogy of fallot
  • truncus ateriosus
  • transposition of the great arteries
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9
Q

development of heart

A

starts as tube-> requires 6 important developmental steps

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10
Q

separation of right heart from left heart: natural structures

A

septum primum, secundum

ventricular septum

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11
Q

abnormalities

A

ASD

VSD (is less than 1cm, not clinical)

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12
Q

most common abnormality

A

VSD

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13
Q

separation of atria from ventricles

A

tricuspid valve

mitral valve

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14
Q

abnormalities of separation of atria from ventricles

A

tricuspid atresia/stenosis

-atresia meaning lack of development

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15
Q

division of pulmonary and arterial outflow

A

pulmonic valve

aortic valve

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16
Q

abnormalities of division of pulmonary and arterial outflow

A

pulmonic stenosis
aortic stenosis
truncus arteriosus
transposition of great arteries

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17
Q

development of junction between valves and ventricular wall abnormalities

A

tetralogy of fallot

endocardial cushions defects (seen in down syndrome)

18
Q

closing of ductus arteriosus normally

A

closes when PG no longer synthesized-> treat with PGE to keep it open

19
Q

what is given to close persistent PDA?

A

aspirin

20
Q

cyanosis involved with PDA?

A

involves toes, not fingers

21
Q

abnormalities of aortic arch

A

-coarctation of aorta
infantile pre-DA: not enough blood to upper body
adult form post-DA: not enough blood to lower part of body

22
Q

what determines flow

A

pressure

23
Q

flow before birth?

A

right to left

24
Q

flow after birth?

A

left to right

25
Q

what does flow from right to left result in?

A

cyanosis

-only occur if there is a non-valve opening and pressures on the right are greater than pressures on the left

26
Q

what are some potential openings that can cause cyanosis?

A

atrial septal defect
VSD
PDA

27
Q

what results in early cyanosis

A

flow from right to left

-mixing of blood in right and left circulations from birth, abnormalities force right to left flow

28
Q

what determines late cyanosis

A

when flow is initially from left to right, but later changes from right to left
-no cyanosis early on, cyanosis after reversal-> takes years and results only after irreversible pulmonary HTN has developed

29
Q

what don’t respond well to increased volume or pressures?

A

RV and pulmonary artery

-with time pulmonary artery pressures increase and flow reverse

30
Q

when are openings in fetal heart important?

A

sometimes openings must exist for baby to survive

  • blood can only get to lungs two ways
  • oxygenated blood can get to left side of heart in four ways
31
Q

what are the two ways blood gets to lungs?

A
  1. thru pulmonic valve or

2. thru a PDA

32
Q

what are the four ways oxygenated blood gets to left side of heart?

A
  1. through LA
  2. ASD
  3. VSD
  4. PDA
    - routes limited by flow considerations
33
Q

when is repair done with early cyanosis?

A

RIGHT AWAY

34
Q

when is repair done with late cyanosis?

A

until child is older

35
Q

when must a repair be done before?

A

pulmonary HTN

36
Q

main features of abnormalities?

A

cyanosis and exercise intolerance

37
Q

what do they clinical features of abnormalities depend on?

A

mixing of oxygenated and un-oxygenated blood

38
Q

what can result from right to left flow?

A
  • emboli
  • infection/abscess
  • elements of blood can gain access to the systemic circulation and CNS without being filtered out in the lungs
39
Q

incidence of heart abnormalities

A
  • 6-8/1000 live births

- higher in pre-mature births

40
Q

epidemiology

A

> 90% unknown
5% chromosomal abnormalities
2-3% hereditary syndrome
<1% rubella ( PDA, pulmonic valvular or arterial stenosis, aortic stenosis, tetralogy of fallot, VSD, cataracts, deafness, microcephaly)
-excessive cigarette smoking, alcohol, thalidomide

41
Q

chest trauma can

A

tear ligamentum arteriosum

Pathology-Cardio (11 decks)

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