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Pediatric Cardiology; Congenital Pathology > Situs and Position/hemodynamics > Flashcards

Situs and Position/hemodynamics Flashcards

1
Q

Atrial situs refers to the

A

location /position of the atria and abdominal organs

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2
Q

“Atrial situs solitus” the arrangement is

A

right sided atrium
right sided trilobed lung
right side liver and gallbladder
left side stomach bubble, spleen, AO
Levocardia apex point to the left

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3
Q

“Atrial situs inverses” the arrangement is

A

Atria are transposed “mirror image”
left side systemic atrium
leftsided trilobed lung and liver
right-sided stomach and Aorta
cardiac apex pointed rightward

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4
Q

“Situs ambiguous” describes

A

everything in-between

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5
Q

Heterotaxy

A

Means different arrangement,
maybe right or left isomerism

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6
Q

Situs ambiguous with right isomerism

A

referred to asplenia or double right-sideness
bilateral trilobed lungs
bilateral right atria
no spleen
bilateral SVC
absent coronary sinus
TAPVR
intact IVC
midline liver

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7
Q

Situs totalis

A

refers to situs inversus totalis which means complete mirror image of all major organs in the chest and abdomen

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8
Q

How are the left and right atria best distinguished apart from one another?

A

by their appendage.

-Right atria appendage is broad base triangle shape
-left atria appendage is narrow and finger like

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9
Q

Situs ambiguous with left isomerism

A

Bilateral left sidedness
* bilateral left atrial appendages
* bilateral bilobed lungs
* polyspleens
* interruption of the IVC with azygos continuation
* ipsilateral pulmonary veins
* persistant LSVC

Absent Sinus node
atrioventricular septal defect
pulmonary outflow obstruction
congenital complete heart block

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10
Q

situs ambiguous with left isomerism is referred as

A

Polysplenia

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11
Q

situs ambiguous with right isomerism is referred as

A

asplenia

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12
Q

Azygos Vein

A

present during interrupted IVC.
-runs parallel to the AO
-takes flow back to the SVC

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13
Q

Right atria with right isomerism

A

Bilateral right sidedness
* bilateral RA appendage
* bilateral SVC (LSVC> LA)
* bilateral IVC (hepatic veins drain into LA )
* Absent (unroofed) coronary sinus
* TAPVR
* Bilateral trilobed lungs
* usually absent spleen

-Unbalanced AVSD- right dominate (think DORV)
-pulmonary outflow obstruction/ atresia
-ventricle - arterial connection abnormalities (DTGA)

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14
Q

Vertical Vein

A

connection between pulmonary veins to the innominate vein to SVC

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15
Q

What does septophobi and septophilic mean?

A

TV is septophilic, likes the septum
MV is septophobic needs to attach to the papillary muscle “phobia of septum”

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16
Q

Scimitar Vein

A

connects one or both of the right pulmonary veins to the IVC in the presence of PAPVR

Infracardiac PAPVR

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17
Q

What are the 3 types of viscero-atrial situs?

A
  1. solitus-normal
  2. inversus- mirrior image
  3. Ambiguous- often associated with splenic syndromes and cardiac isomerism

look at stomach bubble and liver, visceral(abdominal) situs and atrial situs are nearly always the same

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18
Q

Great vessel relations
name 5 types

A
  1. solitus- normal relation
  2. inverted- mirror image but normally related
  3. D-malposed- aortic valve lies to the right of PV (D-TGA)
  4. L-malposed- aortic valve lies to the left of the PV (L-TGA)
  5. A-malposed- aortic valve is directly anterior to the PV
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19
Q

Normal relation heart would be as follows
Abbreviations

A

S,D,S

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20
Q

Inverted normal heart segment abbreviation is

A

I,L,I

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21
Q

Cardiac position needs to clarify two points

A
  1. Where is the heart located in the chest cavity?
  2. Which direction does the apex of the heart point?
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22
Q

Levocardia

A

heart is in the left chest with apex pointed leftward and anteriorly and inferiorly

normal postion

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23
Q

Dextrocardia

A

the heart is in the right chest with the apex pointing to the right

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24
Q

dextroposition

A

Heart is in the right chest with the apex pointing leftward

Can cause hypoplastic right lung

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25
Q

mesocardia

A

midline position of the heart
(apex still slightly pointed to the left but is shifted more midline)

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26
Q

Lable the photo below

A

normal visceral(abdominal) situs

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27
Q

How much of the heart mass lies to the right of the midline of the chest?

A

1/3

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28
Q

What are the four sections of the mediastinum?

A
  1. Anterior mediastinum
  2. Posterior mediastinum
  3. middle mediastinum
  4. Superior mediastinum
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29
Q

What is the anterior mediastinum

A
  • borders sternum and ribs
  • includes fascia, lymph nodes, and vessels
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30
Q

What is the Posterior mediastinum

A
  • Border vertebral column
  • contains the thoracic DAO, trachea, and esophagus
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31
Q

What is the middle mediastinum

A

contains the heart, pericardium, and proximal origins of great vessels

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32
Q

What is the superior mediastinum

A

Bordered by the 1st ribs
contains aortic arch

33
Q

Atrial contractions contributes to __ % of ventricle filling?

34
Q

atrial contraction correlates with ___ wave on the EKG

A

P wave

atrial depolarization

35
Q

IVRT time begins with the ___ of the semilunar valves?

A

closure

proceeds ventricle “relaxation”

36
Q

IVRT time is affected by?

A

preload (left atrial pressure)
Age (increases with age)

37
Q

IVCT time begins with the ___ of the atrioventricular valves?

A

closure of mitral and tricuspid valve

proceeds Ventricle “contraction”

38
Q

IVCT time is affected by?

A

afterload dependant

39
Q

Afterload is a

A

refers to the pressure that the heart must work against to eject blood during ventricular contraction, essentially the resistance the heart faces when trying to pump blood out

40
Q

Preload is a

A

refers to the amount of stretch placed on the cardiac muscle fibers just before contraction, essentially representing the volume of blood filling the ventricle at the end of diastole

41
Q

Heart defects that significantly affect preload include

42
Q

Heart defects that significantly affect afterload include

43
Q

Starlings law

A

what enters the heart must leave the heart

44
Q

Ohm’s law

A

flow is dependant upon pressure and resistance

45
Q

What is normal pulmonary venous pressure?

A

mean of 2mmHg

46
Q

Only veins in the body to carry O2 blood are

A

Pulmonary veins

47
Q

Of the branch pulmonary arteries which is longer and what is it course

A

RIGHT
travels below the aortic arch, posterior to SVC, across the roof of the LA to the lungs

48
Q

Normal pulmonary artery pressure is

A

25/10mmHg

mean of 15

49
Q

The only arteries to carry deoxgenated blood in the body are

A

pulmonary arteries

50
Q

Sysytemic blood can be divided into

A

low-pressure venous return
and high-pressure arterial output

51
Q

Systemic venous return refers to

A

IVC and SVC
coronary sinus

52
Q

How is the SVC formed

A

right and left innominate veins

innominate veins are formed by same side subclavian vein and jugular vein
left side longer

53
Q

azygous vein recieves blood from the___
What does it drain into and what appearance does it give?

A

thoracic and abdominal walls and drains into the SVC
give the appearance of a “shepherds crook”

54
Q

Systemic venous pressure is normally

SVC/IVC, think what RA chamber pressures are

A

6mmHg

mean of 6mmHg

55
Q

Systemic arterial pressures are

think of normal BP and AO pressures

A

120/80mmHg

56
Q

LA pressure is

57
Q

LV pressure
and Ao pressures are?

A

LV- 120/7mmHg
AO- 120/80mmHg

58
Q

RA pressures

59
Q

RV pressures
and PA pressures are

A

RV 25/5mmHg
PA 25/10mmHg

60
Q

Oxygen saturation in the left heart is?
Oxygen saturation in the right heart is?

A

Left- 95%
right- 75%

61
Q

MS and TS can result in ___ preload due to ___

A

decrease preload and cardiac output due to reduced ventricle filling during diastle

MS- not as much flow getting to the LV

62
Q

semilunarvalve stenosis will result in ___ afterload

A

increased afterload

Flow can’t get out so therefore at the end of contraction there is more vol remaining in the LV

63
Q

TR and MR causes the afterload to ___

A

decrease

at the end of contraction there is less vol in the LV/RV because TR/MR happens during systole and will reduce the afterload at the end of contraction

64
Q

AI and PI causes the preload to ___

65
Q

Moderate VSD will effect what chamber

A

Left sided volume overload (LVE)

66
Q

Large VSD blood flow direction will be ___ during early systole and ___ during end systole.

A

Left to right
right to left

67
Q

Large PDA’s will have an affect on the ___ side of the heart

A

left side

there will be an increase in pulmonary venous return to the left side

68
Q

The ability of the heart to alter force of the ventricular contraction in response to increased ventricle volume is?

A

Frank-Starling realtionship

69
Q

Fractional area

A

change in LV area during systole
obtained in PSAX

naormal value 64%
+or- 16%

69
Q

Definition of fractional shortening
Normal values?

A

% of change in LV cavity dimensions from systole to diastole

nml= 25-46%

70
Q

stroke volume

A

amount of blood pumped in a single cycle

30-60mL

71
Q

Cardiac output

A

amount of blood pumped per minute

4-8 L/min

72
Q

Normal values for delta pressure/delta time

dP/dt

73
Q

Normal values for IVRT

A

60-80msec

diastolic measurement

74
Q

end systolic measurments occur at the
end diastolic measurments occur at the

A

Systolic: T-wave
Diastolic: onset of the QRS

75
Q

Contunity equation

A

“what goes in must come out”

CSA=(CSA LVOT)(VTI LVOT)
(VTI AV)

stroke volume

76
Q

Normal QP/QS

A

ratio of 1
abnormal >1.5

77
Q

Bernoulli equation

A

4V^2

determine preassure gradient across valves and shunts

Pediatric Cardiology; Congenital Pathology (14 decks)

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