Trans - Adult and Pediatric Structural and Functional Correlates Flashcards
difference between adult and pediatric cardiac diseases
[1] adult - acquired cardiac diseases (eg. coronary heart disease
[2] pediatric - congenital cardiac diseases
coronary artery balloon angioplasty
procedure used to open blocked coronary arteries wherein a balloon is inserted into the artery via catheter and inflated
adult heart rate
60-100 bpm
newborn heart rate
110-150 bpm
heart rate in 2yr child
85-120 bpm
heart rate in 4yr child
75-115 bpm
heart rate in 6 yr child
60-100 bpm
CT ratio of pediatric
0.55
[T/F] newborns cannot increase stroke volume
T
newborn cardiac output is depended on?
heart rate
effect of thymus in chest xray
enlarged cardiac shadow
main difference of fetal and adult circulation
site of gas exchange
umbilical vein
entrance of oxygenated blood from placenta into the fetus
ductus venosus
shunts blood from umbilical vein away from liver into the IVC
foramen ovale
connects LA and RA to allow bypassing of pulmonary circuit
ductus arteriosus
connects pulmonary trunk and aorta to allow bypassing of pulmonary circuit
umbilical arteries
exit of deoxygenated blood from fetus into placenta
consequences of interruption of umbilical cords upon birth
[1] increase in systemic vascular resistance –> closure of ductus venosus
consequences of lung expansion upon birth [4]
[1] fall in pulmonary vascular resistance
[2] increased pulmonary blood flow
[3] increased LV pressure –> closure of foramen ovale
[4] increased blood O2 content –> closure of ductus arteriosus
what causes ductus venosus closure
increased systemic vascular resistance
what causes foramen ovale closure
increased LV pressure upon lung expansion
what causes ductus arteriosus closure
increased blood pO2 upon lung expansion, causing contraction of the smooth muscle
fate of ductus venosus
ligamentum venosum
fate of ductus arteriosus
ligamentum arteriosum
fate of formen ovale
fossa ovalis
fate of umbilical arteries
medial umbilical ligaments
fate of umbilical vein
ligamentum teres
incidence of congenital heart disease
4-8 per 1000 live births
Baltimore-Washington infant study - conclusions
frequency of certain cardiac defects varies according to gender:
[1] males - TGA, AV stenosis, tricuspid atresia
[2] females - AV canal defects, ASD, VSD
environmental factors causing congenital heart disease [2]
[1] maternal illness / infection
[2] drug exposure
[T/F] late cardiac defects are more critical
F, it is early cardiac defects which are more critical
examples of early cardiac defects [5]
[1] laterality and looping defects [2] cardiac outflow tract defects [3] AV septum defect [4] VSD membranous type [5] TAPVR
examples of late cardiac defects [6]
[1] VSD muscular type [2] obstructive lesions [3] ASD [4] PDA [5] Ebstein's malformation of tricuspid [6] cardiomyopathies
examples of acyanotic heart disease [2]
[1] left to right shunt
[2] obstructive lesions
examples of cyanotic heart disease [3]
[1] right to left shunt
[2] transpositions of great vessels
left to right shunt - effects
[1] increased pulmonary blood flow
[2] pulmonary hypertension –> congestive heart failure
[3] RV hypertrophy
right to left shunt - effects
[1] reduction in pulmonary blood flow –> cyanosis
Tetralogy of Fallot
[1] pulmonary stenosis
[2] overriding aorta
[3] RV hypertrophy
[4] VSD
Ebstein’s anomaly
Downward displacement of an abnormal tricuspid valve into the right ventricular cavity. Part of the right ventricle is thus incorporated into the right atrium (atrialized right ventricle) and the remaining ventricular cavity is malformed and reduced.
why are complex lesions called complex lesions?
these lesions involve mixing of pulmonary blood flow and systemic blood flow as a result of complex interactions between systemic vascular resistance and pulmonary vascular resistance
obstructive lesions - effects
[1] pressure overload on ventricle –> hypertrophy
[2] low cardiac output
tachypnea
pulmonary overcirculation
Eissenmenger’s syndrome
the process in which a left to right shunt causes increased flow through the pulmonary vasculature, causing pulmonary hypertension, which in turn causes increased pressures in the right side of the heart and reversal of the shunt into a right-to-left shunt.
ostium secundum defects
interatrial communications within fossa ovalis
ostium primum defects
partial AV septal defect
ASD - general direction of flow? why?
left to right, LA pressure is higher
[T/F] there is faster flow through a VSD if pulmonary stenosis is absent
F
difference of partial and complete AVSD
partial AVSD still has 2 valve orifices, complete AVSD only has 1 valve orifice (abnormal valve arrangement)
partial AVSD is physiologically similar to
ostium secundum ASD
PDA - effects
[1] increased pulmonary blood flow –> decrease in lung compliance
[2] increased pulmonary return –> hypertrophied / dilated LV
[3] continuous murmur
methods of closure for PDA
[1] coil closure
[2] device closure
types of pulmonary stenosis
[1] valvar
[2] supravalvar
[3] subvalvar / infravalvar
[4] branch peripheral –> stenosis of left, right, or both pulmonary arteries
pulmonary stenosis defect develops during first __ weeks of pregnancy
8
aortic stenosis - effect
[1] decreased cardiac output
[2] left ventricle hypertrophy –> may lead to chest pain
how does aortic stenosis often occur in adults?
deposition of calcium in the valve (calcific aortic stenosis)
coarctation of aorta - effects
[1] hypertension (high BP before point of coarctation, low BP beyond point of coarctation)
Blalock-Thomas-Taussing Shunt
treatment for Tetralogy of Fallot –> anastomosing pulmonary artery with subclavian artery, bypassing pulmonary stenosis
pulmonic atresia
pulmonic valve is replaced by a solid sheet of tissue (valve stays closed) –> closed pulmonary circuit
Ebstein’s anomaly - effects
[1] poor development of tricuspid valve –> tricuspid regurgitation
[2] backing up of blood –> RA dilation, fluid buildup in heart
[3] poor pumping of RV –> not enough oxygen –> cyanosis
tricuspid atresia
tricuspid valve is missing –> blockage of blood flow from RA to RV
tricuspid atresia - effects
[1] hypoplastic RV –> underwork
tricuspid atresia usually comes with these other defects:
[1] ASD
[2] VSD
[3] pulmonic stenosis
treatment of tricuspid atresia
Blalock-Thomas-Taussig Shunt
most common cyanotic congenital heart defect
transposition of great arteries
truncus arteriosus
[1] truncus arteriosus instead of pulmonary trunk and aorta
[2] overrides both ventricles
[3] large VSD
TAPVR
total anomalous pulmonary venous return
[1] pulmonary veins connect / lead to right atrium
[2] ASD present
OPQRST
onset precipitating/aggravating factors quality radiation severity timing
precordial bulge indicates:
cardiomegaly
vibratory / still’s murmur
innocent murmur in children caused by small ascending aortic diameter
innocent pulmonic murmur
continuous venous hum, louder in diastole
long term effect of cyanosis
hypoxemia –> tissue death
causes of cyanosis
[1] right to left shunt
[2] decreased pulmonary blood flow
[3] ventriculoarterial discordance {TGA}
[4] low cardiac output
congestive heart failure
clinical condition wherein the heart cannot meet the metabolic demands of the body
Harrison’s groove indicates
congestive heart failure
in fetal circulation, fraction of blood flowing through RV
2/3
in fetal circulation, fraction of blood flowing through foramen ovale
1/3
