Aortic Valve Stenosis Quiz
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Questions and Answers

What are some symptoms of heart failure?

Breathlessness, sweating, poor feeding, recurrent chest infections.

What are some signs of heart failure?

Poor weight gain or faltering growth, tachypnoea, tachycardia, heart murmur, gallop rhythm, enlarged heart, hepatomegaly, cool peripheries.

What percentage of infants with significant cardiac disease have extracardiac anomalies?

25%

Are extracardiac anomalies often multiple or single?

<p>Multiple</p> Signup and view all the answers

What percentage of infants with extracardiac anomalies have an established syndrome?

<p>One-third</p> Signup and view all the answers

Which body system is most frequently affected by extracardiac anomalies?

<p>Musculoskeletal system</p> Signup and view all the answers

Does the presence of an extracardiac anomaly increase or decrease the mortality in infants with CHD?

<p>Increase</p> Signup and view all the answers

What should be understood about the difference between fetal circulation and adult circulation?

<p>The difference between fetal circulation and adult circulation should be understood.</p> Signup and view all the answers

What should be described about the common congenital cardiovascular abnormalities?

<p>The common congenital cardiovascular abnormalities should be described.</p> Signup and view all the answers

What should be demonstrated about the management of a congenital cardiovascular disease?

<p>A basic understanding of the management of a congenital cardiovascular disease should be demonstrated.</p> Signup and view all the answers

What is the importance of anastomoses between the coronary arteries?

<p>Anastomoses between the coronary arteries provide alternative routes for blood flow in case of occlusion or blockage of one artery.</p> Signup and view all the answers

What is the anatomical position of the conducting system of the heart and how does it control heart rate?

<p>The conducting system of the heart is located in the myocardium and controls heart rate by generating and transmitting electrical impulses.</p> Signup and view all the answers

Where is pain originating from the heart referred to and why?

<p>Pain originating from the heart is referred to the left side of the chest, left arm, and jaw due to shared nerve pathways between the heart and these areas.</p> Signup and view all the answers

What is the function of the AV Bundle of His in the cardiac conduction system?

<p>The AV Bundle of His is responsible for conducting electrical signals from the atria to the ventricles in the heart.</p> Signup and view all the answers

Where does the Left Bundle branch descend in the heart?

<p>The Left Bundle branch descends on the left side of the membranous part of the IV septum in the heart.</p> Signup and view all the answers

What is the role of the Cardioacceleratory and Cardioinhibitory centers in the brainstem?

<p>The Cardioacceleratory and Cardioinhibitory centers in the brainstem regulate the heart rate and force of contraction.</p> Signup and view all the answers

Which nerves supply the heart with sympathetic and parasympathetic fibers?

<p>The sympathetic fibers travel in T1-5(6) spinal nerves, while the parasympathetic fibers travel in the Vagus nerve.</p> Signup and view all the answers

Define the term 'coronary arteries' and explain their role in the blood supply to the heart.

<p>Coronary arteries are the branches of the ascending aorta that supply oxygen and nutrients to the heart muscle. They fill during diastole and provide a reliable blood supply to the heart.</p> Signup and view all the answers

What is the significance of the right coronary artery in the blood supply to the heart? Name its branches.

<p>The right coronary artery (RCA) is one of the main coronary arteries and supplies the right side of the heart. Its branches include the SA nodal branch, right marginal branch, posterior interventricular artery, and AV nodal branch.</p> Signup and view all the answers

Explain the concept of coronary dominance and name the dominant artery in majority of people.

<p>Coronary dominance refers to the artery that gives off the posterior interventricular/posterior descending artery. In approximately 80% of people, the right coronary artery (RCA) is dominant.</p> Signup and view all the answers

What is the embryological cause of atrial septal defect (ASD)?

<p>Atrial septal defect (ASD) is caused by failure of proper development of the septum secundum or failure of closure of the ostium primum.</p> Signup and view all the answers

What is the embryological cause of ventricular septal defect (VSD)?

<p>Ventricular septal defect (VSD) is caused by a defect either in the membranous or muscular portion of the IV septum or failure of fusion of the membranous or muscular portions.</p> Signup and view all the answers

What is the embryological cause of Tetralogy of Fallot?

<p>Tetralogy of Fallot is caused by unequal division of the conus cordis with resultant anterior displacement (malalignment) of the aorticopulmonary septum.</p> Signup and view all the answers

What is the embryological cause of transposition of the great vessels?

<p>Transposition of the great vessels is caused by the failure of the aorticopulmonary (conotruncal) septum to spiral.</p> Signup and view all the answers

What is the embryological cause of coarctation of the aorta?

<p>Coarctation of the aorta is caused by narrowing of the aorta, usually distal to the origin of the left subclavian artery from the arch of the aorta.</p> Signup and view all the answers

What are some potential causes of congenital heart defects?

<p>Chromosomal abnormalities, prematurity, low birth weight, prostaglandins, high altitude and low atmospheric oxygen tension, and hypoxia are potential causes of congenital heart defects.</p> Signup and view all the answers

What is the anatomical position of the conducting system of the heart and how does it control heart rate?

<p>The conducting system of the heart is located in the myocardium and controls the heart rate by generating and conducting electrical impulses.</p> Signup and view all the answers

What are the potential consequences of anastomoses between the coronary arteries?

<p>Anastomoses between the coronary arteries allow for collateral circulation and can provide an alternate blood supply to the heart in case of blockage or occlusion of a coronary artery.</p> Signup and view all the answers

What is the role of the AV bundle of His in the cardiac conduction system?

<p>The AV bundle of His is responsible for conducting the electrical impulses from the atria to the ventricles, allowing for coordinated contraction of the heart.</p> Signup and view all the answers

What is the significance of the right coronary artery in the blood supply to the heart?

<p>The right coronary artery supplies blood to the right atrium, right ventricle, and the posterior part of the interventricular septum.</p> Signup and view all the answers

How old is the patient on the ECG?

<p>Do not know</p> Signup and view all the answers

Calculate the rate of the ECG.

<p>60</p> Signup and view all the answers

Are the normal P waves present?

<p>No</p> Signup and view all the answers

Does this ECG show signs of ventricular hypertrophy?

<p>Yes</p> Signup and view all the answers

What is the duration of the QT interval on this ECG?

<p>Do not know</p> Signup and view all the answers

What are the potential causes of prolonged QT interval?

<p>Acute Myocardial Ischaemia, Myocarditis, Bradycardia, Head Injury, Hypothermia, U&amp;E Imbalance (K+ Ca2+ Mg2+), Congenital, Drugs (Quinidine, Antihistamines, Macrolides, Amiodarone, Phenothiazines)</p> Signup and view all the answers

What does an abnormal ST segment elevation indicate?

<p>Infarction</p> Signup and view all the answers

What is the significance of inverted T waves in lead I, II, and V4-V6?

<p>Ischemia/Infarction</p> Signup and view all the answers

What does T wave inversion indicate in the presence of Digoxin?

<p>Digoxin effects</p> Signup and view all the answers

What are the potential causes of metabolic abnormalities on an ECG?

<p>Hyperkalemia (tall, tented T wave, widened QRS), Hypokalemia (small T waves, prominent U waves), Hypercalcemia (short QT interval), Hypocalcemia (long QT interval, small T waves)</p> Signup and view all the answers

Study Notes

Embryological Development of the Heart

  • The primitive pulmonary vein incorporates into the wall of the left atrium and sends two branches to each lung.
  • Atrial growth eventually incorporates all four branches into the wall.
  • These branches meet with developing venous plexuses near the lungs.

Septation of the Outflow Tracts

  • At 6 weeks, conotruncal ridges (cushions) begin to form and grow distally and spiral.
  • When the two conus swellings have fused, the septum divides the conus into an anterior and posterior portion, forming the outflow tracts of the right and left ventricles.

Aortic Arches

  • Pharyngeal arches develop, each with its own pair of arteries from the aortic sac.
  • 1st to 6th arches develop cranial to caudally over 3-4 weeks.
  • Each arch terminates in the paired dorsal aorta.

Fates of Embryological Structures

  • Sinus venosus: Right atrium (smooth part) and Coronary sinus
  • Primitive Atrium: Right and Left Atria
  • Bulbus cordis:
    • Proximal 1/3: Right Ventricle
    • Middle 1/3: Conus cordis (Infundibulum) and Aortic vestibule
    • Distal 1/3: Proximal Aorta and Pulmonary trunk
  • Endocardial cushions: AV valves, Membranous IV septum, Lower IA septum, Spiral septum

Congenital Heart Defects (CHD)

  • Patent foramen ovale: Defect in septum secundum, causing blood to bypass the pulmonary circulation.
  • Patent ductus arteriosus: Connection between the 6th aortic arch and left dorsal aorta, allowing oxygenated blood to bypass the pulmonary circulation.

Foetal Circulation

  • Ductus venosus: Oxygenated blood from the placenta through the umbilical vein bypasses the liver and enters the inferior vena cava.
  • Foramen ovale: Bypasses the pulmonary circulation, allowing oxygenated blood to flow directly from the right atrium to the left atrium.
  • Ductus arteriosus: Bypasses the pulmonary circulation, allowing oxygenated blood to flow directly from the pulmonary artery to the aorta.

Congenital Heart Defects (CHD)

  • Acyanotic: Ventricular Septal Defect (VSD), Atrial Septal Defect (ASD), Patent Ductus Arteriosus (PDA)
  • Cyanotic: Tetralogy of Fallot (TOF), Transposition of the Great Arteries

Clinical Features and Management of CHD

  • Ventricular Septal Defect (VSD):
    • Small VSDs: May close on their own
    • Medium to large VSDs: Require closure to prevent complications
  • Patent Ductus Arteriosus (PDA):
    • Small PDA: May close on its own
    • Large PDA: Requires closure to prevent complications
  • Atrial Septal Defect (ASD):
    • Small ASDs: May close on their own
    • Medium to large ASDs: Require closure to prevent complications
  • Tetralogy of Fallot (TOF):
    • Palliative surgery: Modified Blalock–Taussig shunt to increase pulmonary blood flow
    • Definitive surgery: Closure of VSD and relief of right ventricular outflow tract obstruction### Congenital Heart Defects
  • Atrioventricular Septal Defect (AVSD): occurs when there is a hole between the chambers of the heart and problems with the valves that control blood flow between the upper and lower chambers of the heart
  • Presentation: detected during antenatal ultrasound screening or routine echocardiography screening in a newborn infant with Down syndrome
  • Symptoms: cyanosis at birth or heart failure at two weeks to three weeks of life, with no murmur heard
  • Management: treat heart failure medically and surgical repair at three to six months of age

Heart Valve Defects

  • Atresia: occurs when a valve does not form correctly and lacks a hole for blood to pass through
  • Stenosis: occurs when the flaps of a valve thicken, stiffen, or fuse, and the valve cannot fully open
  • Regurgitation: occurs when a valve does not close tightly, and blood leaks back through the valve

Pulmonary Valve Stenosis

  • Definition: narrowing of the pulmonary valve, which allows blood to flow from the right ventricle into the pulmonary artery
  • Symptoms: most children with this defect have no signs or symptoms other than a heart murmur
  • Diagnosis: ejection systolic murmur is best heard at the upper left sternal edge
  • Treatment: balloon valvuloplasty, which is successful in 85% of cases

Aortic Valve Stenosis

  • Definition: occurs when there is a problem with the aortic valve, which allows blood to flow from the left ventricle into the aorta
  • Symptoms: depend on the severity of the obstruction, may present with chest pain or syncope
  • Diagnosis: small-volume, slow-rising pulses, carotid thrill, ejection systolic murmur maximal at the upper right sternal edge
  • Treatment: balloon valvuloplasty in older children, surgical valvotomy or valve replacement in others

Left Heart Outflow Obstruction

  • Definition: occurs when there is a blockage in the left side of the heart that prevents blood from flowing out of the heart and to the rest of the body
  • Symptoms: heart failure, shock, and collapse, often at around two days of age
  • Treatment: surgical repair or balloon dilation

Coarctation of the Aorta

  • Definition: occurs when the aorta is narrowed or blocked, which can reduce blood flow to the lower body
  • Symptoms: absent femoral pulses, severe heart failure, and metabolic acidosis
  • Treatment: surgical repair or balloon dilation### Heart Development
  • Conus cordis and truncus arteriosus develop concurrently, not sequentially
  • Heart defects occur in approximately 8 in 1,000 births
  • Causes of heart defects include genetic and teratogenic factors, such as Rubella virus, social drugs, thalidomide, insulin-dependant diabetes, and hypertension, as well as genetic syndromes like Down's, DiGeorge, and trisomy 18
  • Craniofacial abnormalities are linked to cardiac malformation due to neural crest cells

Formation of Endocardial Tube

  • Initial nourishment and oxygenation occur via diffusion
  • Heart is the first functional organ in the embryo, developing around days 22-25
  • Splanchnic lateral plate mesoderm produces angiogenic cells, leading to blood islands and the primary heart field
  • Day 17: Splanchnic lateral plate mesoderm produces angiogenic cells
  • Day 18: Endothelial lined tubes surrounded by myocytes form
  • Day 20: Two sides of the horseshoe fuse to form a single heart tube, ventral to the gut tube

Heart Tube Development

  • Day 22: Myocardial cells infiltrate cardiac jelly, begin contraction and electrical activity
  • Days 22-24: Heart tube folding occurs
  • Days 28: Folding complete, left medial view, anterior view
  • Formation of trabeculae in primitive ventricle and bulbus cordis

Septation

  • Day 23-35: Endocardial cushion cells from neural crest, dorsal and ventral cushions meet, forming left and right AV canals
  • Day 30: Remodelling of ventricle wall, erosion and remodelling in ventricular wall leads to trabeculae
  • Day 34-35: Muscular growth forms inferior part of AV septum
  • Superior part derived from endocardial cushions, completed by about 8 weeks

Atrial Septation

  • Day 26-33: Septum primum forms, separation but maintains pulmonary bypass
  • Day 33-37: Septum secundum forms, crescentic growth never entirely complete
  • Formation of foramen ovale

Congenital Conditions

  • Ventricular septal defect (VSD): defect in membranous or muscular portion of IV septum
  • Tetralogy of Fallot: unequal division of conus cordis, anterior displacement of aortic origin
  • Transposition of great vessels: failure of aorticopulmonary septum to spiral
  • Coarctation of aorta: narrowing of aorta, usually distal to origin of left subclavian artery

ECG Interpretation

  • Identity, standardization
  • Rate calculation
  • Rhythm analysis
  • P wave analysis
  • PR interval analysis
  • QRS complex analysis
  • QT interval analysis
  • ST segment analysis
  • T wave analysis
  • Axis determination
  • Abnormal components
  • Formulation of interpretation

Note: The study notes have been organized into sections to facilitate easy understanding and review of the material.

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Related Documents

congetinal heart disease.pdf
Coronary Circulation & Conduction System PDF
Development of the Heart and Great Vessels PDF
ECG Interpretation PDF

Description

Test your knowledge on aortic valve stenosis, a condition caused by maldevelopment or thickening of the aortic valve. Learn about the different subtypes and severity levels of this left ventricular outlet obstruction.

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