Cardiovascular Pathology 5 Flashcards
in fetal circulation, the _____ resistance is high leading the shunt to go ___ → ____
pulmonary; (lungs have not expanded yet but after birth, the pulmonary resistance will ↓)
R→ L bypassing the lungs
what are the two physiologic R → L shunts in the fetus?
- foramen ovale
- ductus arteriosus
the patency of the ductus arteriosus can be maintained by giving _____
prostaglandins
what leads to the closure of the ductus arteriosus after birth?
prostaglandins help keep it open. they are produced by the placenta and metabolized by the lungs.
following birth there is ↓ prostaglandins due to: ↓ production and ↑ metabolism
What are some complications of a L → R shunt?
- right heart failure because it is not used to the large volume of blood.
- pulmonary circulation congestion (plethoric lung fields) → recurrent episodes of infections
with congenital malformations can cause a R→ L shunt?
- Tetralogy of Fallot
- transposition of the great vessels
- truncus arteriosus
- tricuspid atresia
- total anomalous pulmonary venous connection
what are the four malformations seen in tetralogy of fallot?
- Pulmonary stenosis: (degree determines prognosis)
- Right ventricular hypertrophy
- overriding aorta
- VSD
PROV
what determines the degree of prognosis in a patient with tetralogy of fallot?
the degree of pulmonary stenosis
why do patients with tetralogy of fallot squat a lot?
squatting ↑ the systemic resistance and thus helps alleviate the R → L shunt by forcing more of the blood the go through the pulmonary vessels from the right ventricle
squatting ↑/ ↓ ________ resistance
↑ systemic (aortic) resistance
tetralogy of fallot is associated with ________ syndrome
down syndrome
the VSD in tetralogy of Fallot puts these patients at a higher risk for developing_____
infective endocarditis
_____ and _____ help with survival in a patient with transposition of the great vessel
PDA and VSD because they help mix the blood
what is truncus arteriosus?
failure of partitioning of the embryologic truncus into aorta and pulmonary artery;
single great artery gets blood from BOTH ventricles
underlying VSD
tricuspid atresia is usually associated with _____
ASD to bypass obstruction
what is the developmental abnormality in total anomalous pulmonary venous connection (TAPVC)
the pulmonary veins drain into the left inominate vein or coronary sinus or right atrium instead of the left atrium like normal
TAPVC is technically a L→ R shunt because: _______ but it is associated with a _____ in order to be compatible with life
blood flow that should be going the left atrium is instead going to the right atrium;
ASD → right to left shunt due to the lower left atrial pressure → cyanosis
list of left to right shunts:
D’s:
- ASD
- VSD
- PDA
clinical features of VSD:
- pulmonary HTN
- CHF
- pan systolic murmor
_____ murmur can be heard with VSD
pan systolic
what is eisenmenger complex?
shunt reversal seen with VSD due to the ↑ pulmonary HTN → ↑ pressure in the right atrium → reversal of shunt from L→ R to R→ L because pressure on the R > L now
eisemneger complex leads to cyanosis
____ is the most common congenital cardiac malformation diagnosed in adults
ASD
what are the three types of ASD and which is the most common?
- ostium primum
- ostium secundum (MOST COMMON)
- sinus venosus
continuous “machine like” murmur is seen with ______
PDA
_______ can be given to close the PDA
indomethacin (prostaglandin synthesis inhibitor)
maternal ______ infection is associated with PDA
rubella
PDA connects and causes blood to flow from _____ to ____ and usually closes due to _____
aortic arch to the left pulmonary artery closes due to high oxygen tension
what fetal condition is maternal rubella infection associated with?
PDA
what are 3 cardiac malformations that can cause obstruction?
- coarctation of aorta
- pulmonary stenosis and atresia
- aortic stenosis and atresia (hypo plastic left heart syndrome)
coarctation of the aorta is associated with ______ syndrome
Turner’s (XO)
what are the two types of coarctation of the aorta and how are they different?
- preductal (Infantile coarctation): has PDA and the coarctation is just before the PDA
- post ductal (adult) coarctation: ductus arteriosus is closed
what is differential cyanosis and what defect is it associated with?
cyanosis only in the lower limbs of the body; associated with preductal coarctation of the aorta
the PDA will pass deoxygenated blood into the aorta that goes down to the lower limbs
marked blood pressure difference between the upper and lower limb is seen in ______
post ductal coarctation of the aorta
what are some clinical features in post ductal coarctation of the aorta?
- difference in blood pressures in upper and lower limb
- intermittent claudication
- notching of ribs due to collaterals
- no selective cyanosis
- HTN in upper extremities
notching of the ribs is seen in _____
post ductal coarctation of the aorta due to the collaterals trying to supply blood to the lower extremities
_______ is only seen in preductal coarctation of the aorta but NOT in the post ductal
cyanosis
aortic stenosis is classified into what three types based on location?
- valvular: affects valve cusps
- subvalvular: ring of fibrous tissue between valve cusps resulting in LVH
- supravalvular: elastin defect involving the ascending aorta and with a thickening of the wall leading to luminal obstruction
complete obstruction of the aortic outflow leads to ____ of the left ventricle and aorta and must have _____ for survival
hypoplasia; PDA
what is a gross feature of the underdeveloped left ventricle in hypo plastic left heart syndrome
- dense endocardial fibroelastosis
cardiac myxoma is a ____ tumor seen in the ______
benign; left atrium
how can you try to diagnose a cardiac myxoma?
do an X Ray because they often calcify and these can be seen on x ray
patient has a lobulated pedunculated mass in her left atrium. what would you expect to see on histology slide?
cardiac myxoma;
multinucleated stellate cells suspended in an edematous mucopolysaccharide rich stroma
stellate cells in stroma is seen in the histology of what disease?
cardiac myxoma
what are four common primary sites of tumors that can lead to secondary tumors in the heart?
- lung cancer
- breast
- lymphoma
- malignant melanoma
