Cardiovascular System Flashcards
Read over the following pathologies:
-Congenital Heart Disease
-Acquired Vascular Disease
-Valvular Disease
-Peripheral Vascular Disease
What are the congenital heart diseases?
-Left-to-Right Shunts
-Tetralogy of Fallot
-Coarctation of the Aorta
-Dextrocardia
What are the Left-to-Right Shunt pathologies?
-Atrial Septal Defect
-Ventricular Septal Defect
-Patent Ductus Arteriosus
What is a left to right shunt?
Blood is shunted from systemic circulation to the pulmonary circulation
(Moves blood back into the lungs, more blood going through pulmonary system)
What non radiographic signs are seen with left to right shunts?
Produces pulmonary overload and hypertension
What are the radiographic signs of left to right shunts?
-Increased vascular markings in lung
-Enlarges part(s) of the heart
What pathology is seen with Atrial Septal Defects?
1.Patent Foramen Ovale
What pathology causes right sided enlargement of the heart?
Patent foramen ovale
What part of the heart is affected with patent foramen ovale?
Atrium and ventricle
Where is the foramen ovale seen?
Between the atria of the heart
What causes the pathology of foramen ovale?
It doesn’t close when you’re born
What side of the heart is normally stronger? Why?
Left side will be stronger because it needs to push blood to the whole body (normally)
What side of the hard is stronger with right sided enlargement?
The right side will be stronger
What are Ventricular Septal Defects?
Opening between the ventricles
What part of the heart is enlarged with ventricular septal defects?
Left-sided enlargement
When does shunting occur with ventricular septal defects?
Happens during systole
What pathology is this describing?
Diastolic overloading of left atrium and ventricle
Ventricular Septal Defects
When the left ventricle contracts, where does blood enter with ventricular septal defects?
Pushes blood into the right, and immediately going into the pulmonary circulation
T/F
With ventricular septal defects, the right side is stronger.
False; blood doesn’t sit in the right for long, so the right doesn’t need to get stronger
Where does extra blood enter with ventricular septal defects?
Extra blood enters to left atrium and ventricle
What type of shunt is seen with Patent Ductus Arteriosus?
Left to right shunt
What is the cause of patent ductus arteriosus?
From bifarct of pulmonary arteries to aorta
What should the patent ductus arteriosus become before birth?
Should become ligamentum arteriosum
What side is enlarged with patent ductus arteriosus?
Left-sided enlargement
What radiographic sign is seen with patent ductus arteriosus?
Prominent aortic knob
Where does the blood flow with patent ductus arteriosus?
Blood flows out to the aorta
What is Eisenmenger Syndrome?
With prolonged left to right shunts it causes Eisenmenger syndrome from the extra blood pushed into the pulmonary circulation, which leads to pulmonary hypertension.
What age is Eisenmenger Syndrome uncommon to see?
Uncommon before age of 2
What side becomes hypertrophic with Eisenmenger Syndrome?
Right-sided hypertrophy
What happens to the shunt with Eisenmenger Syndrome?
Shunt becomes reversed
What are the radiographic appearances of Eisenmenger Syndrome?
Cardiomegaly
Increased pulmonary artery size
Reduced pulmonary vasculature
T/F
If a left to right shunt is small they get fixed on their own
True
What procedure is done if a left to right shunt is too big?
If they’re bigger they need surgery
What are the symptoms of left to right shunts?
Weaker, tired, short of breath, cyanosis
What are the 4 signs of a tetralogy of fallot?
1.Ventricular septal defect
2.Pulmonary stenosis
3.Overriding of the aorta above the ventricular defect
4.Right ventricular hypertrophy
What happens to blood flood in the systemic and pulmonary system with tetralogy of fallot?
Decreased pulmonary flow, increased systemic flow
What radiographic sign is seen with tetralogy of fallot?
“Coeur en sabot” Clog shaped heart
What is pulmonary stenosis?
When the trunk is narrowed, blood pressure is increased, the right side of the heart has to work harder so it gets bigger
What is the risk of tetralogy of fallot?
Death (Need surgery or you die)
What percentage of patients have the aorta running on the right side of the body instead of left with tetralogy of fallot?
25% of patients
What is Coarctation of the Aorta?
Narrowing of the aorta just beyond left subclavian artery
Where is blood supply and pressure the greatest with coarctation of the aorta?
Blood supply and pressure is greater in the upper extremities compared to the lower
What are the Radiographic Appearances of coarctation of the aorta?
-Rib notching – typically posterior ribs 4-8
-Figure 3 dilation before/after stenosis
What is the Cause of hypertension in kids?
Coarctation of the Aorta
What is the cause of rib notching with Coarctation of the Aorta?
Body wants blood in the lower, through an alternate path (collateral flow) through intercostal vessels which starts to wear away at the ribs causing rib notching
What is the Figure 3 sign seen with Coarctation of the Aorta?
Indent at the stenosis of the aorta
What is Dextrocardia?
When the Apex of the heart points to the right
What are the two types of dextrocardia?
1.Dextrocardia of embryonic arrest
2.Dextrocardia situs inversus
What is another name for dextrocardia of embryonic arrest?
Isolated dextrocardia
What is dextrocardia of embryonic arrest commonly associated with?
Commonly associated with severe defects of the heart and pulmonary hypoplasia
What type of dextrocardia is the worst?
Isolated dextrocardia worse than dextrocardia inversus
What causes isolated dextrocardia?
The Lung is too small, so the heart moves over to the right side
Read over the following list of Acquired Vascular Diseases:
Atherosclerosis
Arteriosclerosis
Coronary Artery Disease
Congestive Heart Failure
Hypertension
Aneurysm
Dissection of the Aorta
Arteriovenous Fistula
Thrombus and Embolus
What is Atherosclerosis caused by:
-Hypertension
-Obesity
-Smoking
-High-cholesterol diet
-Lack of exercise
What can atherosclerosis result in?
-Coronary Artery Disease
-Strokes
-Peripheral Vascular Disease
What is Arteriosclerosis?
“Hardening” of the arteries
What is Arteriosclerosis caused by?
1.Calcification of the tunica media
2.Atherosclerosis
What can Arteriosclerosis result in?
-Hypertension
-All things associated with atherosclerosis
What modalities are used to image Arteriosclerosis?
Doppler US, CTA/MRA, SPECT/PET
What can the calcification and hardening of the tunica media be caused by?
infections, congenital
What is Coronary Artery Disease (CAD)?
Narrowing and occlusion of the coronary arteries which causes ischemia of heart muscle tissues and oxygen deprivation of myocardium.
What is dead cardiac tissue replaced with in coronary artery disease?
Fibrotic tissue
What medication decreases blood pressure in cases of CAD?
Nitroglycerin to decrease blood pressure
What are the symptoms of Oxygen deprivation of myocardium seen with CAD?
Angina Pectoris
Unstable Angina
T/F
CAD can cause a myocardial infarction
True
What symptoms are seen with coronary artery disease?
Pain in left jaw and arm, tightness in chest
What pathology is a precursor to a heart attack
Coronary artery disease
What modalities are used to image coronary artery disease?
SPECT, CT, CTA/coronary angiography, MRI
What treatments are offered for Coronary Artery Disease (CAD)?
1.Coronary angiography
2.Coronary Artery Bypass Graft (CABG x 1,2,3,4)
What treatments are done with Coronary angiography?
1.Percutaneous Transluminal Angioplasty
2.Stent placement
Where is a Coronary Artery Bypass Graft placed?
-Internal thoracic or mammary arteries or great saphenous vein
What is Congestive Heart Failure (CHF)
Inability of the heart to adequately pump enough blood
What side of failure is more common with congestive heart failure?
Left sided failure more common
What are the Causes of CHF?
-Hypertension
-Coronary Artery Disease; MI (myocardial infarction)
-Faulty valves; congenital defects
-Obstructive process increasing peripheral resistance to blood flow
(Anything that increases blood pressure)
What is the modality of choice for left sided congestive heart failure?
Echocardiography modality of choice for left ventricular performance
What test is typically used to image congestive heart failure?
Ecg is typically used, lots of modalities can show it
How does acute congestive heart failure appear?
If it’s acute you wouldn’t see it
T/F
With congestive heart failure, the heart becomes enlarged
True
What CT ratio indicates cardiomegaly?
Cardiothoracic Ratio (C/T Ratio) exceeding 50% = Cardiomegaly
What signs are seen Left-sided failure in congestive heart failure?
-Pulmonary edema and pleural effusion
-Enlarged superior pulmonary veins
What signs are seen right-sided failure in congestive heart failure?
-Dilated right atrium and ventricle
-Edema in lower limbs and abdomen
What is the Leading cause of CHF and strokes?
Hypertension
What does hypertension cause to the blood vessels?
Damages the blood vessels-They are easier for plaques to stick to
What is systolic blood pressure?
Pressure in peripheral vessels when left ventricle contracts
What is Diastolic blood pressure?
Pressure in peripheral vessels when left ventricle relaxes
How do you calculate BP
BP= Cardiac output × Resistance
What is the systolic blood pressure that indicates hypertension?
Systolic BP > 140 mmHg
What is the diastolic blood pressure that indicates hypertension?
Diastolic BP > 90 mmHg
What are the two types of Hypertension?
Primary
Secondary
What percentage of cases make up primary hypertension?
90-95% of all cases
What is the cause of primary hypertension?
-Idiopathic/Essential (not a specific thing that is causing it, just leading to it)
What are some factors that contribute to primary hypertension?
-Genetics
-Non-specific lifestyle factors
-Benign or malignant hypertension
What is benign hypertension
Hypertension developing over time
What is malignant hypertension?
Something happens to give you a huge spike in blood pressure
What is Secondary hypertension caused by? Give some examples:
-Caused by an underlying condition
a.Renal artery stenosis, Coarctation of the aorta
b.Chronic renal disease
c.Medications (birth control pill)
What is an Aneurysm
Bulging out of an artery from a localized weakness in the wall
What are the Types of Aneurysms?
1.Saccular or berry
2.Fusiform
What part of the artery is affected with saccular/berry Aneurysms?
Involves only 1 side of the artery (only one wall)
(Think of a balloon with one side weak)
What part of the artery is affected with fusiform Aneurysms?
Involves the entire circumference (all around it is involved and the entire circumference bulges)
What are the Causes of Aneurysms?
-Atherosclerosis, infection (syphilis), trauma, congenital (Marfan Syndrome)
What is Marfan syndrome?
Disorder of the connective tissues
What are the risks of aneurysms?
May enlarge and rupture
What modality is used for Abdominal Aortic Aneurysms?
Ultrasound
What modalities are the best for aortic aneurysm ruptures and berry aneurysms in the brain?
CTA and MRA are best for aortic aneurysm rupture and berry aneurysms in the brain
What modality is best to treat an aneurysm?
Cerebral angiography is used to treat the aneurysm
What is Dissection of the Aorta?
Blood enters the wall of the aorta and separates its layers and Creates a true and false lumen (pseudoaneurysm)
T/F
Dissection of the Aorta is Potentially life threatening
True
In what type of patients is Dissection of the Aorta common in?
Common in patients with hypertension, Marfan’s, sometimes from a guide wire
What is the modality of choice for a Dissection of the Aorta?
CT (+ contrast) modality of choice
What are the radiographic signs of a Dissection of the Aorta?
-Double-barrel aorta with a linear filling defect (See two areas filled with contrast and a thin line between them-wall separating the 2 lumens)
Where do most Dissections of the Aorta start?
Most start just above aortic valve
What is an Arteriovenous Fistula?
An Abnormal connection between an artery and vein
What are the causes of an Arteriovenous Fistula?
-Congenital (AVM)
-Surgically created-AV fistula in the arm
-Acquired-Trauma healed this way
What is a Thrombus?
An Intravascular clot
What are the Causes of a Thrombus?
1.Slow blood flow
2.Roughened endothelial layer
3.More viscous blood
What can cause a roughened endothelial layer?
-Inflammation, injury, atherosclerosis
-Things like high blood pressure damage the walls of the blood vessels.
What can cause more viscous blood?
-Polycythemia-Thicker blood that moves slower and can cause clots
What is an Embolus
A “Floating” clot
-Piece of thrombus that has broken off
What is the cause of an Air emboli?
Not purging the IV line properly
What is stenosis
-Narrowing of the opening of the valve
What is Incompetency and Insufficiency?
When the valves do not close completely or invert
What happens to the mitral valve with incompetency/insufficiency?
Inverts into the left atrium or the aortic valve
What valves are commonly affected with incompetency/insufficiency and stenosis?
Commonly affect the mitral and aortic valves
What is the modality of choice to image incompetency/insufficiency and stenosis?
Doppler echocardiography is the modality of choice
What is Peripheral arterial disease?
When the extremities (usually legs) do not receive adequate blood flow
What are the non radiographic Signs of Peripheral arterial disease?
-Claudication or cramping
-Dry sores on the toes
What modality is initially used to image Peripheral arterial disease? What modalities follow?
-US first, then CT/MRI
What are the radiographic signs of Peripheral arterial disease?
-Calcifications
-Occlusions/stenosis-with contrast
What are Arrhythmias
-Irregular heart beat
What are the two types of arrhythmias?
1.Tachycardia
2.Bradycardia
What bpm indicates tachycardia?
More than 100 beats per minute
What bpm indicates bradycardia?
-Less than 60 beats per minute
(SA damaged AV takes over)
What are the 3 types of Irregular heart beats?
1.V-Tach
2.V-Fib
3.A-Fib
What is V-Tach (Ventricular Tachycardia) caused by?
-Caused by improper electrical activity
What is V-Tach (Ventricular Tachycardia)?
-Ventricles beat fast and out of rhythm with atria
What sign (non radiographic) indicates V-Tach (Ventricular Tachycardia)?
3 or more ventricular beats and faster than 100 bpm more than 3 times in a row
T/F
With V-Tach (Ventricular Tachycardia), the ventricles do not have time to fill
True
What are the symptoms of V-Tach (Ventricular Tachycardia)?
-Dizziness, light-headedness, possibly LOC
What can V-Tach (Ventricular Tachycardia) lead to?
May become V-Fib
What can V-fib lead to?
Cardiac arrest
What is used to treat V-fib cardiac arrest?
Defibrillator to shock heart back into normal rhythm and CPR
What is V-Fib (Ventricular Fibrillation) caused by?
-Caused by improper electrical activity
What is V-Fib?
When the ventricles quiver rather than contracting
What are the non radiographic signs of V-Fib?
-No pulse
-Cardiac arrest
What is A-Fib (Atrial Fibrillation)?
-Rapid and irregular beating of the atria
What are the symptoms of A-Fib?
SOB, palpitations, weakness
T/F
A-Fib is not usually life-threatening
True
What can A-Fib lead to?
-May eventually lead to congestive heart failure
-Increased risk of strokes
