Chapter 12: The Heart Flashcards
1
Q
Which patients are more prone to mitral valve prolapse
A
-Female 7:1
2
Q
What is restrictive cardiomyopathy secondary to
A
- Deposition of amyloid in the wall
- Fibrosis due to radiation
3
Q
During a MI, what is the time frame when there is:
-Onset of ATP depletion
A
Seconds
4
Q
Very generally, what is the clinical presentation of a right to left shunt
A
Cyanosis
5
Q
What are the increases in VSD
A
Increase in pulmonary pressure and blood flow
*Because some of the pressure and flow from the left ventricle is going into the right ventricle and pulmonary arteries
6
Q
Which aortic condition will see an accelerated calcification course and subsequent stenosis
A
Bicuspid aortic valve shows an accelerated course
7
Q
What are the effects of chronic rheumatic fever
A
MITRAL STENOSIS** aka fish mouth appearance
-caused by mitral leaflet thickening, fusion of commissures, thickening of tendinous cords (does not allow valves to open)
-LA enlargement leads to Afib and thromboembolic events
8
Q
What are the light microscopy features of an MI after:
12-24 hours
A
- Pkynosis of nuclei
- Contraction band of necrosis
- Hypereosinophilia
- Early neutrophils
9
Q
What are the gross features of an MI after:
-12-24 hours
A
Dark mottling
10
Q
What is present in the heart with acute rheumatic fever
A
- Pancarditis with Aschoff bodies/nodules which are granulomatous inflammation centered around vessels
- Fibrinoid necrosis of the endocardium and left sided valve with vegetations present
11
Q
What are the morphological findings in a patient with hypertrophic cardiomyopathy
A
- myocardial hypertrophy, especially the septal region (produces banana shape, blocks outflow tract)
- Myocytes are in disarray
12
Q
What is the treatment for an acute infective endocarditis
A
Surgery and antibiotics
13
Q
What is the cause of Naxos syndrome
A
Mutations in the gene encoding the desmosome associated protein plakoglobin
14
Q
What is the qualification for congestive heart failure
A
- When the heart is unable to meet the peripheral demand for blood
- Requires increased filling pressure in order to meet the demand for blood
15
Q
Why is neovasculature seen on the thickening valves during chronic rheumatic fever
A
Because can no longer get the blood via diffusion
16
Q
Which bacteria tends to affect prosthetic valves
A
S. Epidermidis
17
Q
Which metabolic issue is strongly associated with dilated cardiomyopathy
A
Hereditary hemochromatosis (HFE) leading to iron overload
18
Q
What is the prognosis of aortic stenosis
A
- 5 years after developing angina
- 3 years after developing syncope
- 2 years after developing CHF
19
Q
What is the most common primary cardiac tumor and what is their usual location
A
Myxomas usually in the region of fossa ovalis
20
Q
Most hereditary conditions of heart arrhythmias are what inheritance
A
Autosomal dominant
21
Q
What are the organisms commonly involved in infective endocarditis
A
- S viridans
- S aureus
- S epidermidis
- HACEK (Hemophilus, actinobacillis, Cardiobacterium, eikenella, kingella
22
Q
How will a myxoma sound upon auscultation
A
Tumor “plop”
23
Q
What are the clinical complications as a result of a VSD
A
- Right ventricular hypertrophy
- Pulmonary hypertension, which can lead to reverse flow into a right to left shunt, leading to cyanosis
24
Q
What is acute infective endocarditis defined by
A
Rapidly progressing destructive infection of a previously normal valve
25
What is the characteristic of subacute infective endocarditis
Infective endocarditis is slower progressing infection of a previously deformed valve
26
What is the general cause of hypertrophic cardiomyopathy
Genetic disorder that leads to myocardial hypertrophy and diastolic dysfunction with reduced SV and outflow obstruction
27
Which form of VSD is most common
Membranous VSD
28
What are the gross features of an MI after:
| 2 months
Scarring is complete
29
What are the conditions that can lead to abnormalities of leaflets and commissures leading to mitral regurgitation
- Postinflammatory scarring
- Infective endocarditis
- Mitral valve prolapse
- Drugs
30
ASD is most commonly caused by what embryological defect
Secundum (90%)
| -May be multiple or fenestrated
31
Which origins of cancers are seen in carcinoid syndrome
GI tract
Pancreas
Lungs
32
What are the common causes for a patent ductus arteriosus
- Hypoxic infants
| - Increased pulmonary vascular pressure (commonly seen in VSD)
33
What is the heritability of arrhythmogenic right ventricular cardiomyopathy
Autosomal dominant
34
What is the morphological changes seen with dilated cardiomyopathy
- Dilation of all chambers
- Mural thrombi
- Refurgitation of valves
35
What must be present for transposition of the great vessels to be compatible with life, and what is the most common forms
* A shunt to mix blood must be present
- VSD (1/3)
- ASD or PDA (2/3)
36
What is the ejection fraction of dilated cardiomyopathy
<40%
37
What are the light microscopy features of an MI after:
| 1-3 days
- Coagulation necrosis
- loss of nuclei
- Interstitial infiltrate of neutrophils
38
What is the time frame that troponin I will remain in the blood following an MI
5-10 days
39
What correlates with the amount of cardiac lesions seen in carcinoid syndrome
-5-hydroxyindoleacetic acid
40
Which infection and condition can arise as a result of cardiac transplantation
EBV associated B cell lymphoma
41
How is amyloid restrictive cardiomyopathy seen histologically
With the Congo red stain, which yields an apple green birefringence
42
What are the light microscopy features of an MI after:
| .5-4 hours
Waviness of fibers of infarct border
43
What is the degree of severity of the tetrology of Fallot dependent on
The degree of pulmonary stenosis
44
Long QT syndrome is commonly caused by which kind of mutations
- Gain of function in sodium current
| - Loss of function in potassium current
45
What does a mitral valve prolapse sound like on auscultation
Mid systolic click
46
What is the presentation of a patient with dilated cardiomyopathy
- Age 20-50
- progressive CHF
- Arrhythmias
- Embolism
47
What is the major complication with cardiac transplantation
Allograft rejection
48
During a MI, what is the time frame when there is:
| -10% of normal ATP levels
40 minutes
49
What is the time frame that CK-MB with peak following an acute MI
24 hours
50
Which patient population is commonly seen or have takotsubo cardiomyopathy
Women (90%), between ages 58-75
51
What are the causes of abnormalities of the leaflets and commissures leading to aortic regurgitation
Postinflammatory scarring (rheumatic heart disease)
52
What is the best way to measure the amount of hypertrophy in the heart
Heart weight, because there my be wall thickness increase as well as dilation which will mask the increased thickness
53
The presence of a contraction band is indicative of what
Reperfusion injury
54
What is Myxomatous mitral valve and what are the physical finding
Thickening (proteoglycan deposition) and elastic fiber disruption leading to “hooding” of the valve
55
What is occurring during a patent foramen ovale and which can complications arise
* Should close permanently by age 2
- If it doesn’t close, then it can open if there is an increase in right atrial pressure (during bowel movement, pulm HTN, coughing, sneezing)
- Paradoxical embolus
56
What are the three types of damage seen to the valves
1-Collagen (mitral prolapse)
2-Nodular calcification
3-Fibrotic thickening
57
What is the most common valve abnormality
Calcific aortic stenosis
58
What are the gross features of an MI after:
| 2-8 weeks
Grey-white scar
59
What is the findings of myocarditis due to Chagas’ disease
Parasitization of myofibers with mixed inflammatory cell infiltrates (PMN, lymph’s, Macros, and eosinophils)
60
What is the most common cause of death in patients with sudden cardiac death
Fatal arrhythmia due to ischemia induced myocardial irritability
61
What is the most common congenital malformation
VSD (42%)
| ASD (10%)
62
What usually precipitates sudden cardiac death
Coronary artery disease (80-90%), usually being stenosis of one of the three main arteries (75%)
63
Which condition leads to anitschkow (caterpillar) cells
Acute rheumatic heart disease
64
What are the gross features of an MI after:
| .5-4 hours
None
65
What is the process of calcific aortic stenosis
1) Wear and tear due to age HTN, HyperLDL, inflammation
2) Valves contain osteoblasts-like cells, which deposit osteoid-like substance that ossifies
3) Calcifications of cusps prevent complete opening of the valves
66
Which bacteria tends to affect normal valves, IV drug valves, or abnormal valves
S. Aureus
67
What are the increases in ASD
- Increased Right ventricle and Pulmonary artery outflow volumes
* No increases in pressure because the ventricle is unaffected
68
What is unstable or crescendo angina due to and what is a complication
Due to rupture of atherosclerotic plaque, with a partial thrombus
*Usually a history of MI necrosis (50%), with another MI being imminent
69
Mitral valvular calcification commonly occurs with which condition
Mitral valve prolapse
70
What are the complications arising from nonbacterial thrombotic endocarditis (NBTE)
Source of emboli because they are only loosely attached
71
What are the characteristics of stable angina
- Stenotic occlusion of a coronary artery
| - Squeeing or burning sensation with physical activity or stree
72
What does a PDA sounds like upon auscultation
Harsh, machinery like murmur
73
What is the treatment of subacute endocarditis
Antibiotics
74
What are the general findings in an acute MI that was 24+ hours
- Coagulative necrosis
- pyknotic nuclei
- loss of cross striations
75
In the case of eccentric hypertrophy, what is the organization of sacromeres and what is the cause
Serial organization (in series so gets longer) as a result of volume overload
76
What is the hearts response in the left ventricle as a result of pressure overload as in chronic HTN or aortic stenosis
Myocytes becomes thicker and there is hypertrophy concentrically
77
What is the characteristics of mitral valve calcification
Calcific deposits on the Fibrous annulus
78
What are the complications seen with porcine valves
Calcification and tearing
79
What is the portion of the heart that is being supplied by the RCA
- Posterior LV and 1/3 septum
| - RV free wall
80
During a MI, what is the time frame when there is:
| -Microvascular injury
> 1 hour
81
What is the most common form of cardiomyopathy
Dilated
82
What drugs/compounds are strongly linked to dilated cardiomyopathy
- Alcohol strongly strongly
| - Iron overload
83
What are the clinical affects seen as a result of left sided heart failure
- Decreased tissue perfusion (due to decreased CO)
- Congestion of Pulmonary circulation, results in a cough, and dyspnea
- Left atrial dilation resulting in a fib, stasis and thrombus
- Decreased glomerular perfusion
84
Which parasite can cause myocarditis
Trypanosome Cruzi (Chagas disease)
85
What is the cause of takotsubo cardiomyopathy
Excess catecholamines, usually a result of increased stress resulting in the apical balling of the left ventricle
86
What is seen in amyloid restrictive cardiomyopathy
Extracellular deposition of proteins in the interstium that form an insoluble Beta pleated sheet aka transthrytin amyloidosis
87
What is the hearts response in the left ventricle as a result of volume overload as a result of decreased ejection fraction
Myocytes become longer and there is ventricular dilation
88
What is occurring in the transposition of the great vessels
-Aorta and pulmonary vessels are musdivided and results in two separate circuits, and is incompatible with life unless there is a shunt present
89
What are the components of a tetralogy of Fallot
1) VSD
2) Obstruction of pulmonary vessel (Stenosis)
3) Aorta overrides the VSD
4) RV hypertrophy
90
How common are heart defects in patients with Down syndrome
Seen in 40% of patients
91
Most acute MI that result in death occur how long after onset and what is it usually due to
-50% occur one hour after onset, usually secondary to an arrhythmia
92
Which gene malformations are seen in those with mitral and aortic valves
NOTCH1
93
What are the gross features of an MI after:
| -1-3 days
Mottling with yellow-tan infarct center
94
What are Roth spots and what are the indicative
Spots in the retina and indicative of infective endocarditis
95
What is the time frame following and acute MI that troponins and CK-MB can be seen in the blood and which ones are they
Troponins T and I starting about hour 3
96
What are subungual/splinter hemorrhages and what are they indicative of
Small hemorrages under the nails and are indicative of infective endocarditis
97
What are the clinical presentations of carcinoid syndrome
Flushing, diarrhea, dermatitis, bronchoconstriction
98
What is the leading cause of death in the US and what is the leading cause
Ischemic heart disease, with 90% being secondary to atherosclerosis
99
Which condition will have vegetative endocarditis characteristic of warty, line of closure
Rheumatic heart disease
100
What is the time frame that troponin T will remain in the blood following an MI
5-14 days
101
During a MI, what is the time frame when there is:
| -Irreversible cell injury
20-40 minutes
102
Which condition will have vegetative endocarditis characteristic of large and irregular
Infective endocarditis
103
What are the characteristics of unstable or crescendo angina
- Pain in increasing frequency, duration, and severity and progressively lower amounts of physical activity and eventually at rest
- Usually a rupture of atherosclerotic plaque, with a partial thrombus
104
How is prinzmetal angina relieved
Vasodilators
105
Which patient group is at a higher risk for developing coarctation of the aorta
- Males
| - Turner Syndrome
106
What are the characteristics of prinzmetal angina
- Eposodic coronary artery spasm
| - Unrelated to Physical activity, heart rate, or blood pressure
107
What are the changes seen in the valves as the heart ages
- Aortic and mitral valve annular calcification
- Fibrous thickening
- Mitral prolapse of leaflets (increases left atrial size)
- Lambl excrescences
108
What are the light microscopy features of an MI after:
| 3-7 days
- Disintegration of dead myofibers
| - early phagocytosis of fibers by macrophages
109
Valvular insufficiency causes changes in which direction and what does chronic insufficiency lead to
Allows reversed flow, where chronic insufficiency causes volume overload hypertrophy
110
What is Naxos syndrome
- Arrhythmogenic right ventricular cardiomyopathy (ARVC)
| - Distinct hyperkeratosis of plantar palmar skin surfaces***
111
What is the morphological finding in restrictive cardiomyopathy
Both atria are enlarged while the ventricles are normal size
112
What is the clinical presentation of a patient with coarctation of the aorta when there is no PDA present
Usually asymptomatic, but will see hypertension of the upper extremities, but hypotension of the lower extremities
-Claudication and cold lower extremities
113
What are the causes of mitral valve regurgitation
- Abnormalities of leaflets and commissures
- Abnormalities of tensor apparatus
- Abnormalities of left ventricle and/or annulus
114
Which valves are most commonly affected by infective endocarditis
Left sided valves
115
What is the most straining clinical feature of pericardial disease
Loud pericardial friction rub upon auscultation
116
In carcinoid heart disease, which portions of the heart tend to be affected
Right side endocardium and valves because the left is protected by the lungs degrading the mediators of disease
117
The pathogenesis of a patent ductus arteriosus is determined by which factor
-Shunts diameter
118
What is the clinical presentation of a patient with coarctation of the aorta when there is a PDA present
Manifestation at birth, there is cyanosis of the lower half of the body because the deoxygenated blood from the pulmonary circulation is going into the descending aorta
119
How is stable angina relieved
Rest or vasodilators
120
What are the mutations seen with hypertrophic cardiomyopathy
Mutations in the sarcometric proteins, especially Beta myosin heavy chain
121
What are the gross features of an MI after:
| 7-10 days
Maximal yellow-tan softening with depressed red/tan margins
122
What are the changes seen in the myocardium and chambers as the heart ages
- Increased left ventricular chamber size
- Increased epicardial fat
- Lipofuscin and basophilic degeneration
123
What are the gross features of an MI after:
| 3-7 days
Hyperemic border with central yellow tan softening
124
What are the histological findings in the lungs as a result of heart failure
“Heart failure cells” which are hemosiderin laden macrophages as a result of pulmonary congestion leading to high pressure and red cells crossing the vasculature
125
What are the complications seen with artificial valves
Thrombus
126
What is the most common cause of myocarditis
Coxsackie A and B virus
127
What is the cause of rhuematic fever
Fever and systemic inflammatory disorder 10 days to 6 weeks after a pharyngeal infection with Strep A
128
What are the gross features of an MI after:
| 10-14 days
Red-grey depressed infarct borders
129
What is the immunological cytokine associated with myxomas
IL-6
130
In the acute MI complication of a myocardial rupture, what is the cause
Usually a transmural infarct, leading to weakening of the wall 2-4 days later as a result of the inflammation and necrosis
131
What are the light microscopy features of an MI after:
| 10-14 days
Well established granulation tissue with blood vessels and collagen deposition
132
Which compounds can mimic carcinoid heart disease
- Fenfluramine (appetite suppressant and dieting fab)
| - Ergot alkaloids (migraine)
133
What is the genetic component of dilated cardiomyopathy, what is the heritability of it
- Familial 30-50%, with TTN mutation being 20%
| - Autosomal dominant
134
During a MI, what is the time frame when there is:
| -Loss of contractility
<2 minutes
135
What are Jane way lesions and what are they indicative
Small, nonpainful hemorrages on the feet and hands indicative of infective endocarditis
136
Myxomas are associated with mutations in which gene and which syndrome
GNAS1 in McCune-Albright syndome
| PRKAR1A in Carney syndrome
137
What are the most common forms of pericardial disease
-Fibrinoid and serofibrinous
138
What is the prognosis with mitral valve prolapse
- Usually does not affect valve function
| - Becomes site for thrombus formation or infective endocarditis
139
What are Osler nodes and what are the indicative of
Painful raised lesions on the palms and feet that are indicative of infective endocarditis
140
What are the causes of aortic valve stenosis
- Post-inflammatory scarring (rheumatic heart disease)
- Senile calcific aortic stenosis
- Calcification of deformed valve
141
What are the classical morphological features of infective endocarditis and complications stemming from it
Friable, bulky, destructive valvular vegetations that can lead to septic emboli
142
What is the general order of pathogenesis with left sided hypertensive disease
1) Hypertension results in left ventricular hypertrophy
2) LV wall concentrically thickens
3) Diastolic dysfunction results in left astral enlargement
4) Leads to irritation and eventual atrial fibrillation
5) Can lead to CHF and sudden cardiac death
143
Which heart shunt is most common and what are some of the examples
Left to right:
- ASD
- VSD
- PDA
144
What is the clinical complication as a result of a PDA
-Leads to increase in Pulmonary pressure resulting in reversal of the shunt to a right to left shunt and corresponding cyanosis
145
What are the common complications seen following an MI
- Arrhythmia
- Contractile dysfunction
- Fibrinoid pericarditis
- Myocardial rupture
- Infarct expansion leading to thrombosis
- Ventricular aneurysm
146
What is the morphological changes seen in carcinoid heart disease
Glistening White intima plaque-like thickening of the endocardial surfaces and valves
*Plaques are acidmucopolysaccaride rich
147
When are fibrinous and serofibrinous pericardial diseases seen
- Following an acute MI or postinfarction(aka Dressler’s)
| - Uremia
148
What are the characteristics of nonbacterial thrombotic endocarditis (NBTE)
-Small, sterile thrombi loosely attached on the cardiac valve leaflets along the line of closure
149
What is the time frame the CK-MB will remain in the blood following an MI
48-72 hours
150
What is the blood supply to the myocardium
Coronary arteries during diastole
151
What is the portion of the heart that is being supplied by the LCX
Lateral wall of LV
152
What are the causes of abnormalities if tensor apparatus leading to air tic regurgitation
Marfan*
Syphillitic aortitis*
RA
Degenerative aortic dilation
153
What are the effects of right sided heart failure
Aka cor pulmonale causes venous congestion leading to:
- Liver congestion and nutmeg liver
- splenic congestion and splenomegaly
- Peritoneal, pleural and pericardial effusion
- Renal congestion
- Distended jugular vein
- ascites and edema
154
What are the light microscopy features of an MI after:
| 2-8 weeks
Increased collagen deposition
155
What is the most common inherited arrhythmias
Long QT syndrome
156
If you are looking at a histological slide of a patient with myocarditis, and there a excess numbers of eosinophils, what is the likely cause
Hypersensitivity reaction
157
Which bacteria tends to be involved in endocarditis of valve abnormalities
S. Viridans
158
What is the only cause of mitral valve stenosis
Postinflammatory scarring (rheumatic heart disease)
159
How are the valves of the heart nourished
Via diffusion
160
What are the gross features of an MI after:
| 4-12 hours
Start of dark mottling
161
What are lambl excrescences
Small filliform processes forming on the closure lines of the aortic and mitral valves, usually from small thrombi
162
What is the greatest limitation to cardiac transplantation
Allograft arteriolar as a result of intima proliferation leading to stenosis
163
What is the cause of carcinoid syndrome
Serotonin release from carcinoid tumors, which will be seen excreted in the urine
164
What is the time frame that troponin I will peak
24 hours
165
What are the complications seen in the kidney as a result of left sided heart failure
Decreased ejection fraction results in decreased glomerular perfusion. Leads to increased renin production and can lead to prerenal azotemia
166
What is occurring in arrhythmogenic right ventricular cardiomyopathy
Right ventricular wall is replaced with adipose and fibrosis leading to ventricular tachycardia/fibrillation and subsequent death
167
What is the portion of the heart that is being supplied by the LAD
- Apex
| - Anterior LV and 2/3 septum
168
What is the pathogenesis of acute rheumatic fever causing cardiac isssues
Immune cross reacts the streptococcal M protein with cardiac self antigens
169
What is the pathogenesis that accompanies the increased hypertrophy of the heart
While there is an increased thickness of myocytes, there is no corresponding increase in blood supply to match the increased energy demand
170
What are the two common reasons that congestive heart failure occurs
- Loss of myocardial contractile functions (systolic dysfunction)
- Loss of ability to fill the ventricles during diastole (diastolic dysfunction)
171
What are the usual morphological findings in myxomas
Pedunculated or sessile structure:
- “Wrecking ball” causing damage to leaflets on valve
- “Ball-Valve” obstruction
172
IN those patients with Down syndrome, was is the most common source of their heart detects
The second heart field aka arterioventricular space
| -Most commonly defects of the endocardial cushions, which include ostium primum, ASD,AV valves, VSDs
173
What is the time frame that troponin T will peak
12-48 hours
174
What are the clinical complications as a result of left to right shunting
- Pulmonary Hypertension
- Right sided heart failure
- Paradoxical embolization
175
What is the most common cause of left sided heart failure
Left sided heart failure
176
What are the major causes of congenital heart disease
Sporadic genetic abnormalities
- Turner syndrome
- *Trisomies 13,18,21
* Trisomies are the single most common genetic cause
177
In the case of concentric hypertrophy, what is the organization of sacromeres and what is the cause
Parallel organization as a result from pressure overload
178
During an acute MI, what is the first indicator is the blood
Myoglobin, but is not specific
179
Which gene malformations are seen in those with alagille syndrome- which include pulmonary stenosis or tetralogy of Fallot
Jag1
| Notch2
180
What is the general process of restrictive cardiomyopathy
Increased ventricular stiffness (decreased compliance) leading to diastolic dysfunction with normal systolic function
*Atria are enlarged while ventricles are normal
181
What are the light microscopy features of an MI after:
| 7-10 days
- Well developed phagocytosis by macrophages
| - Granulation tissue(vessels between fibers) at Margins
182
What are the causes of restrictive endocarditis
Amyloidosis, radiation induces fibrosis
183
What are the light microscopy features of an MI after:
| >2 months
Dense collagenous scar
184
For mitral valve prolapse, what is the cause of leaflets becoming thickened and rubbery
Myxomatous degeneration (proteoglycan deposits) and elastic fiber disruption
185
What type of calcification is seen in the mitral valve
Annular
186
During a MI, what is the time frame when there is:
| -ATP reduction of 50%
10 minutes
187
What are the serum markers that are present in a rheumatic fever
- Antistreptolysin O
| - Anti-DNAase B
188
What are the histological findings in a patient with dilated cardiomyopathy
Myocytes hypertrophy with interstitial fibrosis
189
What are the light microscopy features of an MI after:
| 4-12 hours
Edema, hemorrhage
190
What is angina pectoris
Transient, recurrent chest pain induced by myocardial ischemia leading that is insufficient to cause a myocardial infarction
191
What is the cause of Mitral valve stenosis
Post-inflammatory scarring due to rheumatic heart disease
192
Which condition will have vegetative endocarditis characteristic of small, line of closure
Nonbacterial thrombotic endocarditis (NBTE)
193
Which valves are most commonly affected by IV drug use
Right sided valves
194
What type of calcification is seen on the aortic valve
Annular
195
What are the causes of hypertrophic cardiomyopathy
100% genetic causes with myofiber disarray being the most common
196
What is sick sinus syndrome
SA node damage leading to bradycardia
197
What condition is nonbacterial thrombotic endocarditis (NBTE) associated with
Malignancy, especially mucinous adenocarcinomas
198
During an MI, which portion of the endocardium is first to undergo necrosis
The farthest from the vessel and closest to the lumen of the chamber
199
Valvular stenosis impedes which direction of flow and what is a common result of chronic stenosis
Impedes forward flow, chronic stenosis causes pressure overload hypertrophy
200
What is the day break up between different immune cell types following an MI
Neutrophils dominate days 3-4
| Macrophages dominate days 7-10
201
What are the physiological changes seen as a result of the transposition of the great vessels
-Since the aorta and systemic circulation is now supplied by the RV, then the RV will become hypertrophic and the LV will atrophy
202
What are the increases in PDA
Increase in pulmonary pressure and blood flow
*Because some of the pressure and flow from the left ventricle is going into the right ventricle and pulmonary arteries
