Heart Week 2: Tid bits Flashcards
What is carcinoid syndrome?
A tumor somewhere in the body, usually the GI tract, releases a hormone, commonly serotonin, which form endocardial plaques on the R side of the heart.
What is myxomatous degeneration? What does it cause?
A pathological degeneration of connective tissue. It can commonly lead to MVP.
What are the two ways mentioned that can cause R heart failure?
- carcinoid syndrome: tumor in GI, releases serotonin, causes tricuspid regurge
- IV drug use
What are the parts of the heart tube, and what do they become?
a. Sinus Venosus- part of R atrium where IVC/SVC enter
b. Primitive Atrium- R/L atria
c. Primitive Ventricle- inlet of ventricles
d. Bulbus Cordis- outlet of ventricles
e. Truncus Arteriosus- aorta, pulmonary arch
What septa form the foramen ovale?
Septum primum and septum secundum.
In the fetus, which ventricle does most of the work?
The right ventricle. It provides 2/3 of CO.
The oxygenated blood from the mother goes thru which two veins?
- Ductus Venosus and straight to the heart.
2. Portal Vein to liver and then into the IVC.
What are the 7 acyanotic congenital heart diseases?
- ASD
- VSD
- PDA
- Congenital AS
- Pulmonic Stenosis
- Coarctation of Aorta
- atrioventricularis communis
What are some signs of ASD?
a. midsystolic murmur (excess blood over pulmonic valve!)
b. RA/RV dilatation
c. most people are asymptomatic
What are some signs of VSD?
a. holosystolic murmur (loud sound = small hole)
b. RV dilatation and hypertrophy
c. often spontaneously close
What are some signs of PDA?
a. LA/LV become overworked bc of excess blood entering pulmonary circulation
b. continuous machine-like murmur heard best at L subclavicular region (loud noise = small hole)
Is congenital AS a lot like adult AS?
Yes. Similar symptoms and presentation.
What are some signs of pulmonic stenosis?
a. RV heave in an effort to expel blood
b. RV hypertrophy
c. R heart failure
d. systolic ejection murmur
What are some signs of coarctation of the aorta?
a. differences in BP between upper and lower body
b. well-developed collateral vessels in thorax
c. it used to make a big difference if coarctation was pre- or post-ductus arteriosus
d. prostaglandins can be used to keep ductus arteriosus open until a surgical intervention can occur.
What are 3 cyanotic diseases?
- tetralogy of fallot
- transposition of great arteries
- Eisenmenger Syndrome
What are some signs of Tetralogy of Fallot?
a. RV outflow obstruction
b. VSD
c. Aorta gets most of the blood
d. hypertrophy of RV
e. “boot-shaped” heart on CXR
f. a correlation of deletion of chromosome 22
What are some signs of Transposition of Great Arteries?
a. pulmonary and systemic blood flows in parallel.
b. use prostaglandins to keep ductus arteriosus open
c. RV hypertrophy bc it is circulating to system
What are some signs of Eisenmenger Syndrom?
a. L-R shunt becomes R-L
b. very serious bc it means blood pressure has backed up into R heart (from L heart, thru lungs, and now at R heart)
c. it can cause digital clubbing
What can chromosomal anomalies to 13, 18, 21, and monosomy X lead to?
13: all kinds of congenital heart defects
18: VSD
21: endocardial cushion defects
Monosomy X: coarctation of the aorta
What is involved in an atrioventricularis communis (atrioventricular septal defect, AVSD)?
AVSD = ostium primum ASD + VSD + mitral abnormality + tricuspid abnormality
Tetralogy of Fallot and Transpostion of Great Arteries arise from what malfunction in development of the conotruncus?
TF: defect in partitioning of the conotruncus
TGA: defect in the twisting of the conotruncus
What happens in persistent truncus arteriosus?
The truncus arteriosus does not divide into two vessels, so the deoxygenated and oxygenated blood mixes.
this is always associated with a VSD
What is anomalous pulmonary venous connection?
When the pulmonary veins do not attach to the LA. If two empty into RA and two into LA (partial) then patient may be asymptomatic.
What are common cyanotic (R to L) congenital heart disease complications?
- paradoxical embolism
2. clubbing of fingertips
Special circulation: heart
Blood flow increases 4-5 fold with heavy exercise (adenosin, low O2)
Special circulation: Brain
local blood flow changes in response to metabolic activity.
Special circulation: skeletal muscles
strong metabolic control (K+, adenosine, CO2)
Special circulation: Kidneys
receive large blood flow, ~25%
Special circulation: Lung
Opposite metabolic regulation: low O2 constricts. Shunts blood from poorly ventilated parts of the lung
Special circulation: Skin
blood flow changes in response to body temperature
What two organ systems are under mostly local control regarding metabolism? What three systems are under local and autonomic control?
local only: heart, brain
local and auto: GI, splanchnic, skeletal muslces
