Heart Week 2: Tid bits

Question 1

What is carcinoid syndrome?

Answer 1

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.

Question 2

What is myxomatous degeneration? What does it cause?

Answer 2

A pathological degeneration of connective tissue. It can commonly lead to MVP.

Question 3

What are the two ways mentioned that can cause R heart failure?

Answer 3

1. carcinoid syndrome: tumor in GI, releases serotonin, causes tricuspid regurge
2. IV drug use

Question 4

What are the parts of the heart tube, and what do they become?

Answer 4

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

Question 5

What septa form the foramen ovale?

Answer 5

Septum primum and septum secundum.

Question 6

In the fetus, which ventricle does most of the work?

Answer 6

The right ventricle. It provides 2/3 of CO.

Question 7

The oxygenated blood from the mother goes thru which two veins?

Answer 7

1. Ductus Venosus and straight to the heart.

2. Portal Vein to liver and then into the IVC.

Question 8

What are the 7 acyanotic congenital heart diseases?

Answer 8

1. ASD
2. VSD
3. PDA
4. Congenital AS
5. Pulmonic Stenosis
6. Coarctation of Aorta
7. atrioventricularis communis

Question 9

What are some signs of ASD?

Answer 9

a. midsystolic murmur (excess blood over pulmonic valve!)
b. RA/RV dilatation
c. most people are asymptomatic

Question 10

What are some signs of VSD?

Answer 10

a. holosystolic murmur (loud sound = small hole)
b. RV dilatation and hypertrophy
c. often spontaneously close

Question 11

What are some signs of PDA?

Answer 11

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)

Question 12

Is congenital AS a lot like adult AS?

Answer 12

Yes. Similar symptoms and presentation.

Question 13

What are some signs of pulmonic stenosis?

Answer 13

a. RV heave in an effort to expel blood
b. RV hypertrophy
c. R heart failure
d. systolic ejection murmur

Question 14

What are some signs of coarctation of the aorta?

Answer 14

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.

Question 15

What are 3 cyanotic diseases?

Answer 15

1. tetralogy of fallot
2. transposition of great arteries
3. Eisenmenger Syndrome

Question 16

What are some signs of Tetralogy of Fallot?

Answer 16

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

Question 17

What are some signs of Transposition of Great Arteries?

Answer 17

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

Question 18

What are some signs of Eisenmenger Syndrom?

Answer 18

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

Question 19

What can chromosomal anomalies to 13, 18, 21, and monosomy X lead to?

Answer 19

13: all kinds of congenital heart defects
18: VSD
21: endocardial cushion defects
Monosomy X: coarctation of the aorta

Question 20

What is involved in an atrioventricularis communis (atrioventricular septal defect, AVSD)?

Answer 20

AVSD = ostium primum ASD + VSD + mitral abnormality + tricuspid abnormality

Question 21

Tetralogy of Fallot and Transpostion of Great Arteries arise from what malfunction in development of the conotruncus?

Answer 21

TF: defect in partitioning of the conotruncus

TGA: defect in the twisting of the conotruncus

Question 22

What happens in persistent truncus arteriosus?

Answer 22

The truncus arteriosus does not divide into two vessels, so the deoxygenated and oxygenated blood mixes.

this is always associated with a VSD

Question 23

What is anomalous pulmonary venous connection?

Answer 23

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.

Question 24

What are common cyanotic (R to L) congenital heart disease complications?

Answer 24

1. paradoxical embolism

2. clubbing of fingertips

Question 25

Special circulation: heart

Answer 25

Blood flow increases 4-5 fold with heavy exercise (adenosin, low O2)

Question 26

Special circulation: Brain

Answer 26

local blood flow changes in response to metabolic activity.

Question 27

Special circulation: skeletal muscles

Answer 27

strong metabolic control (K+, adenosine, CO2)

Question 28

Special circulation: Kidneys

Answer 28

receive large blood flow, ~25%

Question 29

Special circulation: Lung

Answer 29

Opposite metabolic regulation: low O2 constricts. Shunts blood from poorly ventilated parts of the lung

Question 30

Special circulation: Skin

Answer 30

blood flow changes in response to body temperature

Question 31

What two organ systems are under mostly local control regarding metabolism? What three systems are under local and autonomic control?

Answer 31

local only: heart, brain

local and auto: GI, splanchnic, skeletal muslces