The Circulatory System Flashcards
What is cardiovascular disease?
A broad, umbrella term that encompasses a collection of diseases and conditions
What are the two main components of cardiovascular disease?
Diseases of the heart and diseases of the blood vessels
What are some examples of cardiovascular disease?
Aneurysms, heart attacks, varicose veins
What is atherosclerosis?
The gradual buildup of fatty deposits (mainly cholesterol)
What causes plaque?
Lipids that are deposited in the arteries
What does atherosclerosis progressively narrow?
The artery, decreasing the blood flow
When does atherosclerosis begin?
At an early age
What is arteriosclerosis?
The hardening of the wall of the arteries due to the plaque formation and calcification
What is stenosis?
The narrowing of arteries
What is the major cause of a thrombus?
A change in the wall of blood vessels such as the irregularity caused by arteriosclerosis
What is a thrombus?
A blood clot that has attached itself to the inner wall of an artery or vein
What occurs if one of the coronary arteries becomes completely blocked, and that part of the heart muscle dies?
Myocardial infarction
What is the major site of involvement with myocardial infarctions?
The left ventricle
What is myocarditis?
Inflammation of the myocardium
What is pericarditis?
Inflammation of the pericardium
What is cardiac dilation?
When the muscle fibers stretch, causing the heart to enlarge
What is cardiomegaly?
When the heart remains enlarged because of a disease process
What is dyspnea?
Shortness of breath
What is dextrocardia?
Occurs when the hearts displaced to the right side of the body (known as dextroposition)
What is cardiac heterotaxia?
If the heart is reversed so that it is a mirror image of a normal heart
What is situs inversus?
When all the organs of the body are reversed from normal and on the opposite side of the body
What is valvular disease?
When the valves of the heart are affected by some pathologic condition such as thickening or shrinking due to infection
What is an incompetent valve?
Valves that will not operate normally. The valve is normally formed but will not completely close the orifice, which allows retrograde blood flow
What is an insufficient valve?
One that will not operate properly because it is deformed
What is coarctation of the aorta?
The severe narrowing of the aorta that causes the left ventricle of the heart to suffer an increase in workload in order to push blood through the a narrow passageway
If the narrowing of the aorta is severe enough or complete with coarctation, what happens?
Anastomotic vessels develop in an attempt to compensate for the inadequate blood supply to the lower portion of the body
What does coarctation of the aorta result in?
Hypertension in the upper extremities and hypotension in the lower extremities
What are the two varieties of coarctation of the aorta?
Localized and tubular
What is the most common coarctation of the aorta?
Localized (formerly known as adult)
Who does localized coarctation of the aorta occur more often in?
Males
In an adult with coarctation of the aorta, what is apparent?
severe hypertension proximal to the coarctation and results dilation of the aortic arch
What is an important radiographic sign of coarctation of the aorta?
Rib-notching
What does rib-notching show with coarctation of the aorta?
Sharply defined bony erosions along the lower margins of the ribs caused by the development of anastomotic vessels that enlarge under their increased volume and cause pressure erosions on the ribs
What is tubular coarctation?
Hypoplasia of a long segment of aortic arch after the origin of the innominate artery
What are common with tubular coarctation but not localized?
Cardia anomalies
What are congenital heart abnormalities that result of?
Inborn defects caused by failure of the heart or major blood vessels near the heart to develop normally during the growth period before birth
What are the most common types of congenital abnormalities?
Those in which holes in the heart wall occur known as shunts
What are shunts?
Holes in the heart wall and allow pulmonary and systemic blood to mix which causes the lungs to become overloaded with blood
What are the three major types of shunts?
ASD, VSD, and PAD
What are septal defects?
Small openings in the septum of the heart
What are atrial septal defects?
Openings in the septum between the two atria
What are the most common congenital defects of the heart?
ASD
What type of shunt is a ASD?
A left-to-right shunt because the pressure is higher in the left atrium than it is in the right atrium
What is an ASD considered a left-to-right shunt?
A large amount of oxygen-rich blood leaks from the left side back to the right side and back to the lungs
What is increased because of an ASD?
Pulmonary blood flow
In addition to overloading the pulmonary bed with a ASD, what happens?
The right ventricle experiences an overload which produces a radiographic appearance of enlargement of the right ventricle and right atrium
What is a VSD?
If the defect occurs between the two ventricles
What is a VSD more serious than a ASD?
Because there is a greater pressure difference between the two ventricles than between the two atria
Where may a VSD occur?
In the membranous or muscular portion of the ventricular septum
What occurs during systole with a VSD?
Because of higher pressure in the left ventricle, a shunting of blood from the left to the right occurs because of the higher pressure in the ventricle during that phase
If pulmonary vascular resistance produces pulmonary hypertension with a VSD, what happens?
the shunt of blood is then reversed from the right to the left ventricles, resulting in cyanosis
What is the radiographic appearance of a VSD?
Enlargement of the left side of the heart
What is a PAD?
When the arterial duct in a newborn fails to close after birth
What is the arterial duct?
A vessel that extends from the bifurcation of the pulmonary artery to join the aorta just distal to the left subclavian artery
What does the arterial duct do?
It serves to shunt blood from the pulmonary artery into the systemic circulation during intrauterine life
If a PAD does not close, what happens?
Oxygenated blood is continuously shunted from the aorta to the pulmonary artery and back to the lungs instead of going through the aorta to the body. The heart will be overworked
What happens to a persons breathing with PAD?
It becomes dyspneic on light exertion
What does the radiographic image show with PAD?
Enlargement of the left atrium and left ventricle and increased vascular congestion
What occurs when four conditions exist simultaneously?
Tetralogy of Fallot
What has to occur with Tetralogy of Fallot?
- Pulmonary stenosis
- Right ventricle hypertrophy (thickening)
- A VSD
- Displacement of the aorta to the right (or overriding of the aorta above the VSD)
What do the four conditions associated with tetralogy of Fallot cause?
The blood to be unoxygenated, as it does not flow through the pulmonary system
What is pulmonary stenosis?
A narrowing of the pulmonic valve and the muscular region below the valve
What does pulmonary stenosis cause?
A decrease in the amount of blood that is trying to flow from the right ventricle into the pulmonary circulation. Thus, there is a decreased blood flow from the lungs. This is turn causes an election of pressure in the right ventricle and hypertrophy of that chamber as it overworks to pump blood through the narrow pulmonary valve
What does a VSD allow with tetralogy of fallot?
It allows unoxygenated blood in the right ventricle to mix with oxygenated blood in the left ventricle (know as a right-to-left shunt). This allows blood to travel up through the displaced aorta, which opens directly into both the right and left ventricles
What does the aorta carry with a VSD with tetralogy of fallot?
both unoxygenated and oxygenated blood and because of this, the amount of oxygen the aorta carries to the body tissues is decreased
What gives rise to extreme cyanosis and is a common cause of “blue baby”
A VSD associated with tetralogy of Fallot
What happens when the right ventricle enlarges with Tetralogy of Fallot?
It causes the apex of the heart to become displaced upward and laterally which is the classic radiographic appearance known as “Coeur en Sabot”
What are the clinical manifestations associate with Coeur en Sabot?
clubbing of fingers and toes, systolic murmurs and retardation of growth
Where is a shunt inserted for Tetralogy of Fallot?
Between the aorta and pulmonary artery
What is an aneurysm?
A major process that will affect the adult aorta. It is a dilation of an artery (usually the aorta)
What is an aneurysm usually caused by?
Atherosclerosis in almost 80% of cases
What are some common diseases that can cause aneurysms?
Syphilis, Marfan syndrome, and high blood pressure
What is a true aneurysm?
A permanent dilation of all layers of a weakened but intact vessel wall
What are the three different types of aneurysm?
Saccular, Fusiform, and dissecting
What is a saccular aneurysm?
A localized outpouching of one side of the vessel wall, usually located in the cerebral arteries but it may be in the distal abdominal aorta
What is a fusiform aneurysm?
A uniform dilation of the entire portion of the artery. They are usually found in the distal abdominal aorta
What is a dissecting aneurysm?
It occurs when a hemorrhage occurs between the layers of the wall of the artery
What other type of aneurysm can a dissecting aneurysm look like?
A fusiform type as the dissection causes progressive widening of the aortic shadow
When an aneurysm is found in the abdominal aorta, what is it termed?
The triple A for abdominal aortic aneurysm
What is an additional type of aneurysm?
A false aneurysm
What is a false aneurysm?
A pulsating hematoma and must be distinguished as such
What are the dangers of an aneurysm?
Its tendency to increase in size and rupture, leading to massive hemorrhage that may be fatal if it involves a critical organ such as the brain
What is the modality of choice to diagnose aneurysms?
Angiography
What is generally recommended as treatment for aneurysms?
Surgery unless the diameter of the aorta is small (less than 4.5)
What is the major cause of vascular disease?
Atherosclerosis
What is atherosclerosis characterized by?
Irregularly distributed fat deposits in medium and large sized arteries
When does atherosclerosis begin?
When the lining of the artery becomes damaged through some process such as smoking
What accumulates as the site of damage with atherosclerosis?
Plaque, which is low-density lipoproteins
What does plaque formation and stenosis often involve?
The coronary arteries causing arteriosclerotic heart disease
What is arteriosclerotic heart disease also known as?
Cardiovascular disease
What disease remains the leading cause of deaths in the United States
Arteriosclerotic heart disease
What procedure remains among the most frequently performed surgical procedures associated with arteriosclerotic heart disease?
Coronary artery bypass grafting because of hypertension
What accelerates the development of atherosclerotic plaque?
Hypertension, so it is often found un conjunction with arteriosclerotic heart disease
What happens if enough plaque finally accumulates with arteriosclerotic heart disease?
The myocardium is damaged and continual plaque buildup results in a myocardial infarction
What can be seen on radiographic images with arteriosclerotic heart disease?
Mild cardiomegaly as well as calcification in the coronary arteries
What results when the heart cannot supply enough blood at a sufficient rate to meet the metabolic requirement of tissues?
CHF
What can CHF be caused by?
Damage from a heart attack, cardiovascular disease, hypertension, or infection to the heart muscle and damage to the valves
What categories can CHF be divided into?
Right heart failure and left heart failure
What happens when one side of the heart fails while the other side continues its normal output with right or left CHF?
There is increased pressure in the pulmonary or systemic veins, or both, resulting in “backing up” of blood
What is CHF usually accompanied by?
Pleural effusion
What is the classical radiographic sign of CHF?
Diffuse cardiomegaly
What happens when there is left heart failure?
the left ventricle does not pump a volume of blood equal to that of the venous return in the right ventricle
What happens when fluid builds up with left sided heart failure?
A point is reached at which it has nowhere to go but the alveoli and bronchial tree of lungs which produces rales and pulmonary edema
What is left sided heart failure usually caused by?
hypertension, but can result from coronary heart disease or valvular disease
What do the radiographic images show with left sided heart failure?
A congested hilar region of the lungs with increased vascular markings
What might left heart failure lead to?
Right heart failure because increased pressure is transmitted through the pulmonary circulation to the right heart
What does right sided heart failure cause?
dilation of the right ventricle and right atrium
What can the transmission of increased pressure cause with right sided heart failure?
Dilation of the superior vena cava, widening of the right superior mediastinum, and edema of the lower extremities
What can right sided heart failure be caused by?
Pulmonary valvular stenosis, emphysema, or pulmonary hypertension resulting from pulmonary emboli
What is the typical appearance of the pulmonary vessels in an upright chest radiograph with CHF?
The pulmonary vessels in the lower lung zones are larger than those in the apices
What is the typical appearance of the pulmonary vessels in an upright chest radiograph with severe pulmonary venous hypertension associated with CHF?
there is a redistribution of flow so that vessels in the upper zones are larger than those in the lower lung zones
What does a chest radiographic image of a person with CHF show?
a pulmonary vascular shift, an increase in heart size, and more importantly cephalization which is the hallmark on the image
What is the most common cause of CHF in older adults?
hypertensive heart disease
What does high blood pressure, over a long period of time cause?
Narrowing of the systemic blood vessels. Because of this resistance, the left ventricle must work harder, causing dilation and enlargement of the ventricle
What often occurs with the heart with hypertensive heart disease?
there is often downward displacement of the apex of the heart
What does failure of the left ventricle lead to with hypertensive heart disease?
Increased pulmonary venous pressure and congestive failure
What are the radiographic signs and symptoms for hypertensive heart disease?
Same as for CHF
What is hypertrophy?
Enlargement of the atria or ventricles
How is right atria enlargement recognized?
By enlargement of the cardiac shadow to the right of the thoracic spine in the frontal view
What can right atrial enlargement be caused by?
subacute bacterial endocarditis or ASD
How is right ventricular enlargement recognized?
By encroachment of the cardiac shadow into the retrosternal space on the lateral projection
What happens with right ventricular enlargement?
The right ventricle works harder and enlarges in the presence of defects of the pulmonary vascular bed, as with pulmonary hypertension. The alterations in the pulmonary circulation lead to pulmonary arterial hypertension
What is right ventricular enlargement usually associated with?
Right atrial enlargement
How is enlargement of the left atrium seen radiographically?
As a rounded opacity in the retrocardiac region projecting to the left and right of the spine on the posteroanterior projection of the chest
What enlarges with rheumatic heart disease?
The left atrium with mitral stenosis or mitral insufficiency
How is enlargement of the left ventricle seen?
By the cardiac shadow to the left of the spine, often with a round lateral contour projecting below the diaphragm
What happens with enlargement of the left ventricle?
The left ventricle works harder and longer with each beat when it meets increased resistance to the emptying of blood into the systemic circulation as occurs with aortic stenosis, volume overload, and systemic hypertension
What happens to the left ventricle with enlargement?
The ventricle hypertrophies because of the extra exercise and sometimes it becomes displaced laterally
What is pericardial effusion?
Fluid in the pericardial sac
What are the cause of pericardial effusion?
TB and viral infections
When should pericardial effusion be suspected?
When there is a rapid increase in heart size on the chest images without other signs of heart failure
What is an excellent method of demonstrating pericardial effusion?
echocardiography
What amount of fluid can be detected by a echocardiography?
As little as 50 mL, whereas at least 200 mL on a radiographic image
What is the cause of rheumatic fever?
The cause is unknown, but the attacks are preceded by Strep
What do episodes of rheumatic fever cause?
Inflammation of the heart valves rather than the myocardium and leads to scarring deformities of the valves known as rheumatic heart disease
What is the most common valve deformity associated with rheumatic heart disease?
stenosis of the mitral valve
What is valvular disease?
At variable times following acute illness, chronic damage to heart valves may become evident
What happens with valvular disease?
The functional valve damage is produced by stenosis of the valve opening or valvular insufficiency or both
What valves are most commonly affected with valvular disease?
Fibrosis of the mitral valve which usually leads to left heart failure and stenosis and insufficiency of the aortic valve
What does the left heart failure result from with valvular disease?
The left heart failure results either from backup of blood into the lungs caused by stenosis or from regurgitation of blood back through the insufficient valve
What does stenosis and insufficiency of the aortic valve cause with valvular disease?
left ventricular hypertrophy and eventually heart failure. The valves may also become infected, producing infective endocarditis
What is seen on a radiographic image with rheumatoid heart disease?
Calcification of the mitral valve and Kerley B lines
What is subacute bacterial endocarditis caused by?
Organisms that live on the heart valves and produce an inflammatory reaction
What is the most common cause of subacute bacterial endocarditis?
Bacteria
What is the most common predisposing factor to the development of subacute bacterial endocarditis?
Rhuematic vulvitis
What is the most striking feature of subacute bacterial endocarditis?
The formation of large number of emboli because of the breaking off of fragments of the vegetations
What is angiography?
A general term used to describe the radiographic procedure of the vessels of the body
What is arteriography?
The study of the arterial system
What is venography?
The study of the venous system
What is aortography?
The study of the thoracic or abdominal aorta
What is angiocardiography (cardiography)?
the examination of the chambers of the heart
What are the steps taken from angiocradiography?
A catheter is fed into the femoral or brachial artery of the patient
What is an arteriogram?
The injection of contrast material into one or more arteries to make them visible on the radiographic image
What is percutaneous transluminal angioplasty?
With the use of a balloon catheter, it is a procedure for the alleviation of symptoms in patients with arteriosclerosis
What happens with percutaneous transluminal angioplasty?
A catheter is threaded into the artery to the site of the plaque. At this point a balloon is inflated “cracking” the plaque off the arterial wall
What is an endovascular stent repair?
It is not a diagnostic procedure but it is performed with the aid of fluoroscopy
What happens with endovascular stent repair?
A stent is threaded over a catheter and placed in the aorta where the aneurysm is found. The graft (stent( is expanded and fastened in place to form a stable channel for blood flow
What does echocardiography visualize?
The chambers of the heart and the valves; determines septal defects and pericardial effusion
