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What is the order of valves as blood flows throught the heart?
Relative to all mortality causes, where do cardio vascular diseases fall?
Of cardiac diseases, which one is most common?
Atherosclerosis = 80%
By what week in development is the heart formed? Which week are congenital heart diseases developed before?
10th and 9th
What are some causes of congenital heart diseases?
- Most Causes unknown
- - Rubella (german measles) - infection in mother @ 1st Trimester
- -Fetal Alcohol Syndrome - Etoh effects heart development directly
- Chromosomal Abnormalities
- -Down's Syndrome
What are the most common Congential Heart Diseases?
- Atrial septal defect
- Ventricular septal defect
- Tetraology of Fallot
How would you descrive a right to left Shunt? Characteristics?
- Early cyanosis (skips lungs)
- "blue babies"
- more urgent usually than left to right
How would you descrive a left to right Shunt? Characteristics?
- Late cyanosis (reenters lung)
- "blue kids"
What are some pathologies of right to left Shunts?
- Tetrology of Fallot (most common for early cyanosis)
- Transposition of great vessels (death in 1 month)
- Truncus arteriosus
- Tricuspid Atresia
- Total Anomalous Pulmonary Venous Return (TAPVR)
Children May squat to increase systemic vascular resistance
What are some pathologies for left to right Shunts?
- VSD - Ventricular Septal Defect ( MOST COMMON)
- ASD - Atrial Septal Defect (Loud S1; Split S2)
- PDA - Patent Ductus Arteriosus
- VSD > ASD > PDA
This problem leads to progressive pulmonary hypertension and turns into right to left shunt (Eisenmenger's Syndrome)
What is Eisenmeyer's Syndrome?
Any uncorrected VSD, ASD, or PDA. This leads to inc. pulmonary hypertension --> shunt reverses from L --> R to R --> L, Which causes late cyanosis.
Describe a ASD or Atrial Septal Defect
- Septum of connective tissue that has not been fully closed over AFTER BIRTH
- Occurs in 1 in 2000 births
- Normally while in mother venous blood flows from left atrium to the right via the foramen ovale (this is what does not close)
Describe a Ventricular Septal Defect or VSD
- The most common congential heart defect recognized in practice
- Left to right shunt (aka L pressure > R Pressure)
- Inc. Backflow through pulmonary aa. --> Pulmonary Hypertension
- Pulmonary Hypertension offsets the inc. pressure from the left ventricle (Shunt Reversal) and dump unoxygenated blood into circulation --> CYANOSIS
- Produces distinct Hear Murmur
- No Sx Needed w/ most patients (Only large Defects)
What are the four findings in the Tetrology of Fallot?
- 1.)Overriding Aorta (Dextroposition)
- 2.)Pulmonary Stenosis
- 3.)Ventricular Septal Defect
- 4.)Right Ventricular Hypertrophy
Desribe the Tetrology of Fallot (not the Four Findings)
- "Blue Babies" - Cyanosis early after birth (R --> L Shunt accross VSD)
- Death Before puberty w/o surgery
- Radiograph shows BOOT SHAPED HEART due to Right Ventrical Hypertrophy
What is the cause of the Tetrology of Fallot?
Anterosuperior displacement of the infundibular septum
What do people with the Tetrology of Fallot Squat?
Compression of femoral aa. inc. pressure. --> dec. the right to left shunt and directing more blood from the RV to the lungs
Describe the transposition of the great vessels
Aorta leaves RV and Pulmonary trunk leaves LV --> separation of systemic and pulmonary circulations
THIS DOES NOT OCCUR
What is the cause of transposition of the great vessels?
Failure of the aorticopulmonary septum to spiral, not compatible with life unless shunt is present to allow blood to mix