Cardio Pathology

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CVP2015
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239587
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Cardio Pathology
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2013-10-08 20:44:53
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Study cards for QT 1
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  1. Patent Ductus Arteriosus
    • - Communication between the Aorta & Left pulmonary Artery
    • - The shunt that is open in the fetus due to the collapsed lung causing higher resistance than systemic resistance.
    • - Normally after birth (hours-weeks) the lumen starts to obliterate due to smooth muscle contraction and w/in 12days the Ligamentum Arteriosum forms. 
    • CLINICAL FEATURES:
    • dyspnea, fatigue, diminished growth & cardiac failure (w/ Lg shunt)
    • POSSIBLE FEATURES:
    • subacute bacterial endocarditis, aneurysm, noninfectious thrombosis
    • Left-to-Right:
    • may eventually cause pulmonary hypertension & shunt reversal, surgical correction recommended early
    • Right-to-Left:
    • cyanosis & fatigue are main complaints, chest pain of pulmonary hypertension may be present
  2. Ventricular Septal Defect
    • Four Types:
    • - Between the Crista Supraventricularis & Pulmonary Valve
    • - Just caudal to the Crista Supraventricularis
    • - Beneath the septal leaflet of the tricuspid valve in an area where the         A-V conduction bundle is especially susceptable to injury
    • - In the muscular septum near the apex of the right ventricle

    • CLINICAL FEATURES:
    • - defect size + pulmonary vascular resistance = volume of blood 
    • - increase pulmonary blood Q = increase pulmonary vascular R
    • **if pulmonary vascular R increases to a level above systemic R, the shunt is reversed from left-to-right -- right-to-left, making surgical therapy uniformly unsuccessful.**

    -surgical correction may be carried out with primary closure or, if the defect is large a patch is indicated
  3. Psuedotruncus
    • - The name given to a defect which includes hypoplasia or absence of the main pulmonary artery.
    • - Pulmonary circulation is dependent upon a patent ductus arteriosus and a ventricular septal defect

    • SYMPTOMS:
    • - resemble those of tricuspid atresia
    • - dyspnea, fatigability, frequent resp infections, cyanosis, hypoxia & cardiac failure are all common

    • SURGICAL CORRECTION:
    • - involves closing the ventricular septal defect, closing the patent ductus arteriosus and insertion of a dacrom graft betaeen the RV and left main pulmonary artery (RASTELLI PROCEDURE)
  4. TRICUSPID INSUFFICIENCY
    • PRIMARY:
    • - Extremely rare finding
    • SECONDARY:
    • - congenital or rheumatic disease, trauma or endocarditis 

    • CLINICAL FEATURES:
    • - edema and ascites are usually present, as may be hepatomegaly and splenomegaly



    **Since it is usually caused by another cardiac defect, the primary defect must be repaired.  Repair of the Tricuspid Valve is usually limited to valvuloplasty.
  5. Pulmonary Congestion or Edema
    • ACTIVE CONGESTION:
    • SERVERE:
    • - left-to-right shunt
    • MODERATE:
    • - increased speed of circulation
    •      - anemia / thyrotoxicosis / beriberi heart disease
    • - increased blood volume
    •      - pregnancy
    • PASSIVE CONGESTION:
    • CHRONIC LV FAILURE:
    • - severe systolic overload of LV
    •    - systemic hypertension / coarctation of aorta / aortic stenosis
    • - severe diastolic overload of LV
    •    - mitral insufficiency / patent ductus arteriosus / aortic insufficiency 
    • - myocardial damage & failure
    •    - myocarditis / myocardial fibrosis / myocardial infarction
    • - left ventricular aneurysm
    • OBSTRUCTION TO FLOW:
    • mitral stenosis / LA thrombosis / constrictive pericarditis / amyloidosis / endocardial fibroelastosis / compression of pulmonary veins
  6. Beriberi Heart Disease
    - Due to a dietary deficiency of Thiamine.

    • CLINICAL FEATURES:
    • - elevated BP
    • - bounding pulse (extremely)
    • - rapid circulation (extremely)

    • COMMON OCCURRENCES:
    • - increased venous pressure
    • - ascites
    • - edema
    • - right heart failure

    **Responds dramatically to Thiamine therapy.
  7. Atrial Septal Defect
    • 3 common types: 
    • 1. Ostium secudum: central portion of the atrial septum
    • 2. Sinus Venosum: high in septum, near SVC
    • 3. Ostium Primum: low in septum; close to medial leaflet of mitral valve
    • Clinical: can cause upper respiratory infections and fatigue; no cyanosis, but can be mild dyspnea and fatigue 
    • -increased pulmonary flow resulting in pulmonary hypertension which can reverse shunt to become right to left
    • -if it is a primum type defect then severe cardiac failure may be present; this defect should be corrected between the ages 3-5
    • -the defect can be repaired by primary closure
    • -in the ostium primum defect, the cleft in the mitral vlave is sutured; sometimes a pericardial graft is needed to the bridge the gap in the valve
  8. Total Anomalous Pulmonary Venous Return
    • -when 4 pulmonary veins return blood to the right side of the heart; most times atrial septal defects are present so blood can circulate to the left side of the heart
    • Partial anomalous pulmonary venous return: pulmonary venous returns partially to the right side and partially to the left side
    • 3 categories:

    • Supracardiac (50%)- most common; pulmonary venous return empties into left SVC, then innominate vein, then SVC
    • Cardiac (30%)- pulmonary venous return empties into coronary sinus; occasionally goes into right atrium
    • Infracardiac (10%)- pulmonary veins drain into venous trunk that descends and enters IVC or portal vein below diaphragm

    • Clinical: can cause cyanosis, cardiac failure, and pulmonary hypertension
    • 75% of patients die before age 1
    • Surgery tries to aim at rediverting the venous blood to the left side
  9. Vascular Rings
    • -ring of vessels surrounding the esophagus and trachea, most common being the double aortic arch.
    • -defect causing the right and left (innominate) aortic arch to form descending aorta
    • -another common vascular ring is formed round the right aortic arch joined by the ligamentum arteriosum on the left side; the ring circles the trachea and esophagus causing partial obstruction causing difficulty in respiration
    • - surgical correction is directed towards relieving the constriction of the ring around the trachea and esophagus
  10. Mitral Stenosis
    • -narrowing of the mitral valve; most common valvular defect
    • -can impede the flow of blood from the left atrium to the left ventricle during ventricular diastole causing a rise in left atrial pressure 
    • -this high pressure can cause increased pulmonary venous, pulmonary arteriolar, pulmonary artery pressures, and right ventricular systolic pressure 
    • -pulmonary arteriolar sclerosis or pulmonary fibrosis can occur
    • Clinical: palpitations, weakness, orthopnea, dyspnea, pulmonary edema, and hemoptysis are symptoms. Edema and cyanosis appear in advanced stages
    • -mitral commissurotomy can be done which opens the mitral valve along its fused commissures 
    • -acquired mitral stenosis, esp. calcific mitral stenosis requires valve replacement
  11. Pericarditis
    • -acute pericarditis accompanied by severe chest pain; may cause pericardial effusion which can result in a cardiac tamponade 
    • -adhesive pericarditis is when the pericardium thickens and adheres to the heart itself which can be follow by constrictive pericarditis
    • -constrictive pericarditis interferes with the normal function of the heart which may results in the pericardium being surgically removed
  12. Essential Hypertension
    • -80-85% of cases
    • -predisposing factors include heredity, vascular reactivity, renin-angiotensin-aldosterone , neurogenic factors (sympathetic stimuli causing constriction of renal blood vessels), physiology of circulation (vasoconstriction of efferent glomerular arterioles of kidney, vessels of skin and brain)
    • -prolonged hypertension can result from stress (hereditary factor), prolonged emotional strain (physiological factor), acute nephritis, toxemia of pregnancy, etc.
    • -secondary changes include renal ischemia and arteriosclerosis 
    • -a new equilibrium can be achieved once the pressure restores some disturbed aspect of renal function
  13. ARTERIAL PULMONARY ATRESIA
    • Is the Failure of Development of the MAIN PULMONARY ARTERY.
    •           Signs: RHF 
    •          Complication: * Subacute Bacterial Endocarditis
    •                                    * Brain abcess
    •                                     *Embolism
    •                                    * Cerebral Vascular Accidents
    •       Surgical Correction: depends on the right ventricle
    • If the right ventricule chamber is NORMAL in size AS IS pulmonary artery   simple pulmonary valvulotomy  and a closure of the Ductus arterious. 
    • If the right ventricule is HYPOPLASTIC with a NORMAL pulmonary artery - Increase pulmonary flow or use the Rashkind procedure. 
    • If right ventricular is NORMAL and pulmonary artery is HYPOPLASTIC-- Rastelli procedure.
    • If Main pulmonary artery is HYPOPLASTIC - Fontan procedure
  14. TRANSPOSITION OF GREAT VESSELS
    • It’s a complete transposition of the great vessels as the AORTA arises from RIGHT VENTRICLE (anterior to pulmonary artery) and the PULMONARY ARTERY arises from LEFT VENTRICLE (posterior to aorta).
    • What happens??  Blood circulates around and around in the systemic circulation WITHOUT passing through the pulmonary circulation. Likewise,
    • The pulmonary circulation is recirculated WITHOUT passing to systemic. 
    • How patient survive?
    • INTRACARDIAL SHUNTS are presented which will permits mixing of both circulations. 
    • Patent foramen ovale and Ductus arteriosus are presented in most of the cases. 
    • Most commonly associated defect is the VENTRICULAR SEPTAL DEFECT. 
    • Symptoms:  Cynosis, Respiratory Infection, Hypoxia, MI, pulmonary hypertention, CF. 
    • Surgical correction: 
    • Blalock Hanlon technique (DON’T NEED CPB) involves excising a portion of the ATRIAL SEPTUM.  
    • MUSTARD PROCEDURE which involves rearranging the arterial septum so that the blood in arterial chamber will empty into the ventricular  pulmonary artery arise. The chamber receiving blood from pulmonary veins will empty into  the ventricular  aorta arises
  15. SINUS OF VALSAVA ANEURYSM
    • This type of Aneurysm develops in the SINUS VALSAVA IN THE AORTA at its junction with the annulus fibrosus. 
    • Right Coronary Sinus is the mostly involved. 
    • Rupture of this Aneurysm is into the RIGHT VENTRICLE, Occasionally into the RIGHT ATRIUM. 
    • An Aneurysm of the posterior cusp ruptures into the RIGHT ATRIUM. 
    • An Aneurysm of the left cusp ruptures the LEFT or RIGHT ATRIUM or into LEFT VENTRICLE (This type is rare). 
    • The cause of this defect is usually congenital. -  There may be an associated VENTRICULAR SEPTAL DEFECT. 
    • Rupture of the Aneurysm may be marked by  ACUTE ONSET OF LEFT VENTRICULAR FAIURE.
    • Symptoms: Heart failure, Cardiomegaly ( Enlarged Heart)
    • Surgical correction: Direct Suture of the Defect
  16. AORTIC INSUFFICIENCY
    • It occurs when the AORTIC VALVE fails to close completely immediately AFTER SYSTOL.
    • There is an INCREASE in pulse pressure.
    • LEFT  VENTRICLE  becomes Dilated  and Hypertophied
    • Pulmonary Congestion and Edema are common.
    • Symptoms: Cerebral Insufficiency, Dizziness, Pulsating Headaches, Dyspnea, Increased Pulse Pressure, Pulmonary congestion and Edema. 
    • Coronary Insufficiency may occur.  As well Left Heart Failure may occur followed by a Right Heart Failure. 
    • Treatments : Surgical replacement with a PROSTHETIC VALVE.
  17. COR PULMONALE
    • Core pulmonale is a HEART DISEASE which is caused by HYPERTENTION in the PULMONARY CIRCULATION. 
    • HAPPENS DUE to abnormal resistance of blood flow from the RIGHT VENTRICLE. 
    • ACUTE COR PULMONALE is caused by PULMONARY EMBOLISM. 
    • CHRONIC COR PULMONALE is caused by one of the four general categories pulmonary disease:
    • Chronic obstruction Lung Disease. 
    • Pulmoary Fibrosis.
    • Musculoskeletal or Mechanica disorders or the Thoracic Cage. 
    • Primary Disease of the Pulmonary Vessels. 
    • In addition to one of the pulmonary manifestations for a Chronic Cor pulmonale RIGHT HEART FAILURE. 
    • Treatment: Is Directed toward the pulmonary component. 

    Hypertension is the elevation of the basal blood pressure above the normal limits of 145/90 mmHg.
  18. HYPERTENSION
    Physiological Vasoconstriction or an increase of cardiac output due to Emotion, Cold or other causes that will give us a reading higher than 160/90mm.

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