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What causes volume overload in the heart?
What causes pressure overload in the heart?
When figuring equations...
asks for a max gradient, what would be used?
Bernoulli equation only
When does the TV close?
.06 secs after the MV
What are the ranges of pulmonary hypertension?
- Normal: 18-25 mmHg
- Mild: 30-40 mmHg
- Mod: 40-70 mmHg
- Severe: >70mmHg
What formula is used for mean PA pressure?
80 - (acceleration of PV flow/2)
4(v)2 with the velocity of the beginning diastolic PI velocity
What formula is used for the Diastolic PA pressure?
4(v)2 + IVC pressure (mmHg)
Use the velocity of the end diastolic PI velocity
What pathology is associated with Wide Open TR? (2 but one main)
#1 Ebstein's Anomaly
2) Carcinoid Syndrome
What pathology is associated with Wolf Parkinson White?
What pathology is associated with tumors that produce vasoactive substance that will cause damage to the tissues of the heart including the leaflets of the TV and possibly the PV?
Two important times of the development of the fetal heart are?
23 days forms a single tube
43 days forms a complete heart
Order of the heart tube from cranial end to caudal end.
- 1. Truncus Arteriosus
- 2. Bulbus cordis or conus cordis
- 3. the common ventricle or primitive ventricle
- 4. the common atrium or primitive atrium
- 5. sinus venosus
What are the two types of looping?
- d-looping/ dextro- normal
- l-looping/ levo - abnormal
d looping is looping what direction?
to the right
l looping is looping what direction?
to the left
How many sets of aortic arches are there to begin with?
What is left of the aortic arches after cardiogenesis?
- 1. ao arch
- 2. ductus arteriosus
- 3. rt and lt pulmonary arteries
- 4. MPA
- 5. descending AO
What can cause congenital heart diseases? (5)
- 1. environmental factors
- 2. maternal ingestion of toxic substances
- 3. viral exposures
- 4. single gene defects
- 5. unknown
What is the distribution of oxygenated blood from the aorta? (4)
1. 9%- coronary arteries
2. 62% carotid and upper body
3. 29% descending Ao
4. 12% lungs
What is the oxygen saturation of the placenta?
What chamber is considered to be the pumping chamber or the work horse in the fetal heart?
the right ventricle
What is the distribution of flow from the RV?
88% of RV output goes to the MPA to descending Ao
12% of RV output goes to pulmonary arteries into the lungs
What are two pathologies that physicians what to keep the ductus arteriosus open?
1.) preductal coarctation
2.) hypoplastic right heart
What happens once the baby is born?
- 1. low resistance placenta flow removed (cord clamped)
- 2. increases the systemic vascular resistance
- 3. decreases the pulmonary vascular resistance
- 4. Bradykinin and prostaglandins levels drop
- 5. causes the ductus arteriosus to constrict
bradykinin is a ...
prostaglandins is a ...
holosystolic, high pitched blowing
physiology of TR (7)
- 1. RA enlargement
- 2. RV enlargement
- 3. IVC enlargement and dilation of vessels of IVC
- 4. atrial fibrillation
- 5. may have reversal of flow in hepatic v.
- 6. thickening leaflets
- 7. leg and abdominal swelling, liver enlargement and portal HTN
TR is caused by a different pathology, what is it?
What are some common causes of RVVO?
- 1. Aortic and mitral valve diseases
- 2. pulmonary hypertension
- 3. RV infarction of the RCA
- 4. PI (mod to severe)
- 5. pacemaker wires
- 6. heart transplant
What are some less common causes of RVVO?
- 1. congenital ebsteins anomaly
- 2. rheumatic heart disease
- 3. carcinoid syndrome
- 4. trauma
- 5. tumors
- 6. endocarditis
- 7. chordal rupture
- 8. TV prolapse
What is considered to be pulmonary hypertension?
> 30 mmHg in RV
normal RV pressure is 25/10
What are 3 causes of pulmonary hypertension?
1. MV disease
2. congenital lesions
3. cor pulmonale or right heart failure
What is Ebstein's Anomaly?
the ventricle becomes atrialized because valves attached in wrong spot
Physiology of Carcinoid syndrome (6)
- 1. foreshortened chordae
- 2. retracted leaflets
- 3. thickened tricuspid valve leaflets that are retracted.
- 4. dilation of RV
- 5. right heart failure
- 6. wide open TR and PI
What are some cardiac signs of carcinoid syndrome? (2)
elevated venous pressure
systolic and diastole murmurs (TR and PI)
What are 4 clinical signs of carcinoid syndrome?
1. episodes of facial flushing
2. abdominal pain
4. renal and hepatic failure
What is the cardiac treatment of carcinoid syndrome?
Murmur of TS
opening snap, diastolic rumble
5 physiology of TS
- 1. enlarged RA
- 2. dilated IVC
- 3. possible reversal of flow in hepatic V
- 4. thickened leaflets increased with history of rheumatic fever
- 5. doming of TV leaflets in diastole
Quantitation of TS (2)
Velocity: > 1.0 m/s
- narrowing of opening
- normal: 7-9 cm2
- stenotic: < 7 cm2
Echo findings of TS (4)
- 1. CW PSV= > 1.0 m/s
- 2. PW: a decreased E-F slope
- 3. PW: possible absence of "a" wave
- 4. Aliasing
Causes of TS (6)
- 1. Rheumatic heart disease
- 2. systemic lupus erythematosus
- 3. carcinoid syndrome
- 4. loeffler's endocarditis
- 5. metastatic melanoma
- 6. congenital lesions
Murmur of PS
harsh systolic ejection murmur
7 physiology of PS
- 1. RVH
- 2. post-stenotic dilation of the PA
- 3. flattening of the IVS
- 4. increased depth of the "a" wave (normal depth is 2-3 mm.)
- 5. systolic doming of leaflets
- 6. RV failure in later stages
- 7. prominent jugular venous A wave
Assessment of PS (2 but one main)
- 1. CW through PV in PSAX AV level
- Adults: >0.9 m/s
- Children: > 1.1 m/s
5 causes of PS
- 1. congenital = most common
- 2. carcinoid syndrome
- 3. rheumatic heart disease
- 4. sinus of valsalva aneurysm: producing an RVOT obstruciton
- 5. Ross Procedure: surgery to take PV and put into AV position
What velocity would it need to be to produce a 50 mmHg systolic gradient through the PV?
> or = to 3.6 velocity using CW through PV
When would they do surgery for PS?
When would they not do surgery?
PV systolic gradient > 50 mmHg
OR RV > 70 mmHg
Would NOT: if PV > 70 mmHg
Murmur of PI
low-pitched, mid-diastolic murmur
Physiology of PI (5)
- 1. dilated RV
- 2. flattened IVS
- 3. red flash
- 4. diastolic flutter on TV in m-mode
- 5. CW measure AT/acceleration time
6 causes of PI
- 1. pulmonary HTN
- 2. bacterial endocarditis
- 3. valvotomy
- 4. congenital defects
- 5. carcinoid syndrome
- 6. trauma
IVC assessment of pressure
- 5 mmHg = IVC normal and reactive
- 10 mmHg = IVC normal and partial reactive
- 15 mmHg = IVC dilated and reactive
- 20 mmHg = IVC dilated and not reactive