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38 Cards in this Set
- Front
- Back
- 3rd side (hint)
Persistent truncus arteriosus (PTA)
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- caused by abnormal neural crest cell migration, partial development of AP septum
- results in one large vessel leaving heart and receiving blood from both RT and LT ventricles - truncoconal septa and ventricular membranous septum do not form at all - blood from both sides of heart mix and body and lungs receive partially oxygenated blood - usually accompanied with VSD - marked cyanosis (R-->L shunting of blood) |
AP septum
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Ventricular septal defects (VSD)
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1) b/c of deficient development of proximal truncoconal swellings
2) failure of muscular and membranous ventricular septa to fuse 3) endocardial cushion defect 4) excessive perforation of muscular ventricular septum - massive L-->R shunting of blood and pulmonary hypertension - most common cardiac defect |
or is it R-->L?
AP septum |
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D-transposition of great arteries (complete)
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- abnormal neural crest cell migration such taht there is nonspiral development of AP septum
- results in aorta arising abnormally from RT ventricle and pulmonary trunk arising from LT ventricle --> systemic and pulmonary circulations completely separated from one another - need accompanying shunt, like VSD, patent foramen ovale, or patent ductus arteriosus - marked cyanosis (R-->L shunting of blood) |
aorticopulmonary (AP) = truncoconal
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L-transposition of great arties (corrected)
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- aorta and pulmonary trunk are transposed and ventricles "inverted" so that anatomical RT ventricle lies on LT side and anatomical LT ventricle lies on RT side.
- major deviations offset one another so that pattern of blood flow is normal |
AP septum
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Tetralogy of Fallot (TF)
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- skewed development of AP septum
- pulmonary trunk smaller than aorta 1) pulmonary stenosis 2) RT ventricular hypertrophy 3) Overriding aorta (rightward displacement of aorta) - defects raise BP within right ventricle, causing its enlargement 4) Ventricular septal defect = PROVE - marked cyanosis , clinical consequences depend primarily on pulmonary stenosis |
AP septum
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Atrial septal defects (ASDs)
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- septum secundum is too short to completely cover ostium secundum
- problem after birth b/c of massive shunting of blood from L-->R atrium - may lead to enlargement of RT atrium, ventricle and pulmonary trunk - associated with autosomal and sex chromosome aberrations, and trisomies |
ASD
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Foramen secundum defect
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- caused by excessive resportion of septum primum, septum secundum, or both
- results in opening between RT and LT atria - most common clinically significant ASD - result in patent foramen ovale |
ASD
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Common atrium (cor triloculare biventriculare)
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- ASD
- caused by complete failure of septum primum and septu secundum to develop - result is one atrium is formed |
ASD
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Probe patency of foramen ovale
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- ASD
- incomplete anatomic fusion of septum primum and septum secundum. - usually of no clinical importance |
ASD
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Premature closure of foramen ovale
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- ASD
- closure of foramen ovale during prenantal life - results in hypertrophy of RT side of heart, underdevelopment of LT side of heart |
ASD
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Persistent common AV canal
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- failure of fusion of dorsal and ventral AV cushions (inferior/superior)
- common AV canal never partitioned, large hole in center of heart - tricuspid and bicuspid valves represented by one valve common to both sides of heart 1) causes L-->R shunting, enlarged RT atrium and RT ventricle 2) causes mitral valve regurgitation, enlarged LT atrium/ventricle |
AV septum
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Ebstein's anomaly
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- caused by failure of posterior and septal leaflets of tricuspid valve to attach normally to annulus fibrosus
- instead displaced inferiorly into RT ventricle - blocks access of blood to pulmonary orifice, allows blood to regurgitate into RT atrium - result is R-->L shunting thru persistent foramen ovale |
AV septum
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Atrioventricular septum (AV)
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- 4 cushions
- RT/LT endocardial cushion - inferior/superior cushion - end of week 6, inferior and superior cushions fuse--> septum intermedium - divides common AV canal into RT and LT AV canals |
AV septum
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Foramen primum defect
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- caused by failure of AV septum to fuse with septum primum
- results in condition which foramen primum is never closed and generally accompanied by abnormal mitral valve |
AV septum
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Tricuspid atresia (hypoplastic right heart)
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- insufficient amount of AV cushion is available to form the tricuspid valve
- results in complete agenesis of tricuspid valve - no communication between right atrium and right ventricle - marked cyanosis accompanied by the following: 1) patent foramen ovale 2) IV septum defect 3) overdeveloped LT ventricle 4) underdeveloped RT ventricle |
AV septum
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Membranous VSD
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- caused by faulty fusion of RT bulbar ridge/LT bulbar ridge/AV cushions
- opening between RT and LT ventricles allows free flow of blood - large VSD initially associated with L-->R shunting, increased pulmonary blood flow, pulmonary hypertension - L-->R shunting patients complain of excessive fatigue on exertion |
IV septum
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Eisenmenger syndrome
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- uncorrected VSD, ASD, PDA
- all initially associated with L-->R shunting of blood, inreased pulmonary blood flow and hypertension - later hypertension causes marked proliferation of tunica intima and tunica media, resulting in narrowing of lumens - ultimately, pulmonary resistance become higher than systemic and cause R-->L shunting of blood and cyanosis |
IV septum
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Muscular VSD
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- caused by single or multiple perforations in muscular IV septum
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IV septum
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Common ventricle (cor triloculare biatriatum)
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- caused by failure of membranous and muscular IV septa to form
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IV septum
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Postductal coarctation
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- occurs when aorta abnormally constricted
- found distal to the origin of left subclavian artery and inferior to ductus arteriosus - clincally associated with increased BP in upper extremities, lack of pulse in femoral artery, high risk of cerebral hemorrhage and bacterial endocarditis - collateral circulation involving: internal thoracic, intercostal, superior epigastric, inferior epigastric, external iliac arteries - rib notching: dilaion of intercostal arteries erode lower border of ribs, seen in x-ray |
arterial problems
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preductora coarctation
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- aorta constriction located superior to ductus arteriosus
- occurs in Turner syndrome (XO) |
arterial problems
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patent ductus arteriosus (PDA)
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- when ductus arteriosus, connection between LT pulmonary artery and aorta, fails to close
- usually functionally closes within a few hours after birth via smooth muscle contractions --> ligamentum arteriosum - causes L-->R shunting of O2 rich blood from aorta back into pulmonary circulation - treated with prostaglandin synthesis inhibitors, acetylcholine, histamine, catecholamines to close DA |
arterial problems
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Cardiac tamponade
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- rapid accumulation of fluid in pericadium
- fibrous pericardium not elastic - acute pressure on the heart, causes compression of venous return, decreased diastolic capacity, reduced CO increased HR and venous pressure - it is the resulting compression of the heart - treated by pericardiocentesis |
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Surgical significance of transverse pericardial sinus
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- finger can be passed through sinus to aorta and pulmonary trunk
- can pass clamp or place ligature around vessels to divert or stop circulation of blood in large arteries during cardiac surgery |
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Pericarditis
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- inflammation of the pericardium
- may result in: 1) cardiac tamponade 2) pericardial effusion 3) precordial and epigastric pain 4) pericardial murmur 5) pericardial friction rub - symptoms of dysphagia, dyspnea, cough - treated with steroids, paracentesis |
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Pericardial effusion
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- accumulation of liquid in pericardial space
- from inflammation caused by acute pericarditis - compresses heart, inhibiting cardiac filling - englarged heart, water bottle appearance, faint heart sounds - treated by pericardiocentesis - causes cardiac tamponade |
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Pericardiocentesis
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- surgical puncture of pericardial cavity for aspiration of fluid
- relieves pressure on heart - needle inserted through 5th intercostal space left of sternum - b/c of cardiac notch, needle misses pleura and lungs and goes into pericardium |
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Pericardial friction rub
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- surface of pericardium becomes rough and resulting friction sounds like rustle of silk
- heard upon auscultation |
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Cardiomegaly
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- slow increase in size of heart
- this slow increase is allowed by pericardium without pressure |
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Levels of viscera in mediastinum
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- most pictures assume anatomical position, with body lying supine
- in this position, abdominal viscera push mediastinal structures superiorly - in standing position, everything sags inferiorly under influence of pressure - significance: movement of mediastinal structures must be considered during physical and radiological exminations |
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Pulmonary stenosis
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- pulmonary valve stenosis: narrowing, valve cusps are fused, form dome of narrow central opening
- infundibular pulmonary stenosis: conus arteriosus underdeveloped, produce restriction of RT ventricular flow - both may occur together, degree of hypertrophy of RT ventricle variable |
valve disorder
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Cardiovascular accidents (CVA)
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- aka stroke
- when thrombi (clot) forms on wall of left atrium and then breaks off (becomes embolus), occlude artery in the brain - affect vision, cognition, sensory, motor function of parts of body controlled by damamged area of brain |
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Valvular heart disease
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- problems with valve disturb pumping efficiency of heart
- valvular heart disease - produces stenosis (narrowing) or insufficiency - increase workload for heart - produce turbulence that produce vibrations that can be heard as murmurs or felt as thrills - valves can be replaced by valvuloplasty with either artificial valve or xenografted valve |
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Stenosis
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- failure of valuve to open fully, slowing blood flow from chamber
- increased workload for the heart - produce turbulence that produce vibrations that can be heard as murmurs or felt as thrills |
valve disorder
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Valvular insufficiency or regurgitation
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- failure of valuve to close completely
due to nodule formation (scarring) on cusps so edges don't meet - allows variable amount of blood to flow back into chamber - result in increased workload for heart - produce turbulence that produce vibrations audible as murmurs and superficial vibratory sensations (thrills) |
valve disorder
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Prolapsed mitral valve
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- valve exerts back into left atrium because leaflets are enlarged or floppy during systole
- blood regurgitates into left atrium when left ventricle contracts, producing characteristic murmur - chest pain, palpitations, shortness of breath - no treatment is needed |
valve disorder
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aortic valve stenosis
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- most frequent valv abnormality
- results in left ventricular hypertrophy - result of degernative calcification |
valve disorder
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Myocardial infarction
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- sudden occlusion of major artery by embolus
- necrosis of mycardium b/c of local ischemia - usually in coronary artery, arteriosclerosis of coronary arteries |
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