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115 Cards in this Set
- Front
- Back
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What grade are innocent murmurs
Where are they best heard |
I-II/VI
L heart base |
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What abnormalities on PE might cause a suspicion of congenital heart disease |
arterial pulses/jugular veins mucous membranes |
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What are hyperkinetic and bounding "waterhammer" arterial pulses characteristic of (pathophysiology & conditions) |
abnormal diastolic runoff of aortic blood and low arterial diastolic pressure
PDA or severe aortic regurgitation |
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Hypokinetic pulses are typical of moderate to severe |
Left ventricular outflow obstruction (SAS) or other conditions that cause low ventricular output |
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Visable cyanosis develops when the partial pressure of arterial oxygen falls below __ mmHg |
45
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What defects cause cyanotic animals? |
right to left shunting at the level of the heart or great vessels. |
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Distended jugular veins indicate elevated ____ which is indicative of this sided heart disease |
central venous pressure R heart disease (tricuspid/pulmonic stenosis) |
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atrial septal defect is a ___ murmur loudest at ____ |
systolic (diastolic) left base |
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sub-aortic stenosis is a ___ murmur loudest at ____ |
systolic L base |
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Mitral valvue dysplasia is a __ murmur loudest at ___ |
systolic L apex |
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PDA is a ___ murmur loudest at ___ |
continuous left base |
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Pulmonary hypertension (Eisenmenger's syndrome) is a ___ murmur heart loudest at ___ |
none to systolic left base |
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pulmonic stenosis is a ___ murmur loudest at ___ |
systolic left base |
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Tetralogy of Fallot is a ___ murmur loudest at ___ |
systolic left base |
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Tricuspid valve dysplasia is a ___ murmur loudest at __ |
systolic right midprecordium |
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Ventricular septal defect is a ___ murmur loudest at ___ |
systolic right base |
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These conditions primarily cause volume overload (L to R shunting) in dogs |
PDA VSD MVD TVD |
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These conditions primarily cause volume overload (L to R shunting) in cats |
VSD PDA atrial septal defect endocardial cushion defect MVD TVD |
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These conditions primarily cause pressure overload in dogs |
PS AS |
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These conditions primarily cause pressure overload in cats |
dynamic subaortic stenosis |
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These are conditions that primarily cause cyanosis in dogs |
Tetralogy of Fallot (VSD and PDA if pulmonary to systemic shunting) |
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These are conditions that primarily cause cyanosis in cats |
tetralogy of Fallot Endocardial cushion defect |
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What dose the ductus arteriosus perform in the fetus |
diverts blood from the nonfunctional fetal lungs back into the systemic circulation |
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What stimulates ductus arteriosus to close after birth |
- After parturition and onset of breathing, pulmonary vasculature resistance decreases - the ductus reverses - constriction of vascular smooth muscle and functional closing of the ductus arteriosus. |
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How many days after birth is a ductus closed? |
7-10 days |
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How does blood flow with a PDA?
Timing of the murmur?
Where is volume overloaded? |
L to R (aorta to pulmonary artery continuous increased pulmonary blood flow & L atrium/L ventricle |
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What can cause R to L shunting during the first few weeks of life with a PDA? |
the lumen of the PDA remains wide open after birth and the fetal pulmonary hypertension remains.
Have no HX of murmur or evidence of LV enlargement or L to R shunt |
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What radiographic signs are noted with a PDA (4) |
Lateral: L atrial enlargment enlarged pulmonary a. & v. VD: buldge in the descending aorta dilation of the main pulmonary a. |
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On a clock face VD, aorta is located: |
11-1 |
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On a clock face VD, pulmonary artery is located: |
1-2 |
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On a clock face lateral, great vessels are located: |
10-12 |
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What occurs on PE/HX with dogs with R to L PDA shunting (5) |
exertional fatigue hindlimb weakness shortness of breath hyperpnea differential cynosis |
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Describe the murmur with R to L PDA |
no murmur or soft systolic murmur at L base |
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What is differential cyanosis |
cyanosis of the caudal mucous membranes with pink cranial membranes |
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Why do animals with R to L PDA shunting have polycythemia |
The perfusion of kidney's with hypoxemic blood triggers elaboration of erythopoietin and secondary polycythemia and hyperviscoity as PCV increases |
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How long do animals with PDA live? |
PDA and more modest shunts often survive to maturity and live to old age |
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How long do animals with reverse PDA live? |
3-5 years If PCV can be kept below 65% - can live beyond 7 years |
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How is PDA TX? What age is SX chosen Medical TX |
SX (not needed in older pets or small shunt) TX for Heart failure |
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TX with prostaglandin inhibitors is common in infants with PDA. Why is it not used in animals? |
Animals do not have smooth wall in the ductal wall. |
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What are the SX options for TX for PDA? |
L thoracotomy and surgical closure Percutaneous embolization using Dacron strands or Amplatzer stents |
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With embolism TX in PDA, what option is the preferred method for large diameter defects? |
Mushroom shaped self expanding Amplatzer |
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What causes mortality with reverse PDA |
polycythemia and chronic hypoxia (Not CHF) |
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TX for reverse PDA? |
exercise restriction avoidance of stress maintenance of PCV between 58-65% with periodic phlebotomy possibly use RX therapy instead of phlebotomy (hydroxyurea) |
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How should a phlebotomy be performed |
- IV fluids to replace lost blood
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SX TX for reverse PDA? |
closure of reverse PDA is strongly contraindicatied b/c it leads to post-operative acutre RHF and death |
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What allows R to L shunting in the atria of fetus but closes with the L atrial pressure rises after birth? |
foramen ovale |
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What are endocardial cushion (defects) - what occurs to the blood? |
forms the distal atrial septum upper ventricular septum AV valves - allows all 4 chambers to mix |
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When is a patent foramen ovale clinically significant? |
allows R to L shunting |
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Where in the heart a ventral septal defects found |
upper ventricular septum |
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What occurs long term with ASD and VSD |
- L to R shunting myocardial failure CHF - R to L shunting if increase in pulmonary hypertension, PS or tricuspid dysplasia |
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Blood flow through an atrial septal defect occurs during |
diastole |
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What is the type of heart murmur with ASD? |
do not generate an audiable heart murmur because of low pressure flow and pressure gradient |
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When during the cardiac cycle do VSDs occur |
ventricular systole |
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With large VSD, the ventricles act as a common pumping chamber. What will happen to the pulmonary system? |
pulmonary hypertension |
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The development of pulmonary hypertension associatee with a shunting cardiac defect is known as |
Eisnmenger's physiology/syndrome |
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What are typical auscultation findings of ASD (L to R) |
soft grade II-III/VI systloic ejection murmur over the L heart base splitting of the second heart sound |
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What occurs physiologically to the heart with ASD |
dilation of the R atrium and eccentric hypertrophy of the R ventricle |
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THoracic rads with ASD |
R heart enlargment pulmonary artery enlargmenpulmonary hypervascularity |
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What is auscultated with a typical small VSD? |
harsh holosytstolic murmur R heart base |
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Can spontaneous closure of small VSDs occur in animals like children? |
no |
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What is the prognosis for for uncomplicated small ASD/VSD defects |
usually can live a normal life span with out developing clinical signs |
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What C/S and prognosis do large VSD/ASD have |
develope intractable congestive heart failure |
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How is VSD/ASD TX?
When is SX TX recommended |
SX correction, but not commonly performed (b/c need cardiopulmonary bypass).
Apply a constriction band around the main pulmonary artery to crease suprevalvular pulmonic stenosis (decreasing L to R shuntings)
overt or imprending congestive heart failure
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What medical treatment can be sued to reduce systemic vascular resistence for VSD |
systemic arterial vasodilators |
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This is an uncommon abnormality that results from abnormal development of valve leaflets or dialtion of the pulmonary artery annulus |
pulmonic insufficiency |
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This congential heat abnormality causes a to and fro murmur. |
pulmonic insufficiency aortic insuffiency |
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TX for pulmonic insuffiency |
No specific TX TX CHF |
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This congenital heart abnormality frequently accompanies subvalvular aortic stenosis.
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aortic insuffiency |
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What are the pulses like with aortic insuffieciency |
hyperkinetic due to the arterial pulse secondary to increased stroke volume and diastolic runoff of aortic blood. |
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This congenital defect tends to occur alone, but can also occur with tricuspid dysplasia |
PS |
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What type of hypertrophy occurs with PS? |
concentric reduces R ventricular filling and results in ventricular dilation |
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Syncope and sudden death are uncommon with |
PS |
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What are clinical signs of younger dogs with PS? Older dogs? |
asymptomatic in first year of life 35% of dogs with severe disease have C/S of fatigue, syncope, ascites, and/or RCHF
Older dogs - RCHF - ascites |
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Prognosis for PS |
no accurate criteria mild to moderate PS have the potential to live normal lives (barring other congenital complications) |
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TX for mild or moderate PS |
do not require Tx
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TX for marked or symptomatic PS? |
candidates for SX or balloon valvuloplasty (75-80%) effective open patch-graft technique
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What other C/S make the prognosis of PS poor? |
atrial fibrilation CHF |
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This is the most common congenital cardiac malformation in large breed dogs |
subvalvular aortic stenosis |
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What occurs anatomically with SAS |
fixed ridge or ring of fibrous tissue located in the left ventricular outflow tract just below the aortic valve. |
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What breed of dog is SAS found a genetic basis for? |
Newfoundlands |
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What are the 3 grades of SAS |
1. small raised nodules just below the aortic valve 2. narrow ridge of thickened endocardium 3. fibrous band or ridge/collar just below the aortic valve |
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What other 3 congenital abnormalities are found with SAS comonly |
mitral valve dysplasia PDA aortic arch abnormalities |
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What type of hypertrophy occurs with SAS |
concentric |
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Why are dogs with SAS predisposed to bacterial endocarditis? |
damage to the aortic valvular endothelium (jet lesions) |
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Why do dogs with SAS have sudden death?
What age does sudden death occur |
myocardia ischemia and development of malignant ventricular arrhythmias
1-3 years of age |
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TX for SAS (SX) |
-prophylactic AB for endocarditis - Thoracotomy - but need bypass -Ballon dillation but has fatal complications |
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TX for SAS (medical) & MOA of how it helps |
beta blockers reduce HR decrease myocardial O2 consumption improve coronary flow
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What is cor triatriatum |
atrium is partitioned into an accessory atrial chamber which receives venous return and is separated from the true atrium by a perforate membrane. |
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TX for cor triatratrum? |
SX resection ballon dilation of the obstruction membrane can also be attempted. |
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These congenital heart diseases can have R to L shuntings |
PSA VSD/ASD transposition of the great vessels tetralogy of Fallot |
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What age do animals develope Eisenmenger's syndrome |
before 6 m of age |
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Why do animals with R to L shunt develope polycythema? |
secondary to hypoxemia erythropoetin is relased PCV 65-68% secondary thrombosis |
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What is the primary mortality for animals with R to L shunting |
hyperviscosity |
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Puppies are commonly presented with these signs with cyanotic heart disease |
failure to grow shortness of breath exertional fatigue weakness syncope seizures |
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Cyanosis limited to the caudal tissues is known as
Indicative of |
differential cyanosis
R to L shunting PDA |
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For R to L shunting, what is generally seen on radiographs (indepent of the cause) |
pulmonary a & v are small lungs are hypoperfused |
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What features are included in Tetralogy of Fallot |
Pulmonic stenosis seondary R V hypertrophy VSD R positioned aorta (directly over the VSD instead of attached to the L atrium) |
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What breeds is Tetralogy of Fallot common in? |
Keeshond English Bulldog |
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How is tetralogy of Fallot TX |
tollerated for many years if blood flow is maintained and hyperviscosity is controlled. |
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Sudden death is common with this heart disease and CHF is uncommon. |
tetralogy of Fallot |
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TX for tetralogy of Fallot |
SX correction with bypass creating of a systemic to pulmonary shunt periodic phlebotomy |
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What is pulmonary atresia
prognosis |
All the blood ejected from the RH is shunted R to L across a large VSD
die very young |
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What is double outlet right ventricle |
both great vessels exit from the right ventricle |
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What happens with transposition of the great arteries? Prognosis? |
aorta originates from the R ventricle and the pulmonary trunk from the L ventricle |
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This congenital disease has left ventricle and L atrial dilation with severe endocardial thickening with diffuse white opaque thickening of the luminal surface |
endocardial fibroelastosis |
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With this congential disease dogs/cats they develope biventricular failure before 6 months of age |
endocardial fibroelastosis |
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TX and prognosis for endocardial fibroelastosis |
TX CHF poor |
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What is an aorticopulmonary septal defect (window) |
failure of the truncus arteriosus to differentiate opening between the aorta and the pulmonary artery. |
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Where does coarctation and interruption of the aorta occur |
distal to the subclavian artery adjactent to the ductus arteriosus |
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TX for interruption of the aorta |
SX is successful |
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What breed has persistent L cranial vena cava? Prognosis? |
GSD no clinical problem |
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What do thoracic radiographs show with SAS |
- normal - L ventricular hypertrophy - widening of mediastinum (VD) - L atrial enlargment (probable L mitral regurg) |
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How does blood flow through the fetal heart - prior to arriving at the heart |
- O2 blood from placenta via umbilical vein - joins the portal vein and enters liver -blood passes through the hepatic sinus or through the ductus venosus into the caudal vena cava |
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How does blood flow through the fetal heat once arriving from the caudal and cranial vena cava at the r atrium |
- majoriety of blood shunts to L atrium by the foramen ovale - rest of blood ejected through to the R ventricle through the pulmonary artery. - a small % goes to the pulmonary artery to the lungs (high resistance) - most blood crosses the ductus arteriosus into the descending aorta |
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What causes a decrease in tension of the fetal lungs to allow blood to flow in the pulmonary vasculature? |
the increase in arterial oxygen causes a decrease in the pulmonary vascular resistance and allows blood to flow more easily to the lungs.
The increased L ventricle pressure causes closing of the foramen ovale and ductus arteriosus. |
