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PCM Exam 2 > Cardiovascular Pathology 5 > Flashcards

Cardiovascular Pathology 5 Flashcards

1
Q

in fetal circulation, the _____ resistance is high leading the shunt to go ___ → ____

A

pulmonary; (lungs have not expanded yet but after birth, the pulmonary resistance will ↓)

R→ L bypassing the lungs

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2
Q

what are the two physiologic R → L shunts in the fetus?

A
  • foramen ovale

- ductus arteriosus

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3
Q

the patency of the ductus arteriosus can be maintained by giving _____

A

prostaglandins

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4
Q

what leads to the closure of the ductus arteriosus after birth?

A

prostaglandins help keep it open. they are produced by the placenta and metabolized by the lungs.
following birth there is ↓ prostaglandins due to: ↓ production and ↑ metabolism

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5
Q

What are some complications of a L → R shunt?

A
  • right heart failure because it is not used to the large volume of blood.
  • pulmonary circulation congestion (plethoric lung fields) → recurrent episodes of infections
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6
Q

with congenital malformations can cause a R→ L shunt?

A
  • Tetralogy of Fallot
  • transposition of the great vessels
  • truncus arteriosus
  • tricuspid atresia
  • total anomalous pulmonary venous connection
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7
Q

what are the four malformations seen in tetralogy of fallot?

A
  • Pulmonary stenosis: (degree determines prognosis)
  • Right ventricular hypertrophy
  • overriding aorta
  • VSD

PROV

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8
Q

what determines the degree of prognosis in a patient with tetralogy of fallot?

A

the degree of pulmonary stenosis

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9
Q

why do patients with tetralogy of fallot squat a lot?

A

squatting ↑ the systemic resistance and thus helps alleviate the R → L shunt by forcing more of the blood the go through the pulmonary vessels from the right ventricle

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10
Q

squatting ↑/ ↓ ________ resistance

A

↑ systemic (aortic) resistance

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11
Q

tetralogy of fallot is associated with ________ syndrome

A

down syndrome

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12
Q

the VSD in tetralogy of Fallot puts these patients at a higher risk for developing_____

A

infective endocarditis

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13
Q

_____ and _____ help with survival in a patient with transposition of the great vessel

A

PDA and VSD because they help mix the blood

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14
Q

what is truncus arteriosus?

A

failure of partitioning of the embryologic truncus into aorta and pulmonary artery;

single great artery gets blood from BOTH ventricles
underlying VSD

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15
Q

tricuspid atresia is usually associated with _____

A

ASD to bypass obstruction

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16
Q

what is the developmental abnormality in total anomalous pulmonary venous connection (TAPVC)

A

the pulmonary veins drain into the left inominate vein or coronary sinus or right atrium instead of the left atrium like normal

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17
Q

TAPVC is technically a L→ R shunt because: _______ but it is associated with a _____ in order to be compatible with life

A

blood flow that should be going the left atrium is instead going to the right atrium;

ASD → right to left shunt due to the lower left atrial pressure → cyanosis

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18
Q

list of left to right shunts:

A

D’s:

  • ASD
  • VSD
  • PDA
19
Q

clinical features of VSD:

A
  • pulmonary HTN
  • CHF
  • pan systolic murmor
20
Q

_____ murmur can be heard with VSD

A

pan systolic

21
Q

what is eisenmenger complex?

A

shunt reversal seen with VSD due to the ↑ pulmonary HTN → ↑ pressure in the right atrium → reversal of shunt from L→ R to R→ L because pressure on the R > L now
eisemneger complex leads to cyanosis

22
Q

____ is the most common congenital cardiac malformation diagnosed in adults

A

ASD

23
Q

what are the three types of ASD and which is the most common?

A
  • ostium primum
  • ostium secundum (MOST COMMON)
  • sinus venosus
24
Q

continuous “machine like” murmur is seen with ______

A

PDA

25
Q

_______ can be given to close the PDA

A

indomethacin (prostaglandin synthesis inhibitor)

26
Q

maternal ______ infection is associated with PDA

A

rubella

27
Q

PDA connects and causes blood to flow from _____ to ____ and usually closes due to _____

A

aortic arch to the left pulmonary artery closes due to high oxygen tension

28
Q

what fetal condition is maternal rubella infection associated with?

A

PDA

29
Q

what are 3 cardiac malformations that can cause obstruction?

A
  • coarctation of aorta
  • pulmonary stenosis and atresia
  • aortic stenosis and atresia (hypo plastic left heart syndrome)
30
Q

coarctation of the aorta is associated with ______ syndrome

A

Turner’s (XO)

31
Q

what are the two types of coarctation of the aorta and how are they different?

A
  • preductal (Infantile coarctation): has PDA and the coarctation is just before the PDA
  • post ductal (adult) coarctation: ductus arteriosus is closed
32
Q

what is differential cyanosis and what defect is it associated with?

A

cyanosis only in the lower limbs of the body; associated with preductal coarctation of the aorta

the PDA will pass deoxygenated blood into the aorta that goes down to the lower limbs

33
Q

marked blood pressure difference between the upper and lower limb is seen in ______

A

post ductal coarctation of the aorta

34
Q

what are some clinical features in post ductal coarctation of the aorta?

A
  • difference in blood pressures in upper and lower limb
  • intermittent claudication
  • notching of ribs due to collaterals
  • no selective cyanosis
  • HTN in upper extremities
35
Q

notching of the ribs is seen in _____

A

post ductal coarctation of the aorta due to the collaterals trying to supply blood to the lower extremities

36
Q

_______ is only seen in preductal coarctation of the aorta but NOT in the post ductal

A

cyanosis

37
Q

aortic stenosis is classified into what three types based on location?

A
  • valvular: affects valve cusps
  • subvalvular: ring of fibrous tissue between valve cusps resulting in LVH
  • supravalvular: elastin defect involving the ascending aorta and with a thickening of the wall leading to luminal obstruction
38
Q

complete obstruction of the aortic outflow leads to ____ of the left ventricle and aorta and must have _____ for survival

A

hypoplasia; PDA

39
Q

what is a gross feature of the underdeveloped left ventricle in hypo plastic left heart syndrome

A
  • dense endocardial fibroelastosis
40
Q

cardiac myxoma is a ____ tumor seen in the ______

A

benign; left atrium

41
Q

how can you try to diagnose a cardiac myxoma?

A

do an X Ray because they often calcify and these can be seen on x ray

42
Q

patient has a lobulated pedunculated mass in her left atrium. what would you expect to see on histology slide?

A

cardiac myxoma;

multinucleated stellate cells suspended in an edematous mucopolysaccharide rich stroma

43
Q

stellate cells in stroma is seen in the histology of what disease?

A

cardiac myxoma

44
Q

what are four common primary sites of tumors that can lead to secondary tumors in the heart?

A
  • lung cancer
  • breast
  • lymphoma
  • malignant melanoma

PCM Exam 2 (32 decks)

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