describe Pericardial disease
- Fluid accumulation, inflammation, fibrous constriction, or some combination of these processes, usually in association with disease elsewhere in the heart or a systemic disease
define Tamponade
- Acute sydrome (stabbed in the heart)
- Heart can’t beat with the volume of blood in the pericardium
- COnstrictive problems
–> develops Becks triad = Low arterial blood pressure, JVD, muffled heart sounds
–> paradoxus pulse = drop of >10mmHg in arterial blood pressure on inspiration
describe congenitial Heart disease (CHD)
- abnormalities of the heart or great vessels that are present from birth
–> most disorders arise from faulty embryogenesis during weeks 3-8.
- Most common is VSD > ASD > pulmonary stenosis > patent ductus arteriosus
Define shunt
- abnormal cummunication or opening between cardiac chambers and/or blood vessels thru which abnormal blood flow will occur
- L to R OR R to L depending on pressure gradient
define stenosis
- abnormal narrowing causing partial obstruction to normal blood flow
define atresia
- failure of a normal anatomic feature, usually a cardiac valve, to form or develop to a functionally adequate state
Left-to-right shunts
- Initially raise BOTH flow volumes and pressures in the normally low-pressure, low resistance pulmonary circulation
–> leads to right ventricular hypertrophy and atherosclerosis of pulmonary vasculature
- INITIAL INCREASE PULMONARY BLOOD FLOW and is not associated with cyanosis (NONCYANOTIC)
- Eventually pulmonary vascular resistance = systemic levels, thereby producing a RIGHT TO LEFT SHUNT that introduces unoxygenated blood into systemic circulation (LATE CYANOTIC) –> called Eisenmenger syndrome
Ventricular septal defect
- most common (2/3 of cases associated with anomalies)
- mixed blood goes to heart
- functional consequences of VSD depend on the size of the defect and whether there are associated with right-sided malforamtions
- LARGE VSDs cause difficulties virtually from birth
- type of Left-to-right shunt
Atrial septal defect
- Fixed opening in the atrial septum
- classified based on location
–> secundum (90% of all ASD) = result from deficient or fenestrated oval fossa near the center of atrial septum
–> Primum = results from defect in lower portion
–> sinus venosus = results from defect in upper portion
- Right-sided volume overload - pulmonary blood flow may be two or four times normal
- ASD are well tolerated and do not become symptomatic before age 30
Patent ductus arteriosus
- results when the ductus arteriosus, an essential fetal structure that normally spontaneously closes, remains open after birth
- may be essential to preserve life (pulmonary circulation) in hypoplastic heart syndromes
- sounds like a harsh murmur (machinery like)
- Usually asymptomatic at birth, and a narrow PDA may have no effect on child’s growth and development
Atrioventricular septal defect (AVSD)
- Result from embryologic failure of the superior and inferior endocardial cusions of the AV canal to fuse adequately with malformation of tricuspid and mitral valves
- Can be partial or complete
–> partial consists of primum ASD and a cleft anterior mitral leaflet, causing MITRAL INSUFFICIENCY
–> complete AVSD consisting of a large combined AV septal defect and a large common AV valve (essentially a hole in the center of heart)
Right to left shunts
- Cause CYANOSIS EARLY in postnatal life
- Most common is teralogy of fallot (others are transposition of the great arteries)
Tetralogy of Fallot (TOF)
- 4 pathologies in one
–> obstruction of the right ventricular outlow tract (subpulmonary stenosis)
–> right ventricular hypertrophy
–> aorta that overrides the VSD
–> large VSD
- Blood flow comes from right ventricle to the left ventricle –> cyanosis
- Pulmonic stenosis protects pulmonary arteries from HTN PVD
what are the clinical complications + the types of Tetralogy of fallot
- TYPES:
–> subpulmonary stenosis is mild = resembles isolated VSD, and the shunt may be left-to-right without cyanosis (so-called pink tetralogy)
–> Severe subpulmonary stenosis = results in greater resistance to right ventricular outflow (Right to Left shunting and cyanosis)
- CLINICAL COMPLICATIONS:
–> systemic cyanosis, polycythemia/thromboses, endocarditis, cerebral abscess
Transposisiton of the Great arteries
- Aorta arises from the right ventricle, and lies anterior and to the right of the pulmonary artery, which emanates from the left ventricle
- embryologic defect in complete TGA stems from abnormal foramtion of the truncal and aortopulmonary septa
- patients with TGA and a VSD may have a stable shunt
- patients with patent foramen ovale or ductus arteriosus have unstable shunts that tend to close and require immediate interention to creat a new shunt
describe Obstructive congenital anomalies
- obstruction of blood flow may occur at the level of heart valves or within a great vessel
–>includes stenosis or atresa of the aortic or pulmonary valves and COARCTATION OF THE AORTA
- circulation must be shunted thru an ASD or PDA to sustain life
coarctation of the aorta
- Narrowing, constriction of the aorta, high in frequency
- TWo forms:
- proximal to the patent ductus arteriosus (infant/child)
–> severe, do not survive the neonatal period without surgical or catheter-based intervention (CYANOSIS LOWER HALF OF BODY)
- distal to closed ductus arteriosus (ligamentum arteriosum) and distal to the arch vessels (adult)
–> Asymptomatic unless severe narrowing (may be weak pulses and hypotension in lower extremities, claudication, and coldness)
- Coarctation of aorta results in high blood pressure before point of coarctation and low blood pressure byond that point
