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Right-to-left Shunt
A right-to-left shunt is a cardiac shunt which allows blood to flow from the right heart to the left heart. This terminology is used both for the abnormal state in humans and for normal physiological shunts in reptiles. Clinical Significance A right-to-left shunt occurs when: #there is an opening or passage between the atria, ventricles, and/or great vessels; ''and'', #right heart pressure is higher than left heart pressure and/or the shunt has a one-way valvular opening. Small physiological, or "normal", shunts are seen due to the return of bronchial artery blood and coronary blood through the Thebesian veins, which are deoxygenated, to the left side of the heart. Causes Congenital defects can lead to right-to-left shunting immediately after birth: * Persistent truncus arteriosus (minimal cyanosis) * Transposition of great vessels * Tricuspid atresia * Tetralogy of Fallot * Total anomalous pulmonary venous return A mnemonic to remember the conditions associated with rig ...
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Heart
The heart is a muscular Organ (biology), organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrients to the tissue, while carrying metabolic waste such as carbon dioxide to the lungs. In humans, the heart is approximately the size of a closed fist and is located between the lungs, in the middle compartment of the thorax, chest, called the mediastinum. In humans, the heart is divided into four chambers: upper left and right Atrium (heart), atria and lower left and right Ventricle (heart), ventricles. Commonly, the right atrium and ventricle are referred together as the right heart and their left counterparts as the left heart. In a healthy heart, blood flows one way through the heart due to heart valves, which prevent cardiac regurgitation, backflow. The heart is enclosed in a protective sac, the pericardium, which also contains a sma ...
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Tetralogy Of Fallot
Tetralogy of Fallot (TOF), formerly known as Steno-Fallot tetralogy, is a congenital heart defect characterized by four specific cardiac defects. Classically, the four defects are: * Pulmonary stenosis, which is narrowing of the exit from the right ventricle; * A ventricular septal defect, which is a hole allowing blood to flow between the two ventricles; * Right ventricular hypertrophy, which is thickening of the right ventricular muscle; and * an overriding aorta, which is where the aorta expands to allow blood from both ventricles to enter. At birth, children may be asymptomatic or present with many severe symptoms. Later in infancy, there are typically episodes of bluish colour to the skin due to a lack of sufficient oxygenation, known as cyanosis. When affected babies cry or have a bowel movement, they may undergo a "tet spell" where they turn cyanotic, have difficulty breathing, become limp, and occasionally lose consciousness. Other symptoms may include a heart mur ...
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Hypoxemia
Hypoxemia (also spelled hypoxaemia) is an abnormally low level of oxygen in the blood. More specifically, it is oxygen deficiency in arterial blood. Hypoxemia is usually caused by pulmonary disease. Sometimes the concentration of oxygen in the air is decreased leading to hypoxemia. Definition ''Hypoxemia'' refers to the low level of oxygen in arterial blood. Tissue hypoxia refers to low levels of oxygen in the tissues of the body and the term ''hypoxia'' is a general term for low levels of oxygen. Hypoxemia is usually caused by pulmonary disease whereas tissue oxygenation requires additionally adequate circulation of blood and perfusion of tissue to meet metabolic demands. Hypoxemia is usually defined in terms of reduced partial pressure of oxygen (mm Hg) in arterial blood, but also in terms of reduced content of oxygen (ml oxygen per dl blood) or percentage saturation of hemoglobin (the oxygen-binding protein within red blood cells) with oxygen, which is either found singly o ...
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Ventricular Hypertrophy
Ventricular hypertrophy (VH) is thickening of the walls of a ventricle (lower chamber) of the heart. Although left ventricular hypertrophy (LVH) is more common, right ventricular hypertrophy (RVH), as well as concurrent hypertrophy of both ventricles can also occur. Ventricular hypertrophy can result from a variety of conditions, both adaptive and maladaptive. For example, it occurs in what is regarded as a physiologic, adaptive process in pregnancy in response to increased blood volume; but can also occur as a consequence of ventricular remodeling following a heart attack. Importantly, pathologic and physiologic remodeling engage different cellular pathways in the heart and result in different gross cardiac phenotypes. Presentation In individuals with eccentric hypertrophy there may be little or no indication that hypertrophy has occurred as it is generally a healthy response to increased demands on the heart. Conversely, concentric hypertrophy can make itself known in a vari ...
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Overriding Aorta
An overriding aorta is a congenital heart defect where the aorta is positioned directly over a ventricular septal defect (VSD), instead of over the left ventricle. The result is that the aorta receives some blood from the right ventricle, causing mixing of oxygenated and deoxygenated blood, and thereby reducing the amount of oxygen delivered to the tissues. It is one of the four findings in the classic tetralogy of Fallot Tetralogy of Fallot (TOF), formerly known as Steno-Fallot tetralogy, is a congenital heart defect characterized by four specific cardiac defects. Classically, the four defects are: * Pulmonary stenosis, which is narrowing of the exit from the r .... The other three findings are right ventricular outflow tract (RVOT) obstruction (most often subpulmonary stenosis), right ventricular hypertrophy (RVH), and ventricular septal defect (VSD). References External links Congenital heart defects {{circulatory-disease-stub ...
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Pulmonary Stenosis
Pulmonic stenosis, is a dynamic or fixed obstruction of flow from the right ventricle of the heart to the pulmonary artery. It is usually first diagnosed in childhood. Signs and symptoms Some individuals with mild PS may not experience any symptoms. Mild PS is generally a benign condition that requires regular cardiac follow-up but no specific therapy. However, there can be symptomatic cases. For example, a systolic ejection murmur, often accompanied by or without a systolic click, can be heard with a stethoscope. Patients may also feel tired easily (especially during physical activity), breathing difficulties (particularly during exertion), discomfort in the chest and lungs, and some individuals may also experience fainting episodes. In severe cases, patients may experience bluish or greyish skin due to low oxygen levels, especially in babies with critical PS. Cause Pulmonic stenosis is usually due to isolated valvular obstruction ( pulmonary valve stenosis), but it may be due ...
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Cyanosis
Cyanosis is the change of Tissue (biology), tissue color to a bluish-purple hue, as a result of decrease in the amount of oxygen bound to the hemoglobin in the red blood cells of the capillary bed. Cyanosis is apparent usually in the Tissue (biology), body tissues covered with thin skin, including the mucous membranes, lips, nail beds, and ear lobes. Some medications may cause discoloration such as medications containing amiodarone or silver. Furthermore, mongolian spots, large birthmarks, and the consumption of food products with blue or purple dyes can also result in the bluish skin tissue discoloration and may be mistaken for cyanosis. Appropriate physical examination and history taking is a crucial part to diagnose cyanosis. Management of cyanosis involves treating the main cause, as cyanosis is not a disease, but rather a symptom. Cyanosis is further classified into central cyanosis and peripheral cyanosis. Pathophysiology The mechanism behind cyanosis is different dep ...
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Patent Ductus Arteriosus
Patent ductus arteriosus (PDA) is a medical condition in which the ''ductus arteriosus'' fails to close after childbirth, birth: this allows a portion of oxygenated blood from the left heart to flow back to the lungs from the aorta, which has a higher blood pressure, to the pulmonary artery, which has a lower blood pressure. Symptoms are uncommon at birth and shortly thereafter, but later in the first year of life there is often the onset of an increased work of breathing and Failure to thrive, failure to gain weight at a normal rate. With time, an uncorrected PDA usually leads to pulmonary hypertension followed by right-sided heart failure. The ''ductus arteriosus'' is a Fetal circulation, fetal blood vessel that normally closes soon after birth. This closure is caused by vessel constriction immediately after birth as circulation changes occur, followed by the occlusion of the vessel’s lumen in the following days. In a PDA, the vessel does not close, but remains ''patent'' (ope ...
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Atrial Septal Defect
Atrial septal defect (ASD) is a congenital heart defect in which blood flows between the atrium (heart), atria (upper chambers) of the heart. Some flow is a normal condition both pre-birth and immediately post-birth via the Foramen ovale (heart), foramen ovale; however, when this does not naturally close after birth it is referred to as a patent (open) foramen ovale (PFO). It is common in patients with a congenital interatrial septum, atrial septal aneurysm (ASA). After PFO closure the atria normally are separated by a dividing wall, the interatrial septum. If this septum is defective or absent, then oxygen-rich blood can flow directly from the left side of the heart to mix with the oxygen-poor blood in the right side of the heart; or the opposite, depending on whether the left or right atrium has the higher blood pressure. In the absence of other heart defects, the left atrium has the higher pressure. This can lead to lower-than-normal oxygen levels in the arterial blood that su ...
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Ventricular Septal Defect
A ventricular septal defect (VSD) is a defect in the ventricular septum, the wall dividing the left and right ventricles of the heart. It's a common heart problem present at birth ( congenital heart defect). The extent of the opening may vary from pin size to complete absence of the ventricular septum, creating one common ventricle. The ventricular septum consists of an inferior muscular and superior membranous portion and is extensively innervated with conducting cardiomyocytes. The membranous portion, which is close to the atrioventricular node, is most commonly affected in adults and older children in the United States. It is also the type that will most commonly require surgical intervention, comprising over 80% of cases. Membranous ventricular septal defects are more common than muscular ventricular septal defects, and are the most common congenital cardiac anomaly. Signs and symptoms Ventricular septal defect is usually symptomless at birth. It usually manifests a fe ...
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Eisenmenger Syndrome
Eisenmenger syndrome or Eisenmenger's syndrome is defined as the process in which a long-standing left-to-right cardiac shunt caused by a congenital heart defect (typically by a ventricular septal defect, atrial septal defect, or less commonly, patent ductus arteriosus) causes pulmonary hypertension and eventual reversal of the shunt into a cyanotic right-to-left shunt. Because of the advent of fetal screening with echocardiography early in life, the incidence of heart defects progressing to Eisenmenger syndrome has decreased. Eisenmenger syndrome in a pregnant mother can cause serious complications, though successful delivery has been reported. Maternal mortality ranges from 30% to 60%, and may be attributed to Syncope (medicine), fainting spells, Venous thromboembolism, blood clots forming in the veins and traveling to distant sites, hypovolemia, hemoptysis, coughing up blood or preeclampsia. Most deaths occur either during or within the first weeks after delivery. Pregnant wome ...
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Carina Of Trachea
The carina of trachea (also: "tracheal carina") is a ridge of cartilage at the base of the trachea separating the openings of the left and right main bronchi. Structure The carina is a cartilaginous ridge separating the left and right main bronchi that is formed by the inferior-ward and posterior-ward prolongation of the inferior-most tracheal cartilage. The carina occurs at the lower end of the trachea - usually at the level of the 4th to 5th thoracic vertebra. This is in line with the sternal angle, but the carina may raise or descend up to two vertebrae higher or lower with breathing. The carina lies to the left of the midline, and runs antero-posteriorly (front to back). Blood supply The bronchial arteries supply the carina and the rest of the lower trachea. Relations The carina is around the area posterior to where the aortic arch crosses to the left of the trachea. The azygos vein crosses right to the trachea above the carina. Physiology The mucous membrane ...
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