Ana de Luca
Cardiac diseases Sopro no foco tricúspide.
Quando a comunicação é muito grande → inverte o uxo.
Cardiopatias congênitas acianogênicas hipertensão pulmononar → pode causar cianose. Alterações
hemodinâmicas e sintomas precoces (cianose e ICC). Síndrome
Comunicação interatrial - cia
de Eisenmenger.
Forame oval patente/ aberto → shunt E-D.
Sangue do átrio passa 2x pelo pulmão → por isso não tem CIV pequena e moderada: assintomáticas e diagnosticadas pela
cianose → hiper uxo pulmonar. presença de sopro cardíaco.
Esse hiper uxo acumula líquido no pulmão → facilita infecção → Exames e tratamento:
pneumonia de repetição. É uma das causas de sibilância de - ECG: normal ou sobrecarga de VE e AE.
repetição no lactente. - Ecocardiograma: da pra ver qual porção foi acometida e a
repercussão pulmonar.
Má formação da membrana do septo primum → não fecha - Raio X tórax: normal ou cardiomegalia com hiper uxo
forame oval. O átrio dilata com o tempo e pode ter morte súbita pulmonar.
por arritmia e baixo DC.
Tratamento cirúrgico ou fecha espontâneo.
O sopro é mais audível quando o forame fecha pouco.
Se a comunicação for grande → dispneia → altera saturação → If it’s a small VSD, it might be asymptomatic. As the size of the
teste do coraçãozinho. VSD increases, however, symptoms tend to get more severe and
Desdobramento xo do B2 + sopro sistólico. present earlier in life. What sort of symptoms? Well, as blood is
shunted to the right side, blood volume increases on the right
Exames: side, which might lead patients to develop pulmonary
- ECG: sobrecarga da câmara direita → eixo desviado. hypertension, or higher pressures on the pulmonary side. If
- Ecocardiograma: da pra ver a comunicação! E quando coloca pressure increases to a point where the right side’s more than the
doppler vê o sangue se afastando pro AD (aparece em azul). left side, then the direction of blood ow through the VSD can
- Raio X tórax: mostra cardiomegalia (principlamente das switch from being left-to-right to right-to-left; this condition is
câmeras direitas) com hiper uxo pulmonar e tronco arterial known as Eisenmenger syndrome.
pulmonar proeminente.
Coarctação da aorta
Tratamento: cirúrgico paliativo ou corretivo ou fechamento
Assintomática ou dor MMII, ICC, infecções respiratórias e
espontâneo até 1 ano de idade. Adults → surgery is cases of RV
choque. Ritmo de galope, sopro sistólico 2 a 3 +, de ejeção na
enlargement, paradoxical embolism and right-to-left shunt.
BEEA com irradiação para o dorso.
You’ll see an increase in oxygen saturation of blood in the right
Pulsos periféricos MMII diminuídos ou ausentes.
atrium, right ventricle, and pulmonary artery. This extra blood
Diferença entre pulsos e pressão dos MMII e MMSS.
volume passing by the pulmonic valve also causes a delay in the
closure of the pulmonic valve relative to the aortic valve closure.
Estreitamento da A. Aorta. Pouco uxo cerebral → história de
This slight delay can be heard via auscultation as a splitting of the
cefaleia, síncope, desmaio.
S2 sound, as well as a systolic murmur in some cases.
• ECG: normal a taquicardia sinusal SVD e E.
Comunicação intraventricular- civ
• Raio X tórax: normal a cardiomegalia e EAP (edema agudo de
Sangue do VE sofre desvio pra VD e outra parte vai pra aorta → pulmão).
shunt E-D. • Tratamento: medicamentoso, manter PCA e cirúrgico.
Sangue oxigenado do ventrículo esquerdo volta pro direito e Aumento de pressão no VE, causando hipertensão pulmonar.
passa no pulmão → acianogênica + hiper uxo pulmonar.
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, Ana de Luca
Tratamento cirúrgico: retira segmento estenótico e fazer nova
anastomose ou fazer uma abertura maior interpor algo.
Coarctation is a fancy way of saying “narrowing”, so
a coarctation of the aorta means a narrowing of the aorta.
If we look at the heart, we’ve got the right and left atria, the right
and left ventricles, the pulmonary artery leaving the right
ventricle to go to the lungs, and the aorta leaving the left
ventricle to go to the body.
There are two forms of aortic coarctation to be familiar with: an
“infant” form and an “adult” form.
- With the infant form, which accounts for about 70% of cases,
Found in 25% of patients with Turner’s Syndrome.
the coarctation comes after the aortic arch, which branches
o to the upper extremities and to the head, and before the
Diagnosis:
ductus arteriosus.
- Angiogram: visualize narrowing in aorta, anatomy and severity.
- The ductus arteriosus normally only exists during fetal
- Chest X-Ray: rib notching + 3-sign → narrowed aorta
development and closes after birth, but with infantile
resembles notch of number 3 due to prestenotic of aortic arch
coarctation, the ductus arteriosus is usually still open, or
and portenotic of descending aorta dilation.
patent, so there’s a patent ductus arteriosus. In fact,
sometimes this form is also called preductal coarctation.
Since deoxygenated blood is going to the lower extremities,
infants typically present with lower extremity cyanosis, meaning
a bluish or purplish discoloration of the lower limbs, which is often
present even at birth. This is a really important thing to catch,
because without intervention, these infants often don’t survive
past the neonatal period.
Adult coarctation → Compared to infantile coarctation, in this
type there usually isn’t a patent ductus arteriosus; instead, it’s
The red arrows point to rib notching caused by the dilated
been long since closed o and is now known as the ligamentum
intercostal arteries. The yellow arrow points to the aortic knob, the
arteriosum → so, now there’s no mixing of deoxygenated
blue arrow to the actual coarctation and the green arrow to the
and oxygenated blood.
post-stenotic dilation of the descending aorta.
- Causes both upstream and downstream issues → upstream
includes blood ow increases into the aortic branches → higher
- Echocardiograph: visualize location, size, blood turbulance.
BP in upper extremities and head + increased rink of berry
- ECG: left ventricular hypertrophy (increased QRS voltage,
aneurysms because of increased cerebral blood ow.
secondary ST segment or T wave changes), left atrial
- Aorta and aortic valve dilates → risk of aortic dissection.
enlargement.
- Downstream: decreases blood ow downstream the
constriction → decreased BP in lower extremities → weak
Treatment:
pulse in the lower extremities.
- Prostaglandin E → increases ow to lower extremities.
- Since blood pressure’s lower, patients sometimes
experience claudication in their legs, which is pain and
Surgery:
cramping due to reduced perfusion.
- Resection with end-to-end anastomosis.
- Also, when less blood perfuses the kidneys, the kidneys
- Long-segment coarctation: subclavian aortoplasty.
respond by activating the renin-angiotensin aldosterone
- Prosthetic patch aortoplasty.
system, which results in water retention and ultimately
- Balloon angioplasty with stent.
increases blood pressure, causing hypertension.
ff
fl ff flfl fl
Cardiac diseases Sopro no foco tricúspide.
Quando a comunicação é muito grande → inverte o uxo.
Cardiopatias congênitas acianogênicas hipertensão pulmononar → pode causar cianose. Alterações
hemodinâmicas e sintomas precoces (cianose e ICC). Síndrome
Comunicação interatrial - cia
de Eisenmenger.
Forame oval patente/ aberto → shunt E-D.
Sangue do átrio passa 2x pelo pulmão → por isso não tem CIV pequena e moderada: assintomáticas e diagnosticadas pela
cianose → hiper uxo pulmonar. presença de sopro cardíaco.
Esse hiper uxo acumula líquido no pulmão → facilita infecção → Exames e tratamento:
pneumonia de repetição. É uma das causas de sibilância de - ECG: normal ou sobrecarga de VE e AE.
repetição no lactente. - Ecocardiograma: da pra ver qual porção foi acometida e a
repercussão pulmonar.
Má formação da membrana do septo primum → não fecha - Raio X tórax: normal ou cardiomegalia com hiper uxo
forame oval. O átrio dilata com o tempo e pode ter morte súbita pulmonar.
por arritmia e baixo DC.
Tratamento cirúrgico ou fecha espontâneo.
O sopro é mais audível quando o forame fecha pouco.
Se a comunicação for grande → dispneia → altera saturação → If it’s a small VSD, it might be asymptomatic. As the size of the
teste do coraçãozinho. VSD increases, however, symptoms tend to get more severe and
Desdobramento xo do B2 + sopro sistólico. present earlier in life. What sort of symptoms? Well, as blood is
shunted to the right side, blood volume increases on the right
Exames: side, which might lead patients to develop pulmonary
- ECG: sobrecarga da câmara direita → eixo desviado. hypertension, or higher pressures on the pulmonary side. If
- Ecocardiograma: da pra ver a comunicação! E quando coloca pressure increases to a point where the right side’s more than the
doppler vê o sangue se afastando pro AD (aparece em azul). left side, then the direction of blood ow through the VSD can
- Raio X tórax: mostra cardiomegalia (principlamente das switch from being left-to-right to right-to-left; this condition is
câmeras direitas) com hiper uxo pulmonar e tronco arterial known as Eisenmenger syndrome.
pulmonar proeminente.
Coarctação da aorta
Tratamento: cirúrgico paliativo ou corretivo ou fechamento
Assintomática ou dor MMII, ICC, infecções respiratórias e
espontâneo até 1 ano de idade. Adults → surgery is cases of RV
choque. Ritmo de galope, sopro sistólico 2 a 3 +, de ejeção na
enlargement, paradoxical embolism and right-to-left shunt.
BEEA com irradiação para o dorso.
You’ll see an increase in oxygen saturation of blood in the right
Pulsos periféricos MMII diminuídos ou ausentes.
atrium, right ventricle, and pulmonary artery. This extra blood
Diferença entre pulsos e pressão dos MMII e MMSS.
volume passing by the pulmonic valve also causes a delay in the
closure of the pulmonic valve relative to the aortic valve closure.
Estreitamento da A. Aorta. Pouco uxo cerebral → história de
This slight delay can be heard via auscultation as a splitting of the
cefaleia, síncope, desmaio.
S2 sound, as well as a systolic murmur in some cases.
• ECG: normal a taquicardia sinusal SVD e E.
Comunicação intraventricular- civ
• Raio X tórax: normal a cardiomegalia e EAP (edema agudo de
Sangue do VE sofre desvio pra VD e outra parte vai pra aorta → pulmão).
shunt E-D. • Tratamento: medicamentoso, manter PCA e cirúrgico.
Sangue oxigenado do ventrículo esquerdo volta pro direito e Aumento de pressão no VE, causando hipertensão pulmonar.
passa no pulmão → acianogênica + hiper uxo pulmonar.
fl flfi fl fl fl fl fl fl
, Ana de Luca
Tratamento cirúrgico: retira segmento estenótico e fazer nova
anastomose ou fazer uma abertura maior interpor algo.
Coarctation is a fancy way of saying “narrowing”, so
a coarctation of the aorta means a narrowing of the aorta.
If we look at the heart, we’ve got the right and left atria, the right
and left ventricles, the pulmonary artery leaving the right
ventricle to go to the lungs, and the aorta leaving the left
ventricle to go to the body.
There are two forms of aortic coarctation to be familiar with: an
“infant” form and an “adult” form.
- With the infant form, which accounts for about 70% of cases,
Found in 25% of patients with Turner’s Syndrome.
the coarctation comes after the aortic arch, which branches
o to the upper extremities and to the head, and before the
Diagnosis:
ductus arteriosus.
- Angiogram: visualize narrowing in aorta, anatomy and severity.
- The ductus arteriosus normally only exists during fetal
- Chest X-Ray: rib notching + 3-sign → narrowed aorta
development and closes after birth, but with infantile
resembles notch of number 3 due to prestenotic of aortic arch
coarctation, the ductus arteriosus is usually still open, or
and portenotic of descending aorta dilation.
patent, so there’s a patent ductus arteriosus. In fact,
sometimes this form is also called preductal coarctation.
Since deoxygenated blood is going to the lower extremities,
infants typically present with lower extremity cyanosis, meaning
a bluish or purplish discoloration of the lower limbs, which is often
present even at birth. This is a really important thing to catch,
because without intervention, these infants often don’t survive
past the neonatal period.
Adult coarctation → Compared to infantile coarctation, in this
type there usually isn’t a patent ductus arteriosus; instead, it’s
The red arrows point to rib notching caused by the dilated
been long since closed o and is now known as the ligamentum
intercostal arteries. The yellow arrow points to the aortic knob, the
arteriosum → so, now there’s no mixing of deoxygenated
blue arrow to the actual coarctation and the green arrow to the
and oxygenated blood.
post-stenotic dilation of the descending aorta.
- Causes both upstream and downstream issues → upstream
includes blood ow increases into the aortic branches → higher
- Echocardiograph: visualize location, size, blood turbulance.
BP in upper extremities and head + increased rink of berry
- ECG: left ventricular hypertrophy (increased QRS voltage,
aneurysms because of increased cerebral blood ow.
secondary ST segment or T wave changes), left atrial
- Aorta and aortic valve dilates → risk of aortic dissection.
enlargement.
- Downstream: decreases blood ow downstream the
constriction → decreased BP in lower extremities → weak
Treatment:
pulse in the lower extremities.
- Prostaglandin E → increases ow to lower extremities.
- Since blood pressure’s lower, patients sometimes
experience claudication in their legs, which is pain and
Surgery:
cramping due to reduced perfusion.
- Resection with end-to-end anastomosis.
- Also, when less blood perfuses the kidneys, the kidneys
- Long-segment coarctation: subclavian aortoplasty.
respond by activating the renin-angiotensin aldosterone
- Prosthetic patch aortoplasty.
system, which results in water retention and ultimately
- Balloon angioplasty with stent.
increases blood pressure, causing hypertension.
ff
fl ff flfl fl
