3. c) Over time PVR  to that of SVR i) reverses shunt (cyanosis) 2.- R to L shunt a)  pulmonary blood flow i) Cyanosis “blueness” of skin b) examples: i) tetralogy of Fallot ii) great vessel transposition iii) truncus arteriosus iv) tricuspid atresia v) anomalous pulmonary venous connection www.freelivedoctor.com

4. c) long standing cyanosis is associated with “clubbing” of the tips of the fingers and toes www.freelivedoctor.com

5. 3.- Obstructions (of flow) a) coarctation of the aorta b) valvular stenosis i) aortic ii) pulmonary c) complete obstruction is called “Atresia” www.freelivedoctor.com

7. i) VSD most common - close spontaneously (50%) ii) ASD usually not symptomatic before 30 yrs www.freelivedoctor.com

8. iii) DA remains open after birth - ~ 90% occur as isolated anomaly - reversal of flow with  PVR causes cyanosis - PGE will maintain DA cardiac defects such as obstructive disease iv) complete atrioventricular canal defect - all 4 chambers freely communicate (Down syndrome) www.freelivedoctor.com

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19. ii) It is classified by the absence of tricuspid valve, pulmonary stenosis, and VSD. iii) The most Common form is also associated With a hypoplastic right ventricle www.freelivedoctor.com

20. TRICUSPID ATRESIA 1 - atrial septal defect 2 - absent tricuspid valve 3 - ventricular septal defect Blood is shunted through an atrial septal defect to the left atrium and through the ventricular septal defect to the pulmonary artery. The shaded arrows indicate mixing of the blood. www.freelivedoctor.com

22. 1 - superior vena cava 2 - atrial septal defect 3 - left innominate vein 4 - pulmonary veins Oxygenated blood returning from the lungs is routed back into the superior vena cava, rather than the left atrium. The presence of an atrial septal defect is necessary to allow partially oxygenated blood to reach the left side of the heart. Total Anomalous Pulmonary Venous Connection (TAPVC) www.freelivedoctor.com

25. 1 - pinched or coarcted aorta flow patterns are normal but are reduced below the coarctation. Blood pressure is increased in vessels leaving the aorta above the coarctation. The broken white arrow indicates diminished blood flow through the aorta. www.freelivedoctor.com

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30. Aortic stenosis (valvular) 1 - narrowed aortic valve Flow patterns are normal but blood flow to the aorta is reduced as indicated by the broken white arrows www.freelivedoctor.com

32. Subaortic Stenosis www.freelivedoctor.com

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38. ii)  wall thickness iii)  cavity diameter c) volume overload i) “eccentric hypertrophy” ii) chamber dilation iii)  ventricular diameter iv) wall thickness may not change - owing to simultaneous hypertrophy d)  capillary density with hypertrophy i)  demands  ischemia !! www.freelivedoctor.com

43. ii) when Left heart failure is present, hypoxic liver shows signs of “centrilobular necrosis” iii) long standing Right failure - cardiac cirrhosis iv) portal hypertension - congestive splenomegaly v) ascites vi) pleural and pericardial effusions accompany Right heart failure www.freelivedoctor.com

45. b) infections c) malignancies i) lymphomas - Ebstein-Barr virus www.freelivedoctor.com