CARDIOVASCULAR SYSTEM🗸

Aberrant Right Subclavian Artery (ARSA)

 

• Right 4th arch artery obliterates (Normally persists)

• Persisting Arteries
• Right caudal dorsal aorta +
• Right 7th cervical intersegmental artery
• = abnormal right subclavian artery.

• Compresses the esophagus
• "dysphagia lusoria" (difficulty swallowing)

Double aortic arch

Persistence of both sides.

• 4th arch arteries &

• Dorsal aorta.

LAE/Mitral stenosis:

• Straightening of left heart border (Image 1).

• Splaying of carinal angle.

• Double density sign/ double right heart border sign (Image 2).

• Walking man sign:
• lateral chest x-ray (Image 3).
• Left atrium cause elevation of left bronchus

• Third Mogul sign (Image 4):
• Prominent third Mogul
• because of left atrium.

• Dysphagia
• Left atrium → Esophageal compression (Image 5)
• Trans esophageal echocardiography (TEE) is done.

Chamber Enlargement Signs

• RVH: Apex up.

• LVH: Apex down and out.

 

• X-ray shows
• “figure of 8”
• “Snowman”
• “Cottage loaf”

 

• MC causes mortality in 1st week of life

• Pulmonary plethora is seen.

• All 4 chambers of the heart have equal oxygen saturation

• Mnemonic: Tap (TAPVAC) dance in christmas (snowman)

• Due to teratogenic effect of lithium.

• The X-rays show cardiac shadow typically covering the entire thorax.
• Box-shaped heart

• Atrialization of the right ventricle
• Right atrium enlargement.

• Pulmonary oligemia.

• Tricuspid valve
• Downward displacement
• Functionally abnormal

• ECG shows
• Himalayan 'P' waves

• Treatment:
• Cone repair of tricuspid valve.
• Return valve to original position.

Einstein (ebstein) carrying a box (Box shaped heart) in Himalaya (Himalayan waves), with a wolf (WPW) near him

• Pulmonary artery is dilated due to increased pressure.

• Jug handle appearance of pulmonary artery (Image 1).

• ↓↓ peripheral pulmonary vascularity → Pruning → RVH → Obliterates the retrosternal space.

• On CT (Image 2):
• Diameter of pulmonary artery > Diameter of aorta.
• PA/AA > 1.

Pulmonary Embolism Radio

 

• Predisposing factor: DVT — Bedridden patients/immobilized patients.

• Screening investigation: D-dimer (raised).

• IOC - CTPA/CECT.
• Contrast filling defect is seen.

• X-ray Signs
• Palla sign: Enlarged right descending pulmonary artery
• Hampton's hump: Infarct formation.
• Westermark sign: Focal oligemia.

• POST DUCTAL M/c

Clinical presentation

• Severe coarctation:
• Heart failure in neonates with
• B/L feeble or impalpable femoral pulses

• Moderate:
• Weak femoral pulses and hypertension

• Milder disease:
• Intermittent claudication of lower limbs

• Focal narrowing of aorta.

• Radiofemoral delay
• i.e. LLBP < ULBP.

• Associated with Turner's syndrome.

Auscultation

• Murmur in the shoulder region due to the collaterals

Chest X-ray

• Reverse 3 sign:
• Ba swallow

• Roesler’s sign & figure of 3 appearance
• CXR
• Notching of the inferior margin of 3rd - 9th ribs usually seen >3 years age
• Due to collateral between anterior and posterior intercoastal arteries
• along the lower border become prominent collaterals as compensation

Features

• Males > Females

• Seen in 5th Decade

• Causes Coronary Insufficiency

• Different Blood Pressure (BP)
• Bilateral Upper Limbs

Investigations

• IOC:
• If patient is stable - CT Angiography.
• If patient is unstable - USG - Transesophageal Echocardiography

• Chest X-ray
• Widening of Mediastinum
• Depression of the Left Main Bronchus
• Left main bronchus lies just below the arch of aorta.
• Posteriorly related to descending thoracic aorta.
• left main bronchus is directly compressed
  → seen as depression/indentation on bronchoscopy or imaging.

Classification

DeBakey Classification

Stanford Classification

• A: DeBakey I & II

• B: DeBakey III

Mnemonic:

• DBK → 3 letter → 1, 2, 3

• SF → 2 letter → A, B

 

Management

1st Step:

• IV Esmolol for Permissive Hypotension

F/b:

• DeBakey Type 1 & 2 (Stanford A):
• Graft Repair (Open/EVAR)
• If Deterioration: Surgery

• DeBakey Type 3 (Stanford B):
• Monitor
• Deterioration → Surgery

Clinical Features

• Asymptomatic

• Blue Toe Syndrome
• Due to Emboli from Aneurysm

• Rupture into Left Retroperitoneum
• High Mortality > 50%

• Abdominal Pain

• Pulsatile Mass

IOC:

• Surveillance - ultrasound.

• Initial screening → USG doppler

• Pre-op - IOC → CT Angiography

• Most Common Site: Infrarenal Abdominal Aorta

• Most Important Risk Factor: Atherosclerosis

• Screening: Ultrasound (USG) (From 65 yrs)

Critical Diameter for males (Increased Risk of Rupture Beyond This Size)

• Less by 0.5 cm in females

• ↑ in size >0.5 cm per year→ indication for surgical intervention

• Mnemonic: AA = 55 = 5.5
• Ascending Aneurysm
• Abdominal Aneurysm

Peripheral Vessel Doppler/ Duplex

• 1st IOC
• POVD
• Aneurysm

Intra Cardiac Defibrillator