Cardiovascular System

• general term used to describe congenital defects of the heart
• most common types are left-to-right shunts which permit mixing of blood in systemic and pulmonary circulations
• blood shunts from high-pressure systemic circulation to lower-pressure pulmonary circulation overloading the lungs with blood
• increased load on the heart may cause enlargement depending on location and size of shunt

• free communication between both atria as a result of the lack of closure of the foramen ovale after birth
• shunt overloads right ventricle
• Radiographic Appearance: CXR shows enlargement of right ventricle, right atrium, and the pulmonary outflow tract

• abnormal opening between the ventricles
• shunt causes increase in pulmonary blood flow leading to diastolic overloading and enlargement of the left atrium and left ventricle
• Radiographic Appearance: pulmonary trunk enlargement with no right ventricular enlargement

• vessel shunting blood from the pulmonary artery into the systemic circulation during intrauterine life does not close after birth resulting in a left-to-right shunt
• shunt causes an excess volume of blood returned to the left atrium and left ventricle
• Radiographic Appearance: CXR shows enlargement of the left atrium, left ventricle, and central pulmonary arteries along with a diffuse increase in pulmonary vascularity. The increased blood flow through the aorta proximal to the shunt produces a prominent aortic knob

• Consists of 4 abnormalities: 1) high ventricular septal defect; 2) pulmonary stenosis; 3) overriding of the aortic orifice above the ventricular defect; 4) right ventricular hypertrophy
• narrow opening of pulmonary valve causes inadequate amount of blood to reach lungs for oxygen
• causes cyanosis
• Radiographic Appearance: CXR shows enlargement of right ventricle causing upward and lateral displacement of the apex of the heart; echocardiograph to demonstrate

• narrowing of the aorta usually beyond branching of blood vessels to head and arms
• blood supply and pressure to upper extremities is normal but decreased blood flow to abdomen and legs leading to development of collateral circulation
• Radiographic Appearance: CXR shows rib notching involving posterior ribs 4-8 resulting from pressure erosion by dilated vessels

• heart is positioned on the right side of the thorax
• results in normal function and is usually an incidental finding on a routine chest x-ray

• narrowing of the coronary arteries causes oxygen deprivation of the myocardium and ischemic heart disease
• narrowing is attributable to atherosclerosis
• predisposing factors include hypertension, obesity, smoking, high-cholesterol and lack of exercise
• Radiographic Appearance: angiogram for diagnosis and angioplasty for treatment

• severe chest pain that may radiate to the neck, jaw, and left arm and is often associated with the sensation of chest tightness or suffocation or confused with indigestion
• caused by temporary oxygen insufficiency to myocardium due to atherosclerosis
• may be relieved by placing nitroglycerin tablet under tongue which causes venous dilation

• occlusion of a coronary artery deprives an area of myocardium of its blood supply leading to death of muscle cells
• Radiographic Appearance: CXR to check heart size and rule out CHF; angiogram shows strictures or occlusions as filling defects

• heart is unable to pump blood at sufficient rate and volume to provide an adequate supply to the body
• Radiographic Appearance: CXR may show cardiac enlargement, redistribution of pulmonary venous blood flow, interstitial edema, alveolar edema, and pleural effusions

• localized dilation of an artery, most commonly the abdominal aorta
• weakness in vessel wall caused by athersclerosis, infection, trauma, or defect
• may rupture and cause immediate death depending on location
• 2 Types: 1) saccular - bulging involving only one side of the arterial wall; 2) fusiform - circumferential bulging

• commonly known as high blood pressure
• leading cause of stroke and CHF
• long-standing high blood pressure causes narrowing of systemic blood vessels and increased resistance to blood flow affecting the left ventricle (enlargement), and coronary and carotid vessels increasing the risk of coronary occlusion, myocardial infarction and carotid narrowing leading to stroke

• potentially life-threatening condition in which disruption of the intima (inner layer) permits blood to enter the wall of the aorta and separate its layers
• Radiographic Appearance: PA CXR may demonstrate widening of aortic shadow with irregularity; CT may demonstrate double-barrel channel with linear filling defect within lumen

occurs when arteries become marked by thickening, hardening, and loss of elasticity in the arterial wall

• form of arteriosclerosis
• fatty deposits called plaques develop in the intima and produce progressive narrowing/occlusion of large and medium sized arteries
• CVA (stroke) - plaque formation in the cerebral ateries
• Myocardial Infarct - plaque formation in the coronary arteries
• Risk Factors: elevated cholesterol, high blood pressure, smoking, diabetes, obesity, physical inactivity, high saturated fat diet
• Radiographic Appearance: can be diagnostic (plaques often calcify and appear on plain radiographs, ultrasounds, and MRA) or therapeutic (angioplasty can compress the plaque and open stenosis)

• a mass of coagulated blood or clot usually adhering to the wall of a vein
• precipitating factors include trauma, bacterial infection, prolonged bed rest, and airplane travel
• thrombus may become fibrotic resulting in stricture of occlusion OR part of the thrombus may break off resulting in an embolism

• primarily involves the lower extremities
• blood clot may dislodge to the lungs which can be fatal to patient
• Radiographic Appearance: venogram shows filling defect; ultrasound

• most common are a plaque or a thrombus that enter the bloodstream and become lodged in a vessel resulting in occlusion
• Venous Thromboembolism: emboli travel to right side of the heart becoming lodged in a pulmonary artery
• Arterial Thromboembolism: emboli usually originated in the left side of the heart, entering the aorta, becoming lodged in brain, kidneys, etc
• Radiographic Appearance: arteriogram appears as a filling defect of occlusion

• affects the valves of the heart resulting in an alteration or the normal blood flow through the heart
• Rheumatic fever is a major cause of acquired cardiac valve disease
• Radiographic Appearance: cardiac cath lab procedure for valve function

• stenosis of the mitral valve
• complication of rheumatic heart disease
• results from diffuse thickening of valve by fibrous tissue and/or calcific deposits
• Radiographic Appearance: PA CXR will show left atrium enlargement

• obstruction of flow of blood exiting the heart
• may be caused by rheumatic heart disease, a congenital valvular deformity, or degenerative process of aging
• Radiographic Appearance: PA CXR shows enlargement of left ventricle and rounding of cardiac apex

• accumulation of fluids within pericardial space surrounding the heart
• results from bacteria, viruses, or neoplastic involvement
• Radiographic Appearance: PA CXR will show enlargement of cardia silhouette; ultrasound - echocardiography

• affect the electrical system of the heart muscle, producing abnormal heartbeat
• depending on cause and severity remain untreated, treated with medication of electronic pacemaker
• Ventricular Fibrillation: uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them tremble rather than contract properly

• neoplasms of lymphoreticular system which includes lymph nodes, spleen, and lymphoid tissues of parenchymal organs such as GI tract, lung of skin
• Hodgkins: originate in lymph nodes - localized (single or group)
• Non-Hodgkins: parenchymal organs and multicentric lymph nodes (especially liver, spleen, and bone marrow) are more involved
• Radiographic Appearance: CT detects increased node size; CXR shows mediastinal lymph node enlargement