Definition

A circulatory disorder is … 

characterized by …..

caused by ..etiology or predisposing factors

resulting in a pathological feature (structural change or functional change)  or clinical feauture

Sometimes complicated by ….

Diagnosis is suspected clinically by … and confirmed by ….

Imaging includes the use of

Treatment options depend on …. but includes …..

Etymology if available

Principles

Cardiovascular System

32368b05.800 cardiovascular system heart cardiac artery arteries capillary capillaries arterioles venules veins negative firces positive forces road highway TCV the common vein applied biology Davidoff art Davidoff MD

In the cardiovascular system the relatively positive pressure in the left sided systemic circulation created by the left ventricle, enables flow throught the capillary circulation, perfusion of the cells tissues and organs, and subsequent return of the blood to the relatively low pressure of the right side of the heart.  The pulmonary circulation on the other hand is serviced by the pumping action of the right ventricle, which creates a positive force and flow to the capillaries of the lung and subsequent return to the low pressure of the left atrium.

Wiggers Diagram – Pressures in th Cardiovascular System

33808b.800 heart cardiac physiology pressure EKG ECG pressure curves diagram LV aorta LA left atrium left ventricle systole diastole acv waves Davidoff MD

Venturi Effect

Flow in this tube is demonstrated by the arrows going from right to left through a narrowingin the tube (red) demonstrating a vacuum or suction effect caused by the sudden acceleration of the fluid as it goes through the narrowing or stenosis. This is seen in the U shaped monometer with the fluid level in blue being relatively higher at the site of the stenosis in relation to the pressure more upstream. The suction phenomenon is kown as the Venturi effect is seen in IHSS where the narrowing of the LVOT causes a vacuum effect on the anterior leaflet of the MV resulting in mitral regurgitation. The Venturi effect is also utilised in the functioning of carburettors in fuel driven engines. 34807b05 code heart cardiac SAM IHSS pressure drop vacuum suction acceleration stnosis Venturi effect tube principles

 

Hemorrhage

Acute GI bleed

46590 small bowel fx radioisotope leak into small bowel dx GI bleed hemorrhage Radioactibe labelled sulfur colloid Nuclear Medicine NMscan Davidoff MD

Acute Subdural Hematoma

46633c01.800 brain cerebral meninges subdural hematoma blood SDH hemorrhage bleed acute blood fx acute hematoma s/p trauma CTscan Davidoff MD

SMA and SMV

35026c. hx 45M with GI bleed CVS artery portal vein colon arteriovenous malformation AVM SMA SMV. fx hypervascular mass mid ascending colon fx large arterial feeder – middle colic artery fx enlarged middle colic early draining vein ddx leiomyoma carcinoid tumor neurogenic tumor angioma villous adeno,ma Osler Rendu Weber Courtesy Laura Feldman MD.

Hemorrhage – Ectopic Pregnancy

46750c01.800 hx young female presentingwith vaginal bleeding for 2 weeks, hematocrit of 25, left lower quadrant pain, and LLQ mass HCG 7000 fx uterus endometrial stripe ovary fx mass echogenic cystic complex free fluid loculated fluid hemorrhage blood fx no intrauterine pregnancy dx ectopic pregnancy death Davidoff MD

Hemorrhage

46750c02.800 hx young female presentingwith vaginal bleeding for 2 weeks, hematocrit of 25, left lower quadrant pain, and LLQ mass HCG 7000 fx uterus endometrial stripe ovary fx mass echogenic cystic complex free fluid loculated fluid hemorrhage blood fx no intrauterine pregnancy dx ectopic pregnancy death USscan Davidoff MD

Infarction

This image taken from FB – Wyoming Feb 6th 2019 Acute disaster with trucks off the road causing blockage and standstill on the highway.  Acute thrombosis results in a similar situation 

Lacune as Low Density Focus in the Left Thalamus

72745.600 brain thalamus fx focal ill defined defect lacune of the left thalamus circulatory disease chronic finding cerebral infarct CTscan Courtesy Ashley Davidoff MD

Acute and Chronic Infarction

49685C01 brain DWI occipital lobe fx vague hypodensity right occipital lobe with encephalomalacia and ex vacuo changes in the left occipital and posterior parietal region dx acute infarction right occipital lobe chronic infarction left occipItoparietal lobe a IR white matter disease vague increase in right b T2 gliosis left parietal c DWI bright acute right occipital d CT vague hypodensity right occipital old infarct left dx acute infarction right occipital lobe chronic infarction left parietal lobe MRI diffusion weighted imaging CTscan Courtesy Ashley Davidoff MD

Ischemia

Embolic Disease

Wedge Shaped Infarction

46772c01.800 spleen splenic fx wedge shaped defects dx emboli dx systemic embolization dx splenic infarcts CTscan Davidoff MD

Thrombosis

AVM

AVM of Renal Cell Carcinoma

48107c01 kidney renal mass large cystic mass 2cms solid mass with hypervascularityhypervascular mass suggestion of arteriovenous shunting AV shunting large feeding arteriole and large draining vein dx renalcell carcinoma USscan Davidoff MD

Congestion

Pulmonary Congestion

42076c04 Courtesy Ashley Davidoff MD medical students code batwing distribution congestion heart lung

 

Cardiogenic Shock Drowned Lung

46813c01.800 chest lung pulmonary edema alveolar edema batwing distribution drowned lung dax cardiogenic shock normal CXR plain film of the chest Davidoff MD

CHF – AVR

46432c01 heart cardiac chest fx pulmonary congestion interstitial edema enlarged pulmonary arteries pulmonary arteriole to bronchiole ratio increased cardiomegaly fx enlarged Kerley B line thickened interlobular septa dx congestive heart failure CHF cardiac failure CTscan CXR plain film Davidoff MD 46425 46427 46428 46431 46432 46432c01

Skin Edema CHF

46786c02 skin heart cardiac breast fx left atrial enlargement LAE fx third spacing fx effusions fx skin edema cardiac failure CHF CTscan Davidoff MD

Aneurysms

Marfan’s Syndrome Sinus of Valsalva Aneurysm

07974c01 heart cardiac right atrium aortic valve aortic sinus fx right atrial filling defect dx sinus of Valsalva aneurysm of the right aortic sinusprolapsing into the right atrium (RA defect) dx Marfan’s Syndrome MRI T1 weighted Davidoff MD 07973.800 07974c01 07974.800

 

Atherosclerosis

Penetrating Ulcer

48363 descending thoracic aorta fx aortic ulcer fx atherosclerosis atheroma fx penetrating ulcer CTscan Courtesy Ashley Davidoff MD