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Questions and Answers
What is a characteristic of left-to-right shunts?
What is a characteristic of left-to-right shunts?
- Blood flow is preferentially directed towards the systemic circulation
- PBF is decreased
- PVR is higher than SVR
- PVR is lower than SVR (correct)
What is a consequence of a large left-to-right shunt and low PVR?
What is a consequence of a large left-to-right shunt and low PVR?
- Decreased SVR
- Decreased PBF
- Increased cardiac work for the RV
- Substantial increase in PBF (correct)
What is a result of excessive PBF in patients with left-to-right shunts?
What is a result of excessive PBF in patients with left-to-right shunts?
- Progressive elevation in SVR
- Increased cardiac output
- Decreased PVR
- Progressive elevation in PVR (correct)
What is a complication of volume overload in patients with left-to-right shunts?
What is a complication of volume overload in patients with left-to-right shunts?
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What is a result of diastolic changes in patients with left-to-right shunts?
What is a result of diastolic changes in patients with left-to-right shunts?
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Why may large left-to-right shunts outstrip the capacity of the left side of the heart to maintain adequate systemic perfusion in infants?
Why may large left-to-right shunts outstrip the capacity of the left side of the heart to maintain adequate systemic perfusion in infants?
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Study Notes
Left-to-Right Shunts
- Occur when PVR is lower than SVR, directing blood flow preferentially towards the lungs
- Result in increased PBF (pulmonary blood flow)
Pathophysiologic Problems
- Congestion of the pulmonary circulation
- Intravascular volume overload with increased cardiac work for the LV
- Excessive PBF, resulting in progressive elevation in PVR
Volume Overload Consequences
- Ventricular dilation, placing the heart at a mechanical and physiologic disadvantage
- Reduced diastolic compliance
- Engorgement of respective venous beds, producing signs and symptoms of clinical CHF (congestive heart failure)
Infant's Limited Capacity
- Imature left heart structure limits its capacity to maintain adequate systemic perfusion in the face of large left-to-right shunts
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