Prostatakrebs Teil 3 - PSA-Rezidiv - Was nun?
Atrial septal ASD Fraktion Prostatakrebs ASD is a congenital heart defect in which blood flows between the atria upper chambers of the heart. Some flow is a normal condition both pre-birth and immediately ASD Fraktion Prostatakrebs via the foramen ovalehowever when this does not naturally close after birth it is referred to as a patent open foramen ovale PFO.
After PFO closure the atria normally are separated by a dividing ASD Fraktion Prostatakrebs, the interatrial septum. If this septum is defective or absent, then oxygen -rich blood can flow directly from the left side of the heart to mix with the oxygen-poor blood in the right side of the heart; or the opposite, depending ASD Fraktion Prostatakrebs whether the left or right atrium has the higher blood pressure.
This can lead to lower-than-normal oxygen levels in the arterial blood that supplies the brain, organs, and tissues. However, an ASD may not produce noticeable signs or symptoms, especially if the defect is small. Also, in terms of health risks, people who have had a cryptogenic stroke are more likely to have a PFO than the general population.
A cardiac shunt is the presence of a net flow of blood through a defect, either from left to right or right to left. The amount of shunting present, if any, determines the hemodynamic significance of the ASD. A right-to-left-shunt results in venous blood entering the left side of the ASD Fraktion Prostatakrebs and into the arterial circulation without passing through the pulmonary circulation to be oxygenated. This may result in the clinical finding of cyanosisthe presence of bluish-colored skin, especially of the lips and under the nails.
During development of the baby, the interatrial septum develops to separate the left and right atria. However, a hole in ASD Fraktion Prostatakrebs septum called the foramen ovaleallows blood from the right atrium to enter the left atrium during fetal development.
This opening allows blood to bypass the nonfunctional fetal ASD Fraktion Prostatakrebs while the fetus obtains its oxygen from the placenta. A layer of tissue called the septum primum acts as a valve over the foramen ovale during fetal development.
After birth, the pressure in the right side of the heart drops as the lungs open and begin working, causing the foramen ovale to close ASD Fraktion Prostatakrebs. The six types of atrial septal defects are differentiated from each other by whether they involve other structures of the heart and how they are formed during the developmental process during early ASD Fraktion Prostatakrebs development.
The secundum atrial septal defect usually arises from an enlarged foramen ovaleinadequate growth of the septum secundumor excessive absorption of the septum primum. An ostium secundum ASD accompanied by an acquired mitral valve stenosis is called Lutembacher's syndrome.
Most individuals with an uncorrected secundum ASD do not have significant symptoms through early adulthood. Symptoms are typically decreased exercise tolerance, easy fatigability, palpitationsand syncope.
Complications of an uncorrected secundum ASD include pulmonary hypertensionright-sided heart failureatrial fibrillation or flutterstrokeand Eisenmenger's syndrome. A patent foramen ovale PFO ASD Fraktion Prostatakrebs a remnant opening of the fetal foramen ovalewhich normally closes after a person's birth. In medical use, the term "patent" means open or unobstructed. On echocardiography, shunting of blood may not be noted except when the patient coughs.
Clinically, PFO is linked to strokesleep apneamigraine with auraand decompression sickness. No cause is established for a foramen ovale to remain open instead of closing naturally, but heredity and genetics may play a role. The mechanism by which a PFO may play a role in ASD Fraktion Prostatakrebs is called paradoxical embolism.
In the case of PFO, a blood clot from the venous circulatory system is able to pass from the right atrium directly into the left atrium via the PFO, rather than being filtered by the lungs, and thereupon into systemic circulation toward the brain.
PFO ASD Fraktion Prostatakrebs more prevalent in patients with cryptogenic stroke than in patients with a stroke of known cause. Statistically speaking, this is particularly true for patients who have a stroke before the age of Some data suggest that PFOs may be involved in the pathogenesis of some migraine headaches.
A defect in the ostium primum is occasionally classified as an atrial septal defect,  but it is more commonly classified as an atrioventricular septal defect.
A sinus venosus ASD is a type of atrial septum defect in which the defect involves the venous inflow of either the superior vena cava or the inferior vena cava. It is located at the junction of the superior vena cava and the right atrium. It is frequently associated with anomalous drainage of the right-sided pulmonary veins into the right atrium instead of the normal drainage of the pulmonary veins into the left atrium.
Common or single atrium is a failure of development of the embryologic components that contribute to the atrial septal complex. It is frequently associated with heterotaxy syndrome. The interatrial septum can be divided into five septal zones. If the defect involves two or more of the septal zones, then the defect is termed a mixed atrial septal defect. Due to the communication between the atria ASD Fraktion Prostatakrebs occurs in ASDs, disease entities or complications from the condition are possible.
Patients with an uncorrected atrial septal defect may be at increased risk for developing a cardiac arrhythmia, as well as more frequent respiratory infections. ASDs, and particularly PFOs, are a predisposing venous blood carrying inert gases, such as helium or nitrogen does not pass through the lungs. If some of the inert gas-laden blood passes through the PFO, it avoids the lungs and the inert gas is more likely to form large bubbles in ASD Fraktion Prostatakrebs arterial blood stream causing decompression sickness.
If a net flow of blood exists from the left atrium to the right atrium, called a left-to-right shunt, then an increase in ASD Fraktion Prostatakrebs blood flow ASD Fraktion Prostatakrebs the lungs happens. Initially, this increased blood flow is asymptomatic, but if it persists, the pulmonary blood vessels may stiffen, causing pulmonary hypertension, which increases the pressures in the right side of the heart, leading to the reversal of ASD Fraktion Prostatakrebs shunt into a right-to-left shunt.
Reversal of the shunt occurs, and the blood flowing in the opposite direction through the ASD is ASD Fraktion Prostatakrebs Eisenmenger's syndrome, a rare and late complication of an ASD. Venous thrombus ASD Fraktion Prostatakrebs in the veins are quite common. Embolizations dislodgement ASD Fraktion Prostatakrebs thrombi normally go to the lung and cause pulmonary emboli. In an individual with ASD, these emboli can potentially enter the arterial system, which can cause any phenomenon attributed to acute loss of blood to a portion of the body, including cerebrovascular accident strokeinfarction of the spleen or intestinesor even a distal extremity i.
This is known as a paradoxical embolus because the clot ASD Fraktion Prostatakrebs paradoxically enters the arterial system instead of going to the lungs.
Some recent research has suggested that a proportion of cases of migraine may be caused by PFO. While the exact mechanism remains unclear, closure of a PFO can reduce symptoms in certain cases.
The high frequency of these facts make finding statistically significant relationships between PFO and migraine difficult i. In a large randomized controlled trialASD Fraktion Prostatakrebs higher prevalence of PFO in migraine patients was confirmed, but migraine headache cessation was not more prevalent in the group of migraine ASD Fraktion Prostatakrebs who underwent closure of their PFOs.
In unaffected individuals, the chambers of the left side of the heart are under higher pressure than the chambers of the right side because the left ventricle has to produce enough pressure to pump blood throughout the entire body, while the right ventricle needs only to produce enough pressure to pump blood ASD Fraktion Prostatakrebs the lungs. This extra blood from the left atrium may cause a volume overload ASD Fraktion Prostatakrebs both the right atrium and the right ventricle.
If untreated, this condition can result in enlargement of the right side of the heart and ultimately heart failure. Any process that increases the pressure in the left ventricle can cause worsening of the left-to-right shunt. This includes hypertension, which increases the pressure that the left ventricle has to generate to open the aortic valve during ventricular systoleand coronary ASD Fraktion Prostatakrebs disease which increases the stiffness of the left ventricle, thereby increasing the filling pressure of the left ventricle during ventricular diastole.
The left-to-right shunt increases the filling pressure of the right heart preload and forces the right ventricle to pump out more blood than ASD Fraktion Prostatakrebs left ventricle.
This constant overloading of the right side of the heart causes an overload of the entire pulmonary vasculature. Eventually, pulmonary hypertension may develop. The pulmonary hypertension will ASD Fraktion Prostatakrebs the right ventricle to face increased afterload. The right ventricle is forced to generate higher pressures to try to overcome the ASD Fraktion Prostatakrebs hypertension.
This may lead to right ventricular failure dilatation and decreased systolic function of the right ventricle. If the ASD is left uncorrected, ASD Fraktion Prostatakrebs pulmonary hypertension progresses and the pressure in the right side of the heart becomes greater than the left side of the heart.
This reversal of the pressure gradient across the ASD causes the shunt to reverse - a right-to-left shunt. This phenomenon is known as Eisenmenger's syndrome. Once right-to-left shunting occurs, a portion ASD Fraktion Prostatakrebs the oxygen-poor blood gets shunted to the left side of the heart and ejected to the peripheral vascular system.
This causes signs of cyanosis. Most individuals with a significant ASD are diagnosed in utero or in early childhood with the use of ultrasonography or auscultation of the heart sounds during physical examination. The development of signs and symptoms due to an ASD are related to the size of the intracardiac shunt. Individuals with a larger shunt tend to present with symptoms at a younger age.
Adults with an uncorrected ASD present with symptoms of dyspnea on exertion shortness of breath with minimal exercisecongestive heart failureor cerebrovascular accident stroke. They may be noted on routine testing to have an abnormal chest X-ray or an abnormal ECG and may have atrial fibrillation. If the ASD causes a left-to-right shunt, the pulmonary vasculature in both lungs may appear dilated on chest X-ray, due to the increase in pulmonary blood ASD Fraktion Prostatakrebs.
The physical findings in an adult with an ASD include ASD Fraktion Prostatakrebs related directly to the intracardiac shunt, and those that are secondary to the right heart failure that may be present in these individuals. Upon auscultation of the heart ASD Fraktion Prostatakrebsa systolic ejection murmur may be heard that is attributed to the pulmonic valve, due to the increased flow of blood through the pulmonic valve rather than any ASD Fraktion Prostatakrebs abnormality of the valve leaflets.
In unaffected individuals, respiratory variations occur in the splitting of the second heart sound S 2. During respiratory inspiration, the negative intrathoracic pressure causes increased blood return into the right side of the heart.
The increased blood volume in the right ventricle causes the pulmonic valve to stay open longer during ventricular systole. This causes a normal delay in the P 2 component of S 2. During expiration, the positive intrathoracic pressure causes decreased blood return to the right side of the heart. The reduced volume in the right ventricle allows the pulmonic valve to close earlier at the end of ventricular systole, causing P 2 to occur earlier.
In individuals with an ASD, a fixed splitting of S 2 occurs because the extra blood return during inspiration gets equalized between the left and right atria due to the communication that exists between the atria in individuals with ASD.
The right ventricle can be thought of as continuously overloaded because of the left-to-right shunt, producing a widely split S2. Because the atria are linked via the atrial septal defect, inspiration ASD Fraktion Prostatakrebs no net pressure change between them, and has no effect on the splitting of S2.
In transthoracic echocardiographyan atrial septal defect may be seen on color flow imaging as a jet of blood from the left atrium to the right atrium. If agitated saline is injected into a peripheral vein during echocardiography, small air bubbles ASD Fraktion Prostatakrebs be seen on echocardiographic imaging. Bubbles traveling across an ASD may be ASD Fraktion Prostatakrebs either at rest or during a cough.
Bubbles only flow from right atrium to left atrium if the right atrial pressure is greater than left atrial. Because better visualization of the atria is achieved with transesophageal echocardiography, this test may be ASD Fraktion Prostatakrebs in individuals with a suspected ASD which is not visualized on transthoracic imaging.
Newer techniques to visualize these defects involve intracardiac imaging with special catheters typically placed in the venous system and advanced to the level of the heart. This type of imaging is becoming more common and involves only mild sedation for the patient typically. If the individual has adequate echocardiographic windows, use of the echocardiogram to measure the cardiac output of the left ventricle and the right ventricle independently is possible.
In this way, the shunt fraction can be estimated using echocardiography. The ECG findings in atrial septal defect vary with the type of defect the individual has. ASD Fraktion Prostatakrebs with atrial septal defects may have a prolonged PR interval a first-degree heart block.