Pneumonia

Introduction to the Disease

Pneumonia is a lung infection that can range from minor to severe enough to necessitate
hospitalization. It occurs when an infection causes the air sacs in your lungs (called alveoli by your
doctor) to fill with fluid or pus. This can make it difficult for enough oxygen to enter your
bloodstream.

This lung infection can affect anyone. However, children under the age of two and individuals
over the age of 65 are at a higher risk. This is due to the fact that their immune systems may not be
strong enough to fight it.

Pneumonia can affect one or both lungs. You can also have it and be unaware of it. This is
referred described as "walking pneumonia" by doctors. Bacteria, viruses, and fungus are among the
causes. If you get pneumonia from bacteria or a virus, you can pass it on to someone else.

Smoking cigarettes and consuming too much alcohol might significantly increase your chances of
getting pneumonia.

Signs and Symptoms

The signs and symptoms of pneumonia range from mild to severe, depending on factors such as
the type of germ that caused the infection, as well as your age and overall health. Mild symptoms
and indicators are frequently comparable to those of a cold or flu, but they remain longer.

Signs and symptoms of pneumonia may include:

 Chest pain when you breathe or cough

 Confusion or changes in mental awareness (in adults age 65 and older)
 Cough, which may produce phlegm
 Fatigue
 Fever, sweating and shaking chills
 Lower than normal body temperature (in adults older than age 65 and people with weak
immune systems)
 Nausea, vomiting or diarrhea
 Shortness of breath

Infants and newborns may not show any signs of infection. They may vomit, have a fever and
cough, appear restless or weary, or have difficulties breathing and eating.
Causes

Pneumonia can be caused by a variety of bacteria. Bacteria and viruses are the most common in
the air we breathe. Normally, your body stops these viruses from infecting your lungs. However,
even if your health is normally good, these viruses can sometimes overwhelm your immune system.
Pneumonia is classified based on the sort of germs that cause it and where the illness occurred.

Pathophysiology

The majority of pneumonia cases develop when your body's natural defenses fail, allowing
germs to penetrate and flourish within your lungs. White blood cells rapidly accumulate in order to
eliminate the attacking organisms. They, together with bacteria and fungus, populate the air sacs in
your lungs (alveoli). Breathing may be difficult.

Aspiration of gastric content or bacteria enter the lung

Inflammatory response

Cavity extend to bronchus

Abscess become encapsulated

Tissues necrotize

Increase production of sputum

Purulent sputum
Risk Factor

Pneumonia can affect anyone. But the two age groups at highest risk are:

 Children who are 2 years old or younger

 People who are age 65 or older

Other risk factors include:

 Being in the hospital. If you're in a hospital intensive care unit, you're more likely to have
pneumonia, especially if you're on a breathing machine (a ventilator).
 Chronic illness. If you have asthma, chronic obstructive pulmonary disease (COPD), or heart
disease, you are more prone to get pneumonia.
 Smoking. Tobacco smoking weakens your body's natural defenses against the germs and
viruses that cause pneumonia.
 Immune system that has been weakened or repressed. People with HIV/AIDS, organ
transplant recipients, and those who get chemotherapy or long-term steroids are at risk.

Complications

Even with treatment, some people with pneumonia, especially those in high-risk groups, may
experience complications, including:

 Bacteria in the bloodstream (bacteremia). Bacteria that enter the bloodstream from
your lungs can spread the infection to other organs, potentially causing organ failure.
 Difficulty breathing. If your pneumonia is severe or you have chronic underlying lung
diseases, you may have trouble breathing in enough oxygen. You may need to be
hospitalized and use a breathing machine (ventilator) while your lung heals.
 Fluid accumulation around the lungs (pleural effusion). Pneumonia may cause fluid to
build up in the thin space between layers of tissue that line the lungs and chest cavity
(pleura). If the fluid becomes infected, you may need to have it drained through a chest tube
or removed with surgery.
 Lung abscess. An abscess occurs if pus forms in a cavity in the lung. An abscess is usually
treated with antibiotics. Sometimes, surgery or drainage with a long needle or tube placed
into the abscess is needed to remove the pus.

Prevention

To help prevent pneumonia:

Get vaccinated. Some kinds of pneumonia and the flu can be prevented with vaccines.
Consult your doctor about receiving these shots. Immunization requirements have changed
over time, so make sure to discuss your vaccination status with your doctor, even if you
recall receiving a pneumonia vaccine in the past.
 Ensure that children get immunized. Doctors prescribe a separate pneumonia vaccine for
children under the age of two, as well as children aged two to five who are at high risk of
pneumococcal illness. Children who attend a group child care center should also be
immunized. Flu shots are also recommended for youngsters above the age of six months,
according to doctors.
Maintain good hygiene. Wash your hands frequently or use an alcohol-based hand sanitizer
to prevent yourself from respiratory infections, which can occasionally lead to pneumonia.
Don't smoke. Tobacco use weakens your lungs' natural defenses against respiratory
illnesses.
Maintain a healthy immune system. Get enough sleep, exercise on a regular basis, and
consume a nutritious diet.

Citations

 Pneumonia - Symptoms and causes. (2020, June 13). Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/pneumonia/symptoms-causes/syc-

20354204

 (PDF) diagnostic approaches of pneumonia ... - Researchgate. (n.d.). Retrieved from

https://www.researchgate.net/publication/344488922_Diagnostic_approaches_of_pneumo
nia_for_commercial-scale_biomedical_applications_an_overview.

 Pneumonia. (2017, January 5). WebMD. https://www.webmd.com/lung/understanding-

pneumonia-basics
Influenza

Introduction to the Disease

Influenza is a viral infection that affects your respiratory system, specifically your nose, throat,
and lungs. The flu is a common term for influenza, although it is not the same as stomach "flu"
viruses that cause diarrhea and vomiting.

Influenza viruses are mostly transmitted from person to person through coughing or sneezing.
They can also be disseminated less frequently by touching a contaminated surface and then
touching the lips, eyes, or nose. Individuals can spread the flu to others even before their own
symptoms appear and for up to a week after symptoms appear.

Signs and Symptoms

The flu may appear to be a normal cold at first, with a runny nose, sneezing, and sore throat.
Colds, on the other hand, normally develop slowly, whereas the flu frequently appears abruptly.
And, although one cold might be annoying, the flu usually makes you feel much worse.

Common signs and symptoms of the flu include:

 Fever
 Aching muscles
 Chills and sweats
 Headache
 Dry, persistent cough
 Shortness of breath
 Tiredness and weakness
 Runny or stuffy nose
 Sore throat
 Eye pain
 Vomiting and diarrhea, but this is more common in children than adults

Causes

When an infected person coughs, sneezes, or speaks, the virus spreads through the air in
droplets. You can either directly inhale the droplets or pick up the germs from an object, such as a
phone or computer keyboard, and then transmit them to your eyes, nose, or mouth.

People infected with the virus are likely contagious from a day before symptoms show to five
days after they develop. Children and others with compromised immune systems may remain
contagious for a somewhat longer period of time.
 Influenza viruses are continually evolving, with new strains emerging on a regular basis. If
you've had influenza before, your body has already produced antibodies to combat that particular
strain of the virus. If future influenza viruses are similar to those you've encountered before,
whether through sickness or vaccination, those antibodies may prevent or minimize the severity of
infection.

Furthermore, antibodies against previously encountered influenza viruses may not protect you
from new influenza strains, which may be entirely different viruses from those you had previously.

Pathophysiology

The fundamental mechanism of influenza pathophysiology is caused by lung inflammation and

compromise caused by direct viral infection of the respiratory epithelium, mixed with the impact of
lung inflammation generated by immune responses recruited to deal with the spreading virus.

Influenza virus attachment to Close contact with person

the cell membrane who has influenza

Influenza virus replication,

production of cytokines,
Serine protease inhibitors
granzymes and cytotoxic
factors

Alveolitis induced by
Airway inflammation
influenza virus

Damage of airway Damage of alveolar

Airway hyperactivity
epithelial cells and epithelial cells and
and narrowing
endothelial cells endothelial cells

Exacerbation of bronchial asthma and COPD Pneumonia or ARDS

The sites of action of serine protease inhibitors

The processes that might be inhibited by serine protease inhibitors in influenza virus infection-
induced exacerbation of bronchial asthma and COPD and in the development of pneumonia and
ARDS. ARDS: Acute Respiratory Distress Syndrome

Risk Factor

Factors that may increase your risk of developing the flu or its complications include:

 Age. Seasonal influenza tends to target children 6 months to 5 years old, and adults 65 years
old or older.

 Living or working conditions. People who live or work in facilities with many other
residents, such as nursing homes or military barracks, are more likely to develop the flu.
People who are staying in the hospital also are at higher risk.

 Weakened immune system. Cancer treatments, anti-rejection drugs, long-term use of

steroids, organ transplant, blood cancer or HIV/AIDS can weaken the immune system. This
can make it easier to catch the flu and may also increase the risk of developing
complications.

 Chronic illnesses. Chronic conditions, including lung diseases such as asthma, diabetes,
heart disease, nervous system diseases, metabolic disorders, an airway abnormality, and
kidney, liver or blood disease, may increase the risk of influenza complications.

 Race. Native American people may have an increased risk of influenza complications.

 Aspirin use under age 19. People who are younger than 19 years of age and receiving long-
term aspirin therapy are at risk of developing Reye's syndrome if infected with influenza.

 Pregnancy. Pregnant women are more likely to develop influenza complications,

particularly in the second and third trimesters. Women are more likely to develop
influenza-related complications up to two weeks after delivering their babies.

 Obesity. People with a body mass index (BMI) of 40 or more have an increased risk of flu
complications.

Complications

The flu is usually not harmful if you are young and healthy. Although you may be miserable
while you have it, the flu normally passes in a week or two with no long-term consequences.
However, infants and adults who are at high risk may have issues such as:
  Pneumonia
 Bronchitis
 Asthma flare-ups
 Heart problems
 Ear infections
 Acute respiratory distress syndrome

Pneumonia is one of the most serious complications. For older adults and people with a chronic
illness, pneumonia can be deadly.

Prevention

The influenza vaccine isn't 100% effective, so it's also important to take several measures to reduce
the spread of infection, including:

Wash your hands. Washing your hands often with soap and water for at least 20 seconds is
an effective way to prevent many common infections. Or use alcohol-based hand sanitizers
if soap and water aren't available.
Avoid touching your face. Avoid touching your eyes, nose and mouth.
Cover your coughs and sneezes. Cough or sneeze into a tissue or your elbow. Then wash
your hands.
Clean surfaces. Regularly clean often-touched surfaces to prevent spread of infection from
touching a surface with the virus on it and then your face.
Avoid crowds. The flu spreads easily wherever people gather — in child care centers,
schools, office buildings, auditoriums and public transportation. By avoiding crowds during
peak flu season, you reduce your chances of infection.
Avoid anyone who is sick. And if you're sick, stay home for at least 24 hours after your
fever is gone so that you lessen your chance of infecting others.

Citations

 Influenza (flu) - Symptoms and causes. (2021, October 19). Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/flu/symptoms-causes/syc-20351719

 Abstract and figures – Researchgate. https://www.researchgate.net/figure/Pathogenesis-

of-influenza-virus-infection-induced-exacerbation-of-bronchial-asthma-
and_fig1_303030992

Pulmonary Tuberculosis

Introduction to the Disease

Tuberculosis is a bacterial infection that can spread from person to person through the air. When it
attacks the lungs, it is referred to as pulmonary tuberculosis. It can produce severe coughing, chest
pain, and a variety of other symptoms.

Tuberculosis (TB) bacteria are primarily found in the lungs, but they can infect other regions of the
body as well. Miliary tuberculosis is a more advanced form of tuberculosis that occurs when
bacteria move via the bloodstream and attack organs other than the lungs.

Signs and Symptoms

Symptoms of TB can develop slowly and may vary. The main symptoms of pulmonary TB include:

 A bad cough that lasts for at least 3 weeks.

 Chest pain
 Coughing up blood or phlegm from the lungs
 Breathlessness

More general symptoms of TB can include:

 Weight loss
 A loss of appetite
 Nausea and vomiting
 Low energy or fatigue
 Fever and chills
 Night sweats

People with latent TB do not have any symptoms or feel sick.

Causes

Mycobacterium tuberculosis is a type of bacteria that causes tuberculosis (M. tuberculosis). This
type of bacteria infects roughly one-third of the world's population. However, only about 10–20%
of people infected with this virus develop "active TB."

A person with "latent TB" is one who carries the bacteria but does not develop symptoms. This
is not contagious, but it can progress to active tuberculosis, especially if a person's immune system
is compromised by a condition such as HIV.

When the immune system is unable to keep the bacteria from multiplying, tuberculosis (TB) can
become active. However, many people who have latent tuberculosis never develop active disease. A
skin or blood test can be used by a doctor to detect M. tuberculosis.

When people with active pulmonary tuberculosis cough, sneeze, or speak, they expel the
bacteria in the form of tiny water droplets. These droplets travel through the air and can be inhaled.
 However, in order to contract TB, an individual must be in close contact with someone who has
active TB for an extended period of time. A TB infection in a body part other than the lungs is
usually not contagious.

Pathophysiology

Infection begins when a person inhales droplet nuclei containing tubercle bacilli, which then reach
the lungs' alveoli. Alveolar macrophages consume these tubercle bacilli, and the vast majority of
them are destroyed or inhibited.

Frequent close Weak immune

contact with a person system caused by
who has active TB HIV

Inhales tubercle
bacilli

Damaged lung Spread though the

Lungs
tissue lymphatic system

Alveoli (where gas

exchanged occurs)

Triggers body
immune response

Inflammatory Kill and traps

response (monocytes Healing process
mycobacteria
& neutrophils)
Risk Factor

Anyone can get tuberculosis, but certain factors can increase your risk, including:

 Weakened immune system

A healthy immune system often successfully fights TB bacteria. However, several conditions and
medications can weaken your immune system, including:

 HIV/AIDS
 Diabetes
 Severe kidney disease
 Certain cancers
 Cancer treatment, such as chemotherapy
 Drugs to prevent rejection of transplanted organs
 Some drugs used to treat rheumatoid arthritis, Crohn's disease and psoriasis
 Malnutrition or low body weight
 Very young or advanced age

Complication

Tuberculosis can be lethal if not treated. Untreated active illness primarily affects the lungs,
although it can also affect other regions of the body.

Tuberculosis complications include:

 Spinal pain. Back pain and stiffness are frequent TB consequences.

 Joint damage. Tuberculous arthritis (arthritis caused by tuberculosis) typically
affects the hips and knees.
 The membranes that cover your brain swell (meningitis). This can result in a
long-lasting or intermittent headache that lasts for weeks, as well as mental
alterations.
 Liver or kidney problems. Your liver and kidneys aid in the removal of waste and
pollutants from your bloodstream. Tuberculosis in these organs has the potential to
affect their functionality.
 Heart problems. In rare cases, tuberculosis can infect the tissues surrounding your
heart, causing inflammation and fluid accumulations that can impair your heart's
capacity to pump adequately. This disorder, known as cardiac tamponade, is
potentially lethal.
Prevention

If you test positive for latent tuberculosis infection, your doctor may urge you to take drugs to
reduce your risks of getting active tuberculosis. Only active tuberculosis is contagious.

If you have active tuberculosis, it usually takes a few weeks of therapy with TB drugs before you
are no longer contagious. To help keep your friends and family from getting sick, follow these tips:

Stay at home. During the first few weeks of treatment, avoid going to work, school, or
sleeping in a room with other people.
Ventilate the room. Tuberculosis germs spread more quickly in compact, closed
environments with no movement of air. Open the windows and use a fan to blow interior air
outside if it's not too cold outside.
Keep your mouth shut. Cover your mouth with a tissue if you laugh, sneeze, or cough. Put
the filthy tissue in a bag, seal it, and toss it.
Put on a face mask. During the first three weeks of therapy, wearing a face mask when
you're around other people may help reduce the chance of transmission.

Citations

 Villines, Z. (2019, June 21). What to know about pulmonary tuberculosis. Medical News

Today. https://www.medicalnewstoday.com/articles/325526#when-to-see-a-doctor

 Tuberculosis - Symptoms and causes. (2021, April 3). Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/tuberculosis/symptoms-causes/syc-

20351250

 Cmt, T. (n.d.). TB Online - How TB infects the body: The Tubercle. TB Online.

https://www.tbonline.info/posts/2016/3/31/how-tb-infects-body-tubercle-1/
Myocardial Infarction

Introduction to the Disease

A myocardial infarction (also known as a heart attack) is a potentially fatal ailment caused by a
shortage of blood flow to your heart muscle. A lack of blood flow can be caused by a variety of
circumstances, but it is most commonly caused by a blockage in one or more of your heart's
arteries. The afflicted cardiac muscle will begin to die if there is no blood supply. If blood flow is not
rapidly restored, a heart attack can result in permanent cardiac damage and death.

When a heart attack happens, blood supply to a section of your heart stops or is significantly
reduced, causing that area of your heart muscle to die. When a section of your heart is unable to
pump due to a lack of blood supply, the pumping sequence for the entire heart is disrupted. This
lowers or even prevents blood flow to the rest of your body, which can be fatal if not treated soon.

Signs and Symptoms

Common heart attack signs and symptoms include:

 Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may
spread to your neck, jaw or back
 Nausea, indigestion, heartburn or abdominal pain
 Shortness of breath
 Cold sweat
 Fatigue
 Lightheadedness or sudden dizziness

Not everyone who has a heart attack experiences the same symptoms or the same level of
symptoms. Some people experience modest pain, while others experience severe pain. Some
persons show no signs of illness. For others, the initial symptom could be a cardiac arrest. The more
indications and symptoms you have, however, the more likely you are suffering a heart attack.

Although some heart attacks occur unexpectedly, many patients have warning signs and
symptoms hours, days, or weeks in advance. The first sign could be recurring chest pain or pressure
(angina), which is caused by exercise and eased by rest. Angina is produced by a brief reduction in
blood flow to the heart.

Causes

When one or more of your coronary arteries get clogged, you have a heart attack. A buildup of
fatty deposits, including cholesterol, forms plaques over time, which can restrict the arteries
(atherosclerosis). The majority of heart attacks are caused by this ailment, known as coronary
artery disease.

A plaque can break during a heart attack, releasing cholesterol and other chemicals into the
bloodstream. At the site of the breach, a blood clot forms. If the clot is large enough, it can prevent
blood flow via the coronary artery, depriving the heart of oxygen and nutrition (ischemia).
 A spasm of a coronary artery, which cuts off blood flow to a portion of the heart muscle, is
another cause of a heart attack. Tobacco and illegal narcotics, such as cocaine, can produce a
potentially fatal spasm.

Infection with COVID-19 may also cause heart damage, leading to a heart attack.

Pathophysiology

Acute myocardial ischemia is caused by any occlusion in the coronary arteries. This
obstruction could be caused by plaque rupture, fissuring, or the creation of any superimposed
thrombus. Despite significant advances in the care of acute myocardial infarction, such as
fibrinolysis and fast revascularization, the prognosis remains poor due to the lack of self-repairing
of the previously damaged myocardium, which may result in consequences such as heart failure.

Atherosclerosis Arterial Spasm Plaque rupture or thrombus

Gradual arterial Acute irreversible Sudden arterial

obstruction obstruction occlusion

Reduced blood supply and

increased oxygen demand

Ischemia of cardiac Acute chest pain or angina

muscle caused due to hypoxia

Permanent necrosis of
cardiac muscle
 Myocardial
infarction

Risk Factor

Certain factors may contribute to the undesirable accumulation of fatty plaques

(atherosclerosis), which narrows arteries throughout your body. Most of these risk factors can be
improved or eliminated to lessen your risks of having a first or subsequent heart attack.

Risk factors include:

 Age. Men over the age of 45 and women over the age of 55 are more likely to have a heart
attack than younger men and women.
 Tobacco. This includes smoking and long-term secondhand smoke exposure.
 High blood pressure. High blood pressure can damage the arteries that lead to your heart
over time. High blood pressure combined with other illnesses, such as obesity, high
cholesterol, or diabetes, raises your risk even further.
 High levels of cholesterol or triglycerides in the blood. A high amount of low-density
lipoprotein (LDL) cholesterol ("bad" cholesterol) increases the likelihood of artery
narrowing. A high amount of triglycerides, a type of blood fat related to your food, increases
your chance of having a heart attack.
 Obesity. Obesity is associated with high blood cholesterol levels, high triglyceride levels,
high blood pressure, and diabetes. This risk can be reduced by losing as little as 10% of your
body weight.
 Diabetes. Not producing enough of a hormone generated by your pancreas (insulin) or not
responding effectively to insulin causes your blood sugar to rise, increasing your risk of a
heart attack.
 Metabolic syndrome. Obesity, high blood pressure, and excessive blood sugar levels all
contribute to this syndrome. Having this syndrome is likely to have heart disease than if you
do not.
 Family history of heart attacks. If any of your siblings, parents, or grandparents had a
heart attack while they were young (by the age of 55 for men and 65 for women), you may
be at a higher risk.
 Lack of physical activity. Inactivity relates to elevated blood cholesterol and obesity.
Regular exercisers had improved heart health, as well as reduced blood pressure.
 Stress. You may react to stress in ways that increase your chance of having a heart attack.
 Use of illegal drugs. Using stimulants like cocaine or amphetamines can produce a spasm
in your coronary arteries, which can lead to a heart attack.
 A history of preeclampsia. This disorder causes high blood pressure during pregnancy
and raises the risk of heart disease later in adulthood.
 An autoimmune disorder. A illness like rheumatoid arthritis or lupus can raise your risk of
having a heart attack.
Complication

Complications are often related to the damage done to your heart during a heart attack, which can
lead to:

 Heart rhythm abnormality (arrhythmias). Electrical "short circuits" can develop, leading
in aberrant heart rhythms, some of which can be fatal.
 Heart Failure. A heart attack may cause so much damage to your heart tissue that the
remaining heart muscle is unable to pump enough blood out of your heart. Heart failure can
be either transient or chronic, resulting from substantial and irreversible damage to your
heart.
 Unexpected cardiac arrest. Your heart pauses without warning due to an electrical
disruption that generates an irregular heart rhythm (arrhythmia). Heart attacks raise the
risk of abrupt cardiac arrest, which can result in death if not treated immediately.

Prevention

Here are ways to prevent a heart attack:

Medications. Taking drugs can lower your chances of having another heart attack and help
your damaged heart function better. Continue to take your doctor's prescriptions, and
inquire how frequently you need to be monitored.
Aspects of one's lifestyle. You know the routine: Stay healthy with a heart-healthy diet, don't
smoke, exercise regularly, manage stress, and keep illnesses that can contribute to a heart
attack under control, such as high blood pressure, high cholesterol, and diabetes.

Citations

 Heart attack - Symptoms and causes. (2020, June 16). Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-

20373106

 Heart Attack: What Is It, Causes, Symptoms & Treatment. (n.d.). Cleveland Clinic.

https://my.clevelandclinic.org/health/diseases/16818-heart-attack-myocardial-infarction

 Botleroo, R. A. (2021, August 9). Stem Cell Therapy for the Treatment of Myocardial

Infarction: How Far Are We Now? Cureus. https://www.cureus.com/articles/65575-stem-

cell-therapy-for-the-treatment-of-myocardial-infarction-how-far-are-we-now
Tetralogy of Fallot

Introduction to the Disease

Tetralogy of Fallot is an uncommon disorder characterized by a combination of four congenital

heart abnormalities (congenital).

These flaws, which impair the heart's structure, cause oxygen-depleted blood to flow out of the
heart and into the rest of the body. Because their blood does not carry enough oxygen, infants and
children with tetralogy of Fallot typically exhibit blue-tinged skin.

Tetralogy of Fallot is frequently diagnosed during or shortly after the baby's infancy. Tetralogy of
Fallot may sometimes not identified until adulthood, regardless of the severity of the abnormalities
and symptoms.

All newborns with tetralogy of Fallot require corrective surgery. People with tetralogy of Fallot
will need to see a doctor on a regular basis for the rest of their lives and may be limited in their
activities.

Signs and Symptoms

Signs and symptoms may include:

 A bluish coloration of the skin caused by low blood oxygen levels (cyanosis)
 Shortness of breath and rapid breathing, especially during feeding or exercise
 Poor weight gain
 Tiring easily during play or exercise
 Irritability
 Prolonged crying
 Heart murmur
 Fainting
 An abnormal, rounded shape of the nail bed in the fingers and toes (clubbing)

Causes

Tetralogy of Fallot happens during pregnancy as the baby's heart is forming. In most cases, the
cause is unknown.

Tetralogy of Fallot includes four defects:

1. Lung valve constriction (pulmonary valve stenosis). Blood flow to the lungs is reduced
when the valve that divides the lower right chamber of the heart (right ventricle) from the
primary blood vessel leading to the lungs (pulmonary artery) narrows. The muscle
underlying the pulmonary valve may also be affected by the constriction. The pulmonary
valve does not always form properly (pulmonary atresia).
 2. A hole between the bottom chambers of the heart (ventricular septal defect). A
ventricular septal defect is a hole in the wall (septum) that connects the heart's two bottom
chambers (left and right ventricles). Because of the hole, oxygen-depleted blood in the right
ventricle mixes with oxygen-rich blood in the left ventricle. This creates inefficient blood
flow and lowers the body's supply of oxygen-rich blood. The deficiency has the potential to
weaken the heart over time.
3. The main artery of the body is shifting (aorta). The aorta usually originates from the left
ventricle. The aorta is in the improper location in Fallot tetralogy. It has been relocated to
the right and now sits immediately just above hole in the heart wall (ventricular septal
defect). As a result, the aorta obtains both oxygen-rich and oxygen-depleted blood from the
right and left ventricles.
4. The right lower heart chamber is thickening (right ventricular hypertrophy). The
muscular wall of the right ventricle thickens when the heart's pumping function is strained.
This could cause the heart to harden, weaken, and eventually fail as a result of this.

Pathophysiology

Predisposing factors: Precipitating factors:

Genes Stress
Age Environmental
Rubella
Alcoholism

Alteration of fetal
development

Aorta too large Overriding aorta

Steals space from

Pulmonary stenosis
pulmonary artery

Prevents ventricular Ventricular septal

wall closure defect
Right ventricular
outflow
Mixing of oxygenated Increase ventricular
obstruction
and deoxygenated blood contraction

Decrease O2 supply to Right ventricular

systemic circulation hypertrophy

Hypoxia

Tetralogy of Fallot is characterized by a significant ventricular septal defect (VSD), obstruction

of the right ventricular outflow tract and pulmonary valve, and over-riding aorta. The right
ventricle hypertrophies, deoxygenated blood reaches the aorta through the VSD, and reducing
pulmonary blood flow.

Risk Factor

Risk factors for tetralogy of Fallot include:

 A viral illness during pregnancy, such as rubella (German measles)

 Drinking alcohol during pregnancy
 Poor nutrition during pregnancy
 A mother older than age 40
 A parent who has tetralogy of Fallot
 The presence of Down syndrome or DiGeorge syndrome in the baby

Complications

Complications may include:

 Leaking pulmonary valve (chronic pulmonary regurgitation), in which blood leaks through
the valve back into the pumping chamber (right ventricle)
 Leaking tricuspid valve
 Holes in the wall between the ventricles (ventricular septal defects) that may continue to
leak after repair or may need re-repair
 Enlarged right ventricle or left ventricle that isn't working properly
 Irregular heartbeats (arrhythmias)
 Coronary artery disease
 Enlargement of the ascending aorta (aortic root dilation)
 Sudden cardiac death
Prevention

Eat healthy foods.

Do not drink alcohol when you are pregnant.
Have a regular exercise.
A heart (cardiovascular) surgeon must conduct corrective surgery on all babies with
tetralogy of Fallot. Your baby's growth and development may be stunted if you don't treat
him or her. Based on your or your child's condition, your doctor will select the most
appropriate procedure and the scheduling of the surgery.

Citations

 Tetralogy of Fallot - Symptoms and causes. (2021, August 17). Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/tetralogy-of-fallot/symptoms-

causes/syc-20353477

 Pathophysiology Of Tetralogy Of Fallot.docx [j3no83z9ve4d]. (n.d.). Idocpub.

https://idoc.pub/documents/pathophysiology-of-tetralogy-of-fallotdocx-j3no83z9ve4d

 Beerman, L. B. (2021, October 18). Tetralogy of Fallot. MSD Manual Professional Edition.

https://www.msdmanuals.com/professional/pediatrics/congenital-cardiovascular-

anomalies/tetralogy-of-fallot
Deep Vein Thrombosis

Introduction to the Disease

Deep vein thrombosis (DVT) happens when a blood clot (thrombus) forms in one or more of
your body's deep veins, commonly in your legs. Deep vein thrombosis can cause limb pain or
edema, but it can also occur without warning.

If you have certain medical disorders that alter how your blood clots, you may get DVT. A blood
clot in your legs can also occur if you do not move for an extended period of time, such as after
surgery or an accident, after traveling a long distance, or when on bed rest.

Deep vein thrombosis is dangerous because blood clots in your veins can break free, travel
through your system, and become lodged in your lungs, obstructing blood flow (pulmonary
embolism). Pneumococcal embolism, on the other hand, can develop in the absence of DVT.

When DVT and pulmonary embolism coexist, the condition is known as venous
thromboembolism (VTE).

Signs and Symptoms

Common symptoms include:

 Swelling in your foot, ankle, or leg, usually on one side

 Cramping pain in your affected leg that usually begins in your calf
 Severe, unexplained pain in your foot and ankle
 An area of skin that feels warmer than the skin on the surrounding areas
 Skin over the affected area turning pale or a reddish or bluish color

Causes

A blood clot is the cause of VT. The clot obstructs a vein, preventing blood from flowing
normally throughout your body. Clotting can develop for a variety of causes. These include:

 Injury. Damage to the wall of a blood artery can constrict or halt blood flow. As a result, a
blood clot may form.
 Surgery. During surgery, blood arteries might be injured, leading to the formation of a
blood clot. After surgery, bed rest with minimal to no activity may raise your chance of
forming a blood clot.
 Inactivity or reduced mobility .When you sit a lot, blood can build up in your legs,
especially the lower ones. When you are unable to move for an extended period of time,
your blood flow in your legs may slow. This can result in the formation of a clot.
 Medications. Some drugs make it more likely for your blood to clot.
 Pathophysiology

Pathophysiology may include complete venous stasis and arterial blood flow in the lower
extremity due to blocked venous return or severe edema cutting off arterial blood flow. Venous
gangrene can occur. Infection is rare in venous clots.

Virchow’s Triad

Endothelial Hypercoagulability Stasis

damage

Deep vein Presence of clot in

thrombus deep vein of leg

Clot breakdown

Fibrinogen
breakdown
products in blood
Risk Factor

Risk factors for DVT include:

 Age.
 Sitting for long periods of time, such as when driving or flying.
 Prolonged bed rest, such as during a long hospital stay, or paralysis.
 Injury or surgery.
 Pregnancy.
 Birth control pills (oral contraceptives) or hormone replacement therapy.
 Being overweight or obese.
 Smoking.
 Cancer.
 Heart failure.
 Inflammatory bowel disease.
 A personal or family history of DVT or PE.
 No known risk factor.

Complications

Complications of DVT can include:

 Pulmonary embolism (PE). PE is a potentially fatal complication associated with DVT. It

happens when a blood clot (thrombus) travels to your lung from another area of your body,
generally your leg, and blocks a blood vessel in your lung. If you develop signs and
symptoms of PE, you should seek medical attention right once. A PE can cause sudden
shortness of breath, chest pain while inhaling or coughing, rapid breathing, quick pulse,
feeling faint or fainting, and coughing up blood.
 Post-phlebitic syndrome. Damage to your veins from a blood clot restricts blood flow in
the afflicted areas, causing leg pain and swelling, as well as skin discoloration and ulcers.
 Complications from treatment. Blood thinners used to treat DVTs may cause
complications. Bleeding (hemorrhage) is a potentially dangerous adverse effect of blood
thinners. While using such medications, it is critical to undergo regular blood testing.

Prevention

Avoid sitting still.

Don't smoke.
Exercise and manage your weight.

Citations

 Deep vein thrombosis - Symptoms and causes. (2020, December 22). Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-

causes/syc-20352557
  Delgado, A. (2019, November 13). Everything You Want to Know About Deep Vein

Thrombosis (DVT). Healthline. https://www.healthline.com/health/deep-venous-

thrombosis#causes

 Douketis, J. D. (2021, October 18). Deep Venous Thrombosis (DVT). MSD Manual Professional

Edition. https://www.msdmanuals.com/professional/cardiovascular-

disorders/peripheral-venous-disorders/deep-venous-thrombosis-dvt

 Wong, E., & Chaudhry, S. (n.d.). Venous thromboembolism (VTE). McMaster Pathophysiology

Review. https://www.pathophys.org/vte/#Etiology

Claire S. Libat

N-1B