Main content
Course: NCLEX-RN > Unit 3
Lesson 6: Acyanotic heart diseasesWhat is Eisenmenger syndrome?
Eisenmenger's syndrome is when blood in the heart shunts from right-to-left due to increased pressure in the right ventricle. This increased pressure is usually caused by extra blood flowing through the blood vessels of the lungs, originally caused by left-to-right shunting of blood from a hole in the heart wall. Created by Leslie Samuel.
Want to join the conversation?
- In the video he says that Eisenmenger syndrome causes cyanosis. How can this be part of Acyanotic heart disease? Doesn't acyanotic mean "not blue?"(3 votes)
- eisenmenger syndrome happens when acyanotic heart disease such as ventricular septal defect or atrial septal defect, which increases pulmonary blood pressure is happening for a long time. When the pulmonary vessels cannot hold the increasing blood pressure anymore, blood will backflow into the heart and causing the shunt which starts from left heart to the right heart change into right to the left heart. The changing in blood flow from the right heart to the left heart causes the poorly oxygenated blood from the whole body which comes into the heart from the superior and inferior vena cava goes to the left heart, which recirculate the blood. Because poorly oxygenates blood circulates in the body (hypoxemia), tissues will get lower oxygen while the carbon dioxide level of blood will increase. Bluish color of blood, because of high carbon dioxide level will shows up.(2 votes)
- Is there is any kind of medicine or surgery to cure such a case?
(Either by blocking this gab or trying to oxygenate blood in a different way may be by adding another artificial branchial hearts -like in the octopus- )(1 vote)- Early closure of the VSD prevents the development of pulmonary hypertension. Pulmonary hypertension is irreversible once it develops but it can be medically managed with phosphodiesterase 5 inhibitors (sildenafil); prostanoids (epoprostenol); endothelin receptor antagonists (bosentan), and calcium channel blockers. Pulmonary hypertension that is refractory to medical management requires a lung or heart-lung transplant.(3 votes)
- What is the mechanism for the finger clubbing seen in Eisenmenger syndrome?(2 votes)
- Is Elsenmanger syndrome seen in Tetralogy of Fallot defect? Since they both have clubbing of the fingers and show cyanosis.(2 votes)
- TOF involves four associated malformations: (1) VSD; (2) overriding aorta; (3) right ventricular outflow tract obstruction; (4) right ventricular hypertrophy. The key to your question is the narrowing of the right ventricular outflow tract which either occurs below the valve due to overgrowth of the heart muscle wall or at the level of the valve (pulmonary stenosis or atresia). Essentially blood is blocked from being ejected from the right ventricle into the pulmonary artery. The result is increased pressure in the right ventricle. Because of this, deoxygenated blood shunts through the VSD from the right ventricle to the left ventricle and gets pumped systemically through the overriding aorta.
Eisenmenger syndrome is the result of the shunting of oxygenated blood from the left side of the heart to the right side of the heart, resulting in over-circulation in the pulmonary vasculature, the development of pulmonary hypertension, and a subsequent reversal of shunting due to the gradual development of increased pressures on the right side of the heart.
In TOF blood never shunts from left to right (unless there is some additional defect that complicates the situation). Eisenmenger is the gradual reversal of shunting.(1 vote)
- Is it okay to block VSD after R->L shunt in Eisenmenger syndrome? I think if there is no VSD, high pulmonary pressure might cause extremely high pressure on right ventricle. So RV will exploded or something.. Am I right?(1 vote)
- If you close the VSD then you are perpetuating the problem because the lungs will still be congested and blood will still be backing up into the right side of the heart. You would have to close the VSD before this phenomenon occurs. The only option after the blood starts shunting R->L is to do a lung transplant and either a heart transplant or repair.(1 vote)
- Is their any Diagnosis or cure for this syndrome? or even any syndromes for Vasculitis?(1 vote)
Video transcript
Voiceover: So we're looking at a very interesting building that has two rooms that are separated by this interesting hallway in between. We have some people that are entering into room number one. And these people are entering into room number one, they're trying to get to room number two. So what they're going to
do is go via this hallway. And then they have a number of options. They can take this smaller hallway, here, or they can take this one here. And they can take this one here. So they have a number of options. The beautiful thing about this hallway is that there are tables there with food and snacks and hors
d'oeuvres and all kinds of interesting things that they can eat. And then they can continue on. So these people in this reddish color, they're going to be the satisfied people. They've filled their stomachs and they are good to go, they're
going to continue on into room number two and then they can continue on about their business to do the things that they're supposed to do. Now, what will happen
is, in this situation, if there's a lot of pressure in that room, that will cause people, if
there's an opening here, it can cause some of the people to start going back through this
little channel here to get back into room number one. And then they're going to start moving into, once again, this hallway. Then you can see, it's going to start to get a little congested in here. It's going to get a little tight and that just make things a little awkward, right? So you have these people
that are coming through once again going through
this cycle so that they can, then, get
back to room number two where they were before. And when they start
getting congested in here, they're going to start getting congested farther back and then
even in room number one. Well, that's exactly
what we see in certain individuals that have
non-cyanotic heart disease. With non-cyanotic heart
disease, we're talking about a congenital disorder ... And congenital just means that individual was born with it. What that's going to result
in is, like in this case, we have a hole in the wall between the right ventricle and the left. And the result is going to be that blood, and these are our people,
the blood is going to flow from room two to room one. From the left to the right ventricle. But what is supposed to happen, just like what we saw before,
was people are entering via room one, they're doing what they're supposed to do and then those people are going to leave. And here we see them leaving via these structures that we call
the pulmonary arteries. And they're going to go to our lungs and then they're going through these little hallways and those little hallways are our pulmonary capillaries. And these are exciting too. This is exciting too
because along the way, they're going to pick up some food. But the food in this case is oxygen. So now they're picking
up oxygen and you can see these guys are satisfied and they can continue on and go via room
two, like we saw before with the previous
example, and via room two they can then leave and
go throughout the body to deliver that oxygen
to all of the tissues that need it. But in this case, we
have this little defect that causes blood to
flow from the left side to the right side because
you have significantly higher pressure on this left side then you have on the right. And then that, like we
saw with the previous example, is going to cause these guys to continue on here and that can result in a type of congestion. And that type of congestion we are going to call pulmonary ... Pulmonary congestion. And that pulmonary congestion is just like we saw before, but it's going to be in your capillaries, your
pulmonary capillaries. And that increase in pressure can actually cause damage to these
pulmonary capillaries and if you cause damage to the pulmonary capillaries, that's
going to cause even more pressure because it's
harder to get it through, to get the blood through
these damaged capillaries. That's going to feed
back, you're going to have increased pressure here
because there's so many blood cells trying to
get through, and that can feed back to room
one which, in this case, is your right ventricle. All right? So we have, basically what's happening is, we have an increase in pulmonary ... Pulmonary pressure, and that's basically the pressure in the
lungs, in the capillaries that are throughout the
lungs, the blood vessels in the lungs. And that is going to cause ... So let's draw an arrow pointing here. That increase in pulmonary pressure is going to cause an
increase in the pressure in the right heart. So the pressure in the right heart is going to increase and that can increase significantly. Now, we said that we had that situation here where we're having blood flowing from left to right. But what happens if you continue to get more congestion and more
increase in pressure here and that pressure feeds
back to the right ventricle? Well what's going to
happen is, if the pressure over here gets greater
than on the left side, what can can happen is you end up with a reversal where the blood is now flowing from right to left. And that is what we're going to call Eisenmenger syndrome. Eisenmenger syndrome. So that is something that happens as a result in the buildup of pressure that results in the blood
moving or shunting ... Like you're squeezing that blood through that opening and it's
going from right to left. Now what are we going to
see as a result of that? Well, there's a few things. The blood that we have on the right side, what kind of blood is it? Well, it's going to be
de-oxygenated blood. So now we're going to
have de-oxygenated blood bypassing the lungs and that getting into the bloodstream that's
going throughout the body. And that's never a good thing because the tissues, the organs,
everything needs oxygen. So we're going to have a decrease in oxygen throughout the body. And as a result of that, we're going to get a decrease in function. All of the cells throughout
the body need oxygen and if the oxygen levels start decreasing, that is going to cause them to not function as well as they should. One of the ways that we do see this is with a sign that we call cyanosis. Cyanosis. And what happens here
is, basically, you know you have this de-oxygenated
blood, in this case, that's going throughout the body and that de-oxygenated blood is going to be darker. And when it goes through the skin ... When you're looking at
your skin, let's say this is someone's hand
and you look at the skin, it's going to give it
kind of a bluish color. So it's going to look a little bluish because of how the light
is being reflected. So it's going to give
the skin a bluish color. This is a very bad illustration of skin but you get the point. All right, so cyanosis
is something that we see. Let's continue on with this blood vessel. So we're going to look
at just one blood vessel that is going to be traveling
throughout the body. And we're going to have
our red blood cells that are traveling throughout and these red blood cells are the ones that are responsible for carrying the oxygen through the body. And let's say, what we're looking at here is a normal concentration
of red blood cells. If you're not getting enough oxygen, the body is going to say, "Hey we need "to get more oxygen. So
what we're going to do "is we're going to produce significantly "more red blood cells." And that is called polycythemia. Polycythemia. And you can imagine how
that can cause problems. Because if you have significantly more red blood cells, then the blood is going to be thicker. And as that thicker blood is going through the lungs, it can cause even more congestion and even more of an increase in pressure. And one of the last signs that we see in individuals with Eisenmenger syndrome is what we call clubbing of the fingers. So I'm going to draw a hand over here. Actually, let me use a different tool so it can look smoother. This is my hand and I'm not good at drawing hands, so you're going to have to forgive me here. So that's one finger, two
fingers, three fingers, four fingers ... Don't judge the way my hands look. Okay, so this is my hand. And what we end up seeing
in those individuals ... And the mechanism of this
is not fully understood. It does have to do with the fact that we have less oxygen, but what we end up seeing is what's called
clubbing of the fingers. So you can see these fingers are getting significantly thicker. You see that especially towards the ends of the fingers. And that is called clubbing. So with Eisenmenger syndrome, we have decrease in oxygen levels
because of the fact that we have a right to
left shunting of blood so that de-oxygenated blood is going throughout the body. That is resulting in decreased function. It's also resulting in
cyanosis, polycythemia, and clubbing of the fingers.