29 - Cardiovascular Disease 2 Flashcards
Left-sided heart failure
Kidneys - pre-renal azotemia, salt and fluid retention
Brain - irritability, decreased attention, stupor -> coma
Clinical presentation of left heart failure
Pulm congestion and oedema Heart failure cells Dyspnea Orthopnea PND Blood tinged sputum Cyanosis Elevatory pulmonary WEDGE pressure
Right sided heart failure - aetiology
Aetiology - left failure cor pulmonare
Right sided heart failure - symptoms and signs
Liver and spleen
Kidneys
Pleura/pericardium
Peripheral tissues
Opening problems of valves
Stenosis
Closing problems of valves
Regurgitation / incompetence / insufficiency
Aortic stenosis
Calcification of a deformed valve
Senile
Rheumatic
Mitral stenosis
Rheumatic heart disease
Rheumatic heart diseases is related to Strep A infection
Can cause pancarditis (whole heart) or…
either endo, myo or pericarditis
Pathology of acute valvular problems
Inflammation Aschoff bodies Anitaschkow cells Pancarditis Vegetations on chordae tendinae at leaflet jxn
Pathology of chronic valvular problems
Thickened valves
Commisural fusion
Thick, short, chordae tendinae
Mitral annular calcification
Calcification of the mitral skeleton
Usually no dysfunction
Regurgitation usually but stenosis possible
F»M
Causes of aortic regurgitations
Rheumatic
Infectious
Aortic dilations - syphilis, rheumatoid arthritis, marfan
Causes of mitral regurgitations
Mitral valve prolapse (MVP) Infectious Fen-Phen Papillary muscles, chordae tendinae Calcification of mitral ring
Mitral valve prolapse - what is it, incidence
Myxomatous (connective tissue) degeneration of the mitral valve
Associated with connective tissue disorders
Floppy valve
3% incidence F»M
Easily seen on echocardiagram
Mitral valve prolapse - clinical features
Usually asymptomatic Mid-systolic click Holosystolic murmur if regurg. present Occasional chest pain, dyspnea 97% are cool 3% have infective endocarditis, mitral insuffiency, arrythmias, sudden death
Congenital heart defects e.g.s
Faulty embryogenesis (week 3 - 8)
Usually mono-morphic i.e single lesion
May not be evident until later life
Overall incidence of 1% of births
L->R shunts
No cyanosis
Pulmonary hypertension
Significant pulmonary hypertension is irreversible
All conditions have ‘D’s’ in their name
R->L shunts
Cyanosis
Venous emboli become systemic = paradoxical
All conditions have ‘T’s’ in their name
Obstructions can occur where in congenital heart disease
Aorta
Pulm. art.
ASD - features
Not patent foramen ovale
Usually asymptomatic until adult
90% are secundum
VSD - features
Most common CHD defect
Only 30% are isolated
Often with tetralogy of fallot
90% involve the membranous system
But, if muscular system, = ‘swiss-cheese’ septum
Small ones close spontaneously
Large ones progress to pulm. hypertension
PDA - features
Patent ductus arteriosus
90% isolated
Associated with VSD, coarctation of aorta, pulm/aortic stenosis
Either shunt is possible as pulm hypertension approaches systemic pressure
Closing defect in early life may be life saving
Keeping it open with prostaglandin E may be life-saving
Murmur = continous harsh, machine-like
Why would prostaglandin E be life-saving in PDA?
Transposition of great vessels could have occurred in which case you need deoxy and oxy blood to mix or death would occur.
AVSD - features
Associated with defective, inadequate AV valves
Partial or complete (all 4 chambers freely communicate)
1/3 of complete AVSD have Down’s
R->L shunt causes
Tetralogy of fallot Transposition of great arteries Truncus arteriosus Total anomalous pulmonary venous connection Tricuspid atresia
Process of tetralogy of fallot
- VSD - large one
- Obstruction to RV outflow
- Aorta overrides the VSD
- RV hypertrophy
Survival depends on severity of subpulmonic stenosis
TGA - features
Stands for: transposition of great arteries
Needs a shunt for survival 65% have PDA - unstable shunt 35% have VSD - stable shunt RV is thicker than LV Fatal in first few months
Truncus arteriosus - what is it?
Development failure of separation of truncus arteriosus
Associated with VSD
Produces systemic cyanosis as well as increased pulmonary blood flow
Tricuspid atresia - what is it? + features
Hypoplastic RV
NEEDS a shunt either ASD, VSD or PDA
High mortality
TAPVC - stands for + what is it?
Total anomalous pulmonary venous connection
Pulm. veins do NOT go to LA but to L. innominate vein or coronary sinus
Needs PFO or VSD
Hypoplastic LA
Obstructive CHD e.g.s
Coarctation of aorta
Pulm stenosis/atresia
Aortic stenosis/atresia
Coarctation of aorta
M>F
Infantile form - proximal to PDA = serious
Adult form = closed ductus i.e no PDA
Bicuspid aortic valve 50% of the time
Pulm. stenosis of atresia
If 100% atretic = hypoplastic RV with ASD
Clinical severity is proportional to stenosis severity
Aortic stenosis/atresia
Valvular - severe = hypoplastic LV->fatal
Sub-valvular = aortic wall thick below cusps
Supra-valvular = aortic wall thick above cusps
