29 Cardiovascular disease 2 Flashcards
Explain the pathogenesis of left sided heart failure:
Hypertension, valvular disease and MI increase cardiac work.
Hypertrophy then dilation lead to cardiac dysfunction.
What are the effects of left sided heart failure on other organs?
Kidneys: pre-renal azotemia, salt and fluid retention (low flow confused for low volume).
Brain: irritability -> coma.
Lungs: congestion, oedema, dys/orthopnea, PND, cyanosis.
Aetiology of right sided heart failure: (2)
Left heart failure.
Cor pulmonale.
Effects of right sided heart failure on other organs: (4)
Liver congestion.
Congestive splenomegaly.
Ascites.
Pleural + pericardial effusions.
What are the autopsy findings of congestive heart failure? (4)
Cardiomegaly.
Chamber dilation.
Hypertrophy of fibres.
BOXCAR nuclei.
What is aortic and mitral stenosis commonly caused by?
Rheumatic heart disease.
What is rheumatic heart disease?
Weeks after a group A strep infection, antibodies turn against heart glycoproteins.
What are the acute effects of rheumatic heart disease on the heart? (5)
Chronic? (3)
Inflamm, aschoff bodies, anitschkow cells, pancarditis, vegetations on chordae tendinae.
Thickened valves, commissural fusion and shortened chord tendinae.
What does arotic stenosis result in?
2x gradient pressure.
LVH, ischaemia, angina, CHF.
Describe mitral annular calcification:
Effect:
Who:
Calcification in mitral valve.
Usually no dysfunction.
Regurgitation if so.
F»M.
What are the causes of atrial regurgitations? (5)
Rheumatic, infectious.
Aortic dilatations: syphilis, RA, marfan’s.
What are the causes of mitral regurgitation? (4)
Mitral valve prolapse.
Infectious.
Fen-Pen (old anti obesity drug).
Calcification of mitral ring.
What is a mitral valve prolapse?
Epidemiology?
Clinical features?
Myxomatous degeneration associated with connective tissue disorders.
F»M.
Asymptomatic. Mid-systolic click. Occasional chest pain/dyspnea.
3%-infective endocarditis, sudden death.
How do you easily distinguish between L-R shunts and R-L shunts?
Which causes cyanosis, paradoxical emboli, pulmonary hypertension.
L-R: word starts with D. Pulmonary hypertension.
R-L: name starts with T. Cyanosis and paradoxical emboli.
What does the gene TBX5 lead to?
ASD, VSD.
Which defects in the valve walls lead to physiological R to L shunt during foetal period? (2)
Foramen ovale in the septum secundum.
Ostium secundum in the septum premum.
What does the aorticopulmonary septum do?
Divides bulbus cordis and trunks into 2 main arterial trunks: aorta and pulmonary artery.
What are the causes of an atrial septal defect?
90%: Secundum: defective fossa ovalis.
Premum: Mitral cleft next to AV valves.
Sinus venosus.
Describe the pathology of a ventricular septal defect.
Most common defect.
Associated with Tetralogy of Fallot.
Membranous septum. If muscular - multiple holes are present.
Large develops pulmonary hypertension.
Describe the shunt in a patent ductus arteriosus:
Treatment:
L to R. R to L as pulmonary hypertension approaches systemic pressure.
If isolated - close.
If vessel are transposed - keep open using prostaglandin E1.
What is atrial-ventricular septal defect associated with?
1/3rd have Down’s syndrome.
What are the defects seen in tetralogy of fallot? (4)
VSD.
Obstruction to right ventricular outflow.
Overriding aorta.
Right ventricular hypertrophy.
What is transposition of the great arteries?
What is needed for survival?
Abnormal formation of septa.
RV thicker than LV.
Fatal unless shunt present: PDA/PFO is unstable, VSD is stable.
What is truncus arteriosus and what does it produce?
Failure of separation of trunks arteriosus.
Associated with ventricular septal defect.
Systemic cyanosis and increased pulmonary flow.
What is tricuspid atresia?
Blocked tricuspid valve with hypoplastic right ventricle.
Needs a shunt.
Describe a Total anomalous pulmonary venous connection:
What does it need to survive?
Pulmonary veins don’t go into LA, but connect to vena cava. Hypoplastic left atrium.
Needs PFO or VSD.
What are the causes of obstructive coronary heart disease?
3
Coarctation of the aorta.
Pulmonary stenosis/atresia.
Aortic stenosis/atresia.
Epidemiology of coarctation of the aorta:
M>F. 50% have bicuspid aortic valve.
What happens in 100% atresia of pulmonary valve?
Hypoplastic right ventricle and atrial septal defect.
What happens in 100% atresia of aortic valve?
Hypoplastic left ventricle.
Fatal.
What does the gene NKX2.5 lead to?
ASD.
What effect does 22q11.2 deletion have on the heart?
Conotruncus.
