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BRS - Year 2 > **_🫀🫁Cardio & Resp🫀🫁 - Structural Heart Disease > Flashcards

**_🫀🫁Cardio & Resp🫀🫁 - Structural Heart Disease Flashcards

1
Q

Name this structure

A

Superior vena cava

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2
Q

Name this structure

A

Right pulmonary artery

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3
Q

Name this structure

A

Pulmonary trunk

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4
Q

Name this structure

A

Right atrium

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5
Q

Name this structure

A

Right pulmonary veins

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6
Q

Name this structure

A

Fossa Ovalis

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7
Q

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A

Pectinate muscles

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8
Q

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A

Tricuspid valve

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9
Q

Name this structure

A

Right ventricle

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10
Q

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A

Chordae tendinae

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11
Q

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A

Trabeculae Carneae

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12
Q

Name this structure

A

Inferior vena cava

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13
Q

Name this structure

A

Left pulmonary artery

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14
Q

Name this structure

A

Aorta

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15
Q

Name this structure

A

Left atrium

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16
Q

Name this structure

A

Left pulmonary veins

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17
Q

Name this structure

A

Mitral (bicuspid) valve

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18
Q

Name this structure

A

Aortic valve

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19
Q

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A

Pulmonary semilunar valves

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20
Q

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A

Left ventricle

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21
Q

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A

Papillary muscles

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22
Q

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A

Intraventricular septum

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23
Q

Name this structure

A

Epicardium

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24
Q

Name this structure

A

Myocardium

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25
Q

Name this structure

A

Endocardium

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26
Q

What vessels drain deoxygenated blood into the right atrium?

A

Superior and inferior vena cava

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27
Q

Where does blood go after the right atrium?

A

Through the tricuspid valve into the right ventricle

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28
Q

Where does blood go after the right ventricle?

A

Through the pulmonary semi-lunar valves, into the lungs via the pulmonary arteries

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29
Q

Where does oxygenated blood go after it leaves the lungs?

A

Drained into the left atrium via the pulmonary veins

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30
Q

Where does blood go after the left atrium?

A

Through the mitral valve and into the left ventricle

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31
Q

Where does blood go after the left ventricle?

A

Through the aortic semilunar valves and into the body via the aorta and its branches

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32
Q

What are the layers of the heart wall, from inner to outer?

A

Endocardium
Myocardium
Epicardium

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33
Q

What is the function of the pectinate muscles?

A

Muscular ridges found in the atria
Help to increase the surface area in the right atrium, thereby increasing force of contraction without thickening the wall

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34
Q

What is the function of the chordae tendineae?

A

Cord-like tendons that connect the papillary muscles to to tricuspid and mitral valves
Prevent valves from prolapsing during ventricular systole

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35
Q

What is the function of the trabecular carneae?

A

Irregular muscular columns in the ventricles
Provide additional support to ventricular valves - maintains stroke volume and cardiac output

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36
Q

What is the function of the papillary muscles?

A

Small, cone shaped muscles located in the ventricles
Attach to cusps of atrioventricular valves - prevent prolapse or inversion
Attach via chordae tendineae

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37
Q

What is the intraventricular septum?

A

A muscular wall that separates the ventricles of the heart

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38
Q

What are the 2 phases of the cardiac cycle?

A

Systole and diastole

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39
Q

Which of systole and diastole is longer?

A

Diastole

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40
Q

How do you calculate cardiac output?

A

Stroke volume x heart rate

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41
Q

How do you calculate stroke volume?

A

End diastolic volume - end systolic volume

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42
Q

How do you calculate mean arterial pressure?

A

DBP + 1/3 PP

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43
Q

What are the stages of diastole?

A

Isovolumetric relaxation
Rapid filling
Reduced filling
Atrial systole

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44
Q

What are the stages of systole?

A

Isovolumetric contraction
Rapid ejection
Reduced ejection

45
Q

How many heart sounds are there?

A

2 normally
Up to 4, with pathology

46
Q

What causes S1?

A

Closure of the mitral and tricuspid valves
Occurs with isovolumetric contraction

47
Q

What causes S2?

A

Closure of the aortic and pulmonary valves
Occurs during isovolumetric relaxation

48
Q

What is S3?

A

Low-frequency sounds occurring in early diastole (rapid filling)
Caused by rapid filling and expansions of the ventricles (dilated ventricles, reduced ejection fraction heart failure)
Also can be caused by mitral valve incompetence
NOT ALWAYS PATHOLOGICAL

49
Q

What is S4?

A

Low frequency sounds occurring in late diastole (atrial systole)
Forceful atrial contractions into stiff ventricles
ALWAYS PATHOLOGICAL

50
Q

What is a heart murmur?

A

Sounds caused by turbulent blood flow through heart valves

51
Q

What are the 3 types of murmurs?

A

Systolic
Diastolic
Continuous

52
Q

What do normal heart sounds look like?

A

Heart sounds at the beginning of systole and diastole

53
Q

What sounds would aortic stenosis produce?

A

Significant murmur for the duration of systole

54
Q

What sounds would mitral regurgitation make?

A

Gentle murmur throughout systole

55
Q

What sounds would aortic regurgitation make?

A

Gentle (but louder than mitral regurgitation) murmur throughout diastole

56
Q

What sounds would mitral stenosis make?

A

Gentle murmur in the second half of diastole

57
Q

What sounds would patent ductus arteriosus make?

A

Continuous murmur

58
Q

What are some examples of congenital structural heart diseases (SHDs)?

A

Atrial septal defect (ASD), Ventricular septal defect (VSD)
Coarctation of aorta
Patent foramen ovale (PFO)
Patent ductus arteriosus (PDA)
Tetralogy of Fallot (TOF)

59
Q

What are some typical SHDs that can develop later in life/

A

Valvular dysfunctions:
Atrial stenosis
Regurgitation
Also can be muscular (cardiomyopathies)

60
Q

What are the structural defects that can be seen in heart valves

A

Aortic stenosis
Aortic regurgitation
Mitral stenosis
Mitral regurgitation

61
Q

Outline the epidemiology and common underlying cause of aortic stenosis

A

Most common valvular disease in the US and Europe requiring treatment
Second most frequent cause for cardiac surgery
Largely a disease of older people (>70)
Caused by aortic valve thickening
Preceded by aortic sclerosis (defined as aortic valve thickening without flow limitation)

62
Q

What are the causes of aortic stenosis?

A

Rheumatic heart disease
Congenital heart diseases
Calcium build up

63
Q

What are the risk factors for aortic stenosis?

A

Hypertensions
LDL levels, smoking
Elevated CRP
Congenital bicuspid valves
CKD, radiotherapy, older age

64
Q

What is the first step of the pathophysiology of aortic stenosis?

A
65
Q

What occurs after fibrosis/calcification of the aortic valve, in the pathophysiology of aortic stenosis?

A

Left ventricle has to contract harder to pump blood through the stenotic valve
Leads to concentric LV myocardial hypertrophy

66
Q

What is the result of concentric LV myocardial hypertrophy?

A

Hypertrophic LV becomes stiff overtime and harder to fill leading to decrease cardiac output - diastolic dysfunction
(Can lead to HFpEF)

67
Q

How can the increased pressure in the LV effect the left atrium and the lungs?

A

Pressure in LV backs up to the left atrium
Causes dilation
Left atria loses efficiency to pump blood into left ventricle, leading to backing up of blood and pressure into the lungs
Causes pulmonary congestion

68
Q

What are the signs and symptoms of aortic stenosis?

A

Ejection Systolic murmur (crescendo-decrescendo)
Syncope on exertion
Angina (chest pain, specifically heart) on exertion
Diffuse crackles on auscultation of lungs + dyspnoea

69
Q

How is aortic stenosis diagnosed?

A

Doppler echo

70
Q

What are the management options for aortic stenosis?

A

Aortic valve replacement:
Transcatheter valve replacement
Surgical valve prosthesis

71
Q

What is aortic regurgitation?

A

Diastolic leakage of blood from the aorta into the left ventricle

72
Q

How does aortic regurgitation occur?

A

Incompetence of valve leaflets resulting from either intrinsic valve disease or dilation of the aortic root

73
Q

What are the 2 types of aortic regurgitation clinically?

A

Acute
Chronic

74
Q

What is acute aortic regurgitation?

A

Medical emergency
Presents with sudden onset pulmonary oedema and hypotension/cardiogenic shock

75
Q

What are the consequences of chronic aortic regurgitation?

A

Culminate into congestive cardiac failure

76
Q

What are the 2 categories of causes of aortic regurgitation?

A

Congenital and acquired valve defects
Causes of aortic root dilation

77
Q

What are the causes of aortic valve defects?

A

Rheumatic heart disease
Infective endocarditis
Aortic valve stenosis
Congenital heart defects
Congenital bicuspid valves

78
Q

What are the causes of Aortic root dilation?

A

Marfan’s syndrome
Connective tissue disease
Idiopathic
Ankylosing spondylitis
Traumatic

79
Q

What is the first step in the pathophysiology of aortic regurgitation?

A
80
Q

What is the result of aortic regurgitation?

A
81
Q

What are the symptoms and signs of aortic regurgitation?

A

Diastolic murmur
S3 gallop sound
Angina on exertion
Fatigue
Increased pressure in lungs - leads to pulmonary congestion

82
Q

How will a case of acute aortic regurgitation present?

A

Cardiogenic shock
Tachycardia
Cyanosis
Pulmonary oedema
Diastolic murmur

83
Q

How will chronic aortic regurgitation present?

A

Wide pulse pressure
Corrigan pulse

84
Q

What is the go-to test to diagnose and grade the severity of aortic regurgitation?

A

Echocardiography

85
Q

What are the management options for acute aortic regurgitation?

A

Medical emergency
Aortic valve replacement

86
Q

What are the management options for chronic aortic regurgitation?

A

Vasodilator therapy improves haemodynamics and delays the need for aortic valve replacement/repair

87
Q

What is the aetiology of mitral stenosis?

A

Rheumatic fever main cause (in developing countries)
Obstruction to left ventricular inflow due to structural abnormality of mitral valve
Progression of disease leads to pulmonary hypertension and right heart failure

88
Q

What is the first step in the pathophysiology of mitral stenosis?

A
89
Q

How does impaired blood flow through the mitral valve lead to right sided heart failure?

A
90
Q

What are the symptoms and signs of mitral stenosis?

A

Opening snap, mid-diastolic murmur
Atrial fibrillation
Right sided heart failure, cardiogenic shock/congestive heart failure
Left atrial enlargement - compression of surrounding structures (rare)

91
Q

How can mitral stenosis present in a history/consultation?

A
92
Q

What are the diagnostic options for mitral stenosis?

A

ECG
Chest X ray
Transthoracic echocardiography

93
Q

What are the management options for progressive asymptomatic mitral stenosis?

A

No therapy required

94
Q

What are the management options for severe asymptomatic mitral stenosis?

A

No therapy generally required
Have the option of adjuvant balloon valvotomy

95
Q

What are the management options for severe symptomatic mitral stenosis?

A

Diuretics
Balloon valvotomy
Valve replacement/repair
Adjunct beta-blockers

96
Q

What is the aetiology of mitral regurgitation?

A

Most frequent valvular heart disease
Caused by disruption of any part of mitral valve apparatus
Abnormal reversal of blood flow from the left ventricle to the left atrium

97
Q

What are the causes of acute mitral regurgitation?

A

Mitral valve prolapse
Rheumatic heart disease
Infective endocarditis
Following valvular surgery
Prosthetic mitral valve dysfunction

98
Q

What are the causes of chronic mitral regurgitation?

A

Rheumatic heart disease
SLE
Scleroderma
Hypertrophic cardiomyopathy
Drug related

99
Q

What is the first step of the pathophysiology of mitral regurgitation?

A
100
Q

What are the consequences of mitral regurgitation?

A
101
Q

What are the signs and symptoms of mitral regurgitation?

A

Holosystolic murmur radiating to axilla
S3 heart sound
Decrease in oxygen saturation, tachypnoea, wheeze, crackles and frothy sputum

102
Q

What are the diagnosis options for mitral regurgitation?

A

Transthoracic echocardiography
ECG
Chest X ray
Cardiac MRI/CT Scan

103
Q

What are the management options for acute severe mitral regurgitation?

A

Repairing/replacing supporting valve structures
Prosthetic ring can be inserted to reshape valve

104
Q

What are the management options for chronic severe asymptomatic mitral regurgitation?

A

Watchful waiting
Can opt for surgery

105
Q

What are the management options for chronic severe symptomatic mitral regurgitation?

A

Surgery plus medical treatment

106
Q

What are the 3 main types of cardiomyopathies?

A

Dilated
Hypertrophic
Restrictive

107
Q

Outline dilated cardiomyopathy

A
108
Q

Outline hypertrophic cardiomyopathy

A
109
Q

Outline restrictive cardiomyopathy

A

BRS - Year 2 (46 decks)

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