Cardiac Diseases Flashcards
what is heart failure?
what causes it?
what factors may worsen it?
- result from systolic “pump” dysfunction, increased LV diastolic “stiffness,” and/or acute mechanical complications.
- coronary artery disease, hypertension, dilated cardiomyopathy, valvular disease, congenital heart disease
- Na+ intake, noncompliance with heart failure /BP medications, acute MI, infections, anemia, thyrotoxicosis, pregnancy
what symptoms will patients with cardiac heart failure present with?
- fatigue, dyspnea -inadequate perfusion of peripheral tissues
- elevated intracardiac filling pressures (orthopnea, paroxysmal nocturnal dyspnea, peripheral edema).
what are the clnical signs of cardiac heart failure?
- Tachycardia
- Jugular venous distention
- S3
- pulmonary congestion (rales, dullness over pleural effusion)
- peripheral edema
- hepatomegaly and ascites
how is cardiac heart failure diagnosed?
using echocardiography with doppler
what are the categories of heart failure and what do we see in each?
- I = No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea.
- II = some discomfort at exercise. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea.
- III = marked discomfort exercising. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.
- IV = cant exercise and symptoms present at rest
what should patients with cardiac heart failure avoid?
what is the pharmacological treatment of cardiac heart failure patients?
salt
- ACE inhibitors: for pts with LV systolic heart failure or asymptomatic LV dysfunction
- Diuretics: Use in volume-overloaded pts to achieve normal JVP and relief of edema
- Beta blockers: For pts with symptomatic or asymptomatic heart failure and LVEF <40%, combined with ACE inhibitor and diuretics. Improve the heart’s ability to relax
- Digitalis: For persistently symptomatic pts with systolic heart failure (especially if atrial fibrillation present) added to ACE inhibitor, diuretics, beta blocker
- Aldosterone antagonists: Consider for class III–IV heart failure and LVEF <35%
for class 2 and 3 cardiac heart failure, you use?
cardiac re-synchronization therapy = a pacemaker
what is aortic stenosis?
what are the causes for aortic stenosis?
aortic stenosis leads to what?
aortic valve stiffens
- Congenital unicuspid or bicuspid valve
- Rheumatic fever
- Degenerative calcific changes with aging
progressive left ventricular systolic pressure = eventual concentric hypertrophy
A sustained pressure overload due to aortic stenosis eventually leads to what?
myocardial decompensation. which will decrease the contractility of the myocardium, which leads to a decrease in cardiac output.
what is the clinical presentation of aortic stenosis?
what is the most common cause of death in aortic stenosis?
- Angina (chest pain) – 30–40%
- Dyspnea – Left Heart failure
- Syncope.
ventricular fibrillation
on physical examination of a patient with aortic stenosis, what will be found?
- weak pulse
- Apex beat – Increased amplitude
- Systolic ejection murmur:
- 2nd right intercostal space ,radiating to neck, ejection click
- squatting position, leaning forward increases and Valsalva decreases the intensity of murmur
- S4
- Paradoxical or reverse splitting of S2 in severe AS
- Pulsus parvus et tardus: slow rising pulse
what is the most significant clinical finding indicating aortic stenosis?
A high amplitude left ventricular apex with a weak carotid pulse strongly suggest AS
what do these indicate?
mild aortic stenosis
what is this?
aortic stenosis
what is this?
left ventricular hypertrophy
what can cause mitral stenosis?
- Rheumatic fever (very common)
- Congenital
- SLE
- infective endocarditis
narrowing of mitral opening will cause?
Prolonged period of raised Left Atrial Pressure also leads to Left Atrial dilatation (LAD) causing what?
increased Left Atrial Pressure leading to pulmonary congestion, pulmonary Hypertension and finally to right sided heart failure
Atrial Fibrillation and Mural thrombi
what is the clinical presentation of mitral stenosis?
- Dyspnea, PND, Orthopnea, Recumbent cough,
- Raised JVP, Para sternal heave, Diastolic thrill -palpable over the apex
- Basal rales, loud S1 and the opening snap, Mid diastolic murmur
what is seen here?
enlargement of the left atrium and right ventricle
what does the ekg show?
atrial fibrillation
what is the most common cause of mitral regurgitation? and what causes it?
mitral valve prolapse which is caused by myxomatous degeneration (degeneration of the valve itself) which is associated with Increased risk of cerebral embolic event
what other cause can lead to mitral regurgitation?
rheumatic heart disease (common in many other countries) and Coronary artery disease- Ischemia of papillary muscles.
how does mitral valve regurgitation progress?
chronic compensated phase of mitral valve regurgitation results in?
- sudden volume overload on Left ventricle which increases left ventricular filling pressures
- blood backs up from the left ventricle to the left atrium causing ↑ left atrial pressures. which goes to the lungs
- pulmonary edema and dyspnea
eccentric left ventricular hypertrophy
clinical presentation of mitral valve regurgitation
- Palpitations and chest pain
- both Left Heart Failure, Right Heart Failure
- Dyspnea, Orthopnea, Paroxysmal Noct. Dysp.
- S3, Holosystolic murmur:
- in MVP: Mid Systolic click followed by Mid to late systolic murmur
