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ICM 1 > Cardiac Diseases > Flashcards

Cardiac Diseases Flashcards

1
Q

what is heart failure?

what causes it?

what factors may worsen it?

A
  • 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
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2
Q

what symptoms will patients with cardiac heart failure present with?

A
  • fatigue, dyspnea -inadequate perfusion of peripheral tissues
  • elevated intracardiac filling pressures (orthopnea, paroxysmal nocturnal dyspnea, peripheral edema).
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3
Q

what are the clnical signs of cardiac heart failure?

A
  • Tachycardia
  • Jugular venous distention
  • S3
  • pulmonary congestion (rales, dullness over pleural effusion)
  • peripheral edema
  • hepatomegaly and ascites
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4
Q

how is cardiac heart failure diagnosed?

A

using echocardiography with doppler

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5
Q

what are the categories of heart failure and what do we see in each?

A
  • 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
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6
Q

what should patients with cardiac heart failure avoid?

what is the pharmacological treatment of cardiac heart failure patients?

A

salt

  1. ACE inhibitors: for pts with LV systolic heart failure or asymptomatic LV dysfunction
  2. Diuretics: Use in volume-overloaded pts to achieve normal JVP and relief of edema
  3. 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
  4. Digitalis: For persistently symptomatic pts with systolic heart failure (especially if atrial fibrillation present) added to ACE inhibitor, diuretics, beta blocker
  5. Aldosterone antagonists: Consider for class III–IV heart failure and LVEF <35%
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7
Q

for class 2 and 3 cardiac heart failure, you use?

A

cardiac re-synchronization therapy = a pacemaker

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8
Q

what is aortic stenosis?

what are the causes for aortic stenosis?

aortic stenosis leads to what?

A

aortic valve stiffens

  • Congenital unicuspid or bicuspid valve
  • Rheumatic fever
  • Degenerative calcific changes with aging

progressive left ventricular systolic pressure = eventual concentric hypertrophy

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9
Q

A sustained pressure overload due to aortic stenosis eventually leads to what?

A

myocardial decompensation. which will decrease the contractility of the myocardium, which leads to a decrease in cardiac output.

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10
Q

what is the clinical presentation of aortic stenosis?

what is the most common cause of death in aortic stenosis?

A
  1. Angina (chest pain) – 30–40%
  2. Dyspnea – Left Heart failure
  3. Syncope.

ventricular fibrillation

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11
Q

on physical examination of a patient with aortic stenosis, what will be found?

A
  • 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
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12
Q

what is the most significant clinical finding indicating aortic stenosis?

A

A high amplitude left ventricular apex with a weak carotid pulse strongly suggest AS

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13
Q

what do these indicate?

A

mild aortic stenosis

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14
Q

what is this?

A

aortic stenosis

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15
Q

what is this?

A

left ventricular hypertrophy

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16
Q

what can cause mitral stenosis?

A
  • Rheumatic fever (very common)
  • Congenital
  • SLE
  • infective endocarditis
17
Q

narrowing of mitral opening will cause?

Prolonged period of raised Left Atrial Pressure also leads to Left Atrial dilatation (LAD) causing what?

A

increased Left Atrial Pressure leading to pulmonary congestion, pulmonary Hypertension and finally to right sided heart failure

Atrial Fibrillation and Mural thrombi

18
Q

what is the clinical presentation of mitral stenosis?

A
  • 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
19
Q

what is seen here?

A

enlargement of the left atrium and right ventricle

20
Q

what does the ekg show?

A

atrial fibrillation

21
Q

what is the most common cause of mitral regurgitation? and what causes it?

A

mitral valve prolapse which is caused by myxomatous degeneration (degeneration of the valve itself) which is associated with Increased risk of cerebral embolic event

22
Q

what other cause can lead to mitral regurgitation?

A

rheumatic heart disease (common in many other countries) and Coronary artery disease- Ischemia of papillary muscles.

23
Q

how does mitral valve regurgitation progress?

chronic compensated phase of mitral valve regurgitation results in?

A
  • 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

24
Q

clinical presentation of mitral valve regurgitation

A
  • 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
25
Q

what is seen here? indicative of?

A

Left atria and left ventricular enlargement seen in chronic MR

26
Q

what happens in AORTIC REGURGITATION?

what are the 2 least common causes for aortic regurgitation?

what are the 2 most common causes for aortic regurgitation?

Acute aortic regurgitation is due to what?

A
  • During diastole, flow of blood from the aorta into the left ventricle (LV).
  • rheumatic fever and syphillis
  • Marfan disease and degeneration of bicuspid aortic valves
  • Infective endocarditis and Chest trauma
27
Q

Chronic AR produces what changes in the heart?

A

left ventricular volume overload that leads to LV enlargement and eccentric hypertrophy.

28
Q

what is the clinical presentation of aortic regurgitation?

A

The principal symptoms: dyspnea, PND, orthopnea,

  • Apex beat: hyperdynamic, and displaced inferiorly and leftward
  • S3 gallop due to development of LV dysfunction.
  • Early diastolic murmur: adjacent to the sternum in the second to fourth left Intercostal space
  • Austin Flint murmur: low-pitched, mid-diastolic rumbling murmur due to blood jets from the AR striking the anterior leaflet of the mitral valve, which results in premature closure of the mitral leaflets.
  • Wide pulse pressure (more than 100mmHg)(diastolic is usualy >60mmHg)
    • de Mussets sign = pts head bob’s with each heartbeat
  • corrigan pulse = Patients’ pulses are of the water-hammer or collapsing type, with abrupt distention and quick collapse.
  • Quincke sign: light transmitted through the patient’s fingertip shows capillary pulsations.
  • The Müller sign is systolic pulsations of the uvula.
  • The Traube sign (also called pistol-shot sounds) refers to booming systolic and diastolic sounds heard over the femoral artery.
29
Q

What is a PDA?

what individuals are more propense to developing this?

What will you see in these patients?

A
  • Failure of normal closure of ductus arteriosus by 10 days of age as pulmonary resistance falls; nn abnormal communication between the descending aorta and pulmonary artery
  • Associated with birth at high altitude and maternal rubella
  • Poor growth

Cyanosis of lower extremities

Features of CHF

Continuous machine like murmur (systolic and diastolic component)

30
Q

what is the most common atrial septal defect?

Ostium primum ASD is more common in what individuals?

when do you see symptoms?

what symptoms can they present with?

A
  • Ostium secondum ASD is the most common one
  • Typical of downs syndrome
  • 30’s or 40’s
  • dyspnea, fatigue, palpitation
31
Q

in patients with ASD, what will you find in physical examination?

A
  • prominent right ventricular impulse
  • Prominent V wave in Jvpulse
  • Wide fixed splitting of S-2
  • Systolic murmer
  • EKG: Left axis deviation, AV block features
  • Chest X ray: Prominent Right atrium, Right ventricle and pulmonary artery.
32
Q

what VSD: ventricular septal defect will close spontaneously?

VSD that do not close in infants, what will they develop?

on physical examination, what will be the finding?

A
  • congenital
  • cardiac heart failure
  • Physical examination:
    • Systolic thrill
    • holosystolic murmer at left lower sternal border, loud P2
33
Q

what are the findings of tetralogy of fallot?

what will be the ecg findings in this patients?

what will be the chest x-ray findings in this patients?

A
  1. Malaligned VSD
  2. Obstruction to RV outflow (wil hear pansystolic murmur)
  3. Aorta that overrides the VSD
  4. RV hypertrophy
  • right ventricular hyertrophy
  • Boot shaped heart with prominent RV
34
Q

what is seen here?

A

boot shaped heart

35
Q

what is wrong here?

what is it indicative of?

A

tall R waves in V1, V2, V3

indicative of right ventricular hypertrophy

ICM 1 (5 decks)

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