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
what is seen here? indicative of?
Left atria and left ventricular enlargement seen in chronic MR
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?
- 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
Chronic AR produces what changes in the heart?
left ventricular volume overload that leads to LV enlargement and eccentric hypertrophy.
what is the clinical presentation of aortic regurgitation?
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.
What is a PDA?
what individuals are more propense to developing this?
What will you see in these patients?
- 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)
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?
- Ostium secondum ASD is the most common one
- Typical of downs syndrome
- 30’s or 40’s
- dyspnea, fatigue, palpitation
in patients with ASD, what will you find in physical examination?
- 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.
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?
- congenital
- cardiac heart failure
- Physical examination:
- Systolic thrill
- holosystolic murmer at left lower sternal border, loud P2
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?
- Malaligned VSD
- Obstruction to RV outflow (wil hear pansystolic murmur)
- Aorta that overrides the VSD
- RV hypertrophy
- right ventricular hyertrophy
- Boot shaped heart with prominent RV
what is seen here?
boot shaped heart
what is wrong here?
what is it indicative of?
tall R waves in V1, V2, V3
indicative of right ventricular hypertrophy
