🫀🫁Cardio & Resp🫀🫁 - Structural Heart Disease Flashcards
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Superior vena cava
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Right pulmonary artery
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Pulmonary trunk
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Right atrium
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Right pulmonary veins
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Fossa Ovalis
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Pectinate muscles
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Tricuspid valve
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Right ventricle
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Chordae tendinae
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Trabeculae Carneae
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Inferior vena cava
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Left pulmonary artery
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Aorta
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Left atrium
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Left pulmonary veins
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Mitral (bicuspid) valve
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Aortic valve
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Pulmonary semilunar valves
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Left ventricle
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Papillary muscles
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Intraventricular septum
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Epicardium
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Myocardium
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Endocardium
What vessels drain deoxygenated blood into the right atrium?
Superior and inferior vena cava
Where does blood go after the right atrium?
Through the tricuspid valve into the right ventricle
Where does blood go after the right ventricle?
Through the pulmonary semi-lunar valves, into the lungs via the pulmonary arteries
Where does oxygenated blood go after it leaves the lungs?
Drained into the left atrium via the pulmonary veins
Where does blood go after the left atrium?
Through the mitral valve and into the left ventricle
Where does blood go after the left ventricle?
Through the aortic semilunar valves and into the body via the aorta and its branches
What are the layers of the heart wall, from inner to outer?
Endocardium
Myocardium
Epicardium
What is the function of the pectinate muscles?
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
What is the function of the chordae tendineae?
Cord-like tendons that connect the papillary muscles to to tricuspid and mitral valves
Prevent valves from prolapsing during ventricular systole
What is the function of the trabecular carneae?
Irregular muscular columns in the ventricles
Provide additional support to ventricular valves - maintains stroke volume and cardiac output
What is the function of the papillary muscles?
Small, cone shaped muscles located in the ventricles
Attach to cusps of atrioventricular valves - prevent prolapse or inversion
Attach via chordae tendineae
What is the intraventricular septum?
A muscular wall that separates the ventricles of the heart
What are the 2 phases of the cardiac cycle?
Systole and diastole
Which of systole and diastole is longer?
Diastole
How do you calculate cardiac output?
Stroke volume x heart rate
How do you calculate stroke volume?
End diastolic volume - end systolic volume
How do you calculate mean arterial pressure?
DBP + 1/3 PP
What are the stages of diastole?
Isovolumetric relaxation
Rapid filling
Reduced filling
Atrial systole
What are the stages of systole?
Isovolumetric contraction
Rapid ejection
Reduced ejection
How many heart sounds are there?
2 normally
Up to 4, with pathology
What causes S1?
Closure of the mitral and tricuspid valves
Occurs with isovolumetric contraction
What causes S2?
Closure of the aortic and pulmonary valves
Occurs during isovolumetric relaxation
What is S3?
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
What is S4?
Low frequency sounds occurring in late diastole (atrial systole)
Forceful atrial contractions into stiff ventricles
ALWAYS PATHOLOGICAL
What is a heart murmur?
Sounds caused by turbulent blood flow through heart valves
What are the 3 types of murmurs?
Systolic
Diastolic
Continuous
What do normal heart sounds look like?
Heart sounds at the beginning of systole and diastole
What sounds would aortic stenosis produce?
Significant murmur for the duration of systole
What sounds would mitral regurgitation make?
Gentle murmur throughout systole
What sounds would aortic regurgitation make?
Gentle (but louder than mitral regurgitation) murmur throughout diastole
What sounds would mitral stenosis make?
Gentle murmur in the second half of diastole
What sounds would patent ductus arteriosus make?
Continuous murmur
What are some examples of congenital structural heart diseases (SHDs)?
Atrial septal defect (ASD), Ventricular septal defect (VSD)
Coarctation of aorta
Patent foramen ovale (PFO)
Patent ductus arteriosus (PDA)
Tetralogy of Fallot (TOF)
What are some typical SHDs that can develop later in life/
Valvular dysfunctions:
Atrial stenosis
Regurgitation
Also can be muscular (cardiomyopathies)
What are the structural defects that can be seen in heart valves
Aortic stenosis
Aortic regurgitation
Mitral stenosis
Mitral regurgitation
Outline the epidemiology and common underlying cause of aortic stenosis
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)
What are the causes of aortic stenosis?
Rheumatic heart disease
Congenital heart diseases
Calcium build up
What are the risk factors for aortic stenosis?
Hypertensions
LDL levels, smoking
Elevated CRP
Congenital bicuspid valves
CKD, radiotherapy, older age
What is the first step of the pathophysiology of aortic stenosis?
What occurs after fibrosis/calcification of the aortic valve, in the pathophysiology of aortic stenosis?
Left ventricle has to contract harder to pump blood through the stenotic valve
Leads to concentric LV myocardial hypertrophy
What is the result of concentric LV myocardial hypertrophy?
Hypertrophic LV becomes stiff overtime and harder to fill leading to decrease cardiac output - diastolic dysfunction
(Can lead to HFpEF)
How can the increased pressure in the LV effect the left atrium and the lungs?
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
What are the signs and symptoms of aortic stenosis?
Ejection Systolic murmur (crescendo-decrescendo)
Syncope on exertion
Angina (chest pain, specifically heart) on exertion
Diffuse crackles on auscultation of lungs + dyspnoea
How is aortic stenosis diagnosed?
Doppler echo
What are the management options for aortic stenosis?
Aortic valve replacement:
Transcatheter valve replacement
Surgical valve prosthesis
What is aortic regurgitation?
Diastolic leakage of blood from the aorta into the left ventricle
How does aortic regurgitation occur?
Incompetence of valve leaflets resulting from either intrinsic valve disease or dilation of the aortic root
What are the 2 types of aortic regurgitation clinically?
Acute
Chronic
What is acute aortic regurgitation?
Medical emergency
Presents with sudden onset pulmonary oedema and hypotension/cardiogenic shock
What are the consequences of chronic aortic regurgitation?
Culminate into congestive cardiac failure
What are the 2 categories of causes of aortic regurgitation?
Congenital and acquired valve defects
Causes of aortic root dilation
What are the causes of aortic valve defects?
Rheumatic heart disease
Infective endocarditis
Aortic valve stenosis
Congenital heart defects
Congenital bicuspid valves
What are the causes of Aortic root dilation?
Marfan’s syndrome
Connective tissue disease
Idiopathic
Ankylosing spondylitis
Traumatic
What is the first step in the pathophysiology of aortic regurgitation?
What is the result of aortic regurgitation?
What are the symptoms and signs of aortic regurgitation?
Diastolic murmur
S3 gallop sound
Angina on exertion
Fatigue
Increased pressure in lungs - leads to pulmonary congestion
How will a case of acute aortic regurgitation present?
Cardiogenic shock
Tachycardia
Cyanosis
Pulmonary oedema
Diastolic murmur
How will chronic aortic regurgitation present?
Wide pulse pressure
Corrigan pulse
What is the go-to test to diagnose and grade the severity of aortic regurgitation?
Echocardiography
What are the management options for acute aortic regurgitation?
Medical emergency
Aortic valve replacement
What are the management options for chronic aortic regurgitation?
Vasodilator therapy improves haemodynamics and delays the need for aortic valve replacement/repair
What is the aetiology of mitral stenosis?
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
What is the first step in the pathophysiology of mitral stenosis?
How does impaired blood flow through the mitral valve lead to right sided heart failure?
What are the symptoms and signs of mitral stenosis?
Opening snap, mid-diastolic murmur
Atrial fibrillation
Right sided heart failure, cardiogenic shock/congestive heart failure
Left atrial enlargement - compression of surrounding structures (rare)
How can mitral stenosis present in a history/consultation?
What are the diagnostic options for mitral stenosis?
ECG
Chest X ray
Transthoracic echocardiography
What are the management options for progressive asymptomatic mitral stenosis?
No therapy required
What are the management options for severe asymptomatic mitral stenosis?
No therapy generally required
Have the option of adjuvant balloon valvotomy
What are the management options for severe symptomatic mitral stenosis?
Diuretics
Balloon valvotomy
Valve replacement/repair
Adjunct beta-blockers
What is the aetiology of mitral regurgitation?
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
What are the causes of acute mitral regurgitation?
Mitral valve prolapse
Rheumatic heart disease
Infective endocarditis
Following valvular surgery
Prosthetic mitral valve dysfunction
What are the causes of chronic mitral regurgitation?
Rheumatic heart disease
SLE
Scleroderma
Hypertrophic cardiomyopathy
Drug related
What is the first step of the pathophysiology of mitral regurgitation?
What are the consequences of mitral regurgitation?
What are the signs and symptoms of mitral regurgitation?
Holosystolic murmur radiating to axilla
S3 heart sound
Decrease in oxygen saturation, tachypnoea, wheeze, crackles and frothy sputum
What are the diagnosis options for mitral regurgitation?
Transthoracic echocardiography
ECG
Chest X ray
Cardiac MRI/CT Scan
What are the management options for acute severe mitral regurgitation?
Repairing/replacing supporting valve structures
Prosthetic ring can be inserted to reshape valve
What are the management options for chronic severe asymptomatic mitral regurgitation?
Watchful waiting
Can opt for surgery
What are the management options for chronic severe symptomatic mitral regurgitation?
Surgery plus medical treatment
What are the 3 main types of cardiomyopathies?
Dilated
Hypertrophic
Restrictive
Outline dilated cardiomyopathy
Outline hypertrophic cardiomyopathy
Outline restrictive cardiomyopathy
