Cardiology Flashcards
Function and location of the trabeculae carnea
Project from the inner surface of the right and left ventricle.
Provide additional support to ventricular valves, maintaining stroke volume and cardiac output
What do the heart sounds correlate to?
S1 - tricuspid and mitral valve shutting
S2- closed aortic and pulmonary valve
S3 – linked with flow of blood into the ventricles.
S4 – linked with atrial contraction.
What stages are isovolumetric relaxation and contraction?
Relaxation- semilunar valve and atriaventricular valves closed but pressure reducing
Contraction- semilunar valve and atrioventricular valve closed but pressure is increasing
Give 4 congenital heart defects examples and describe them
Atrial Septal defect - hole in the wall between both atria
Ventricular septal defect - hole in the wall between both ventricle
Tetralogy of Fallot - overarching aorta over vsd, right pulmonary hypertrophy, ventricular septal defect, narrowing of the pulmonary artery (pulmonary stenosis)
Coarction of the aorta - narrowing of the aorta, leads to thickening of the ventricles
Aortic stenosis:
What is it preceded by?
How is it suspected?
What age is it most likely to happen?
What are the risk factors (8)?
Aetiology
Describe the pathophysiology
What does it lead to?
What happens in rheumatic heart disease?
Presentation(6)?
What do they normally have a history of (5)?
What investigations occur(4)?
- Aortic sclerosis
- Crescendo diminuendo systolic murmur , echo-cardiogram
- 60/70s
- High LDL, high C-reactive protein level, Radiotherapy, CKD, Older age, Congenital bicuspid valve, hypertension, smoking
- Rheumatic heart disease, congenital heart disease, calcium build up
- irritation of the endocaridum of the valve, leads to an inflammatory response that leads to deposition of calcium and leaflet fibrosis and therefore narrowing
- LVH
- Following untreated strep, autoimmune response that leads to inflammatory response and calcium deposition
- End systolic murmur, syncope, angina, heart failure, exertional dysponea and fatigue, heart failure
- High LDL , CKD, rheumatic fever, high lipoprotein, age >65
- TRansthoracic echocardiography , cardiac catherisation, cardiac MRI, ECG chest x-ray
Aortic regurgitation:
What kind of murmur?
What are the congenital and acquired causes (5)?
What are the causes of it through aortic root dilation?
Describe the pathophysiology of acute AR
Describe what happens physiology afterwards
Describe the pathophysiology of chronic AR
Describe what happens physiologically afterwards
How does acute AR present (4)?
How does chronic AR present (2)?
What investigations are done?
What is the management of acute AR?
What is the management of (a)symptomic chronic AR?
- early diastolic murmur
- Congenital heart defect congenital bicuspid valve, infective endocarditis, rheumatic fever, aortic valve stenosis
- Marfan’s syndrome, idiopathic, connective tissue disease, trauma, ankylosing spondylitis
- Infective endocarditis, trauma, vegetations
- Backflow of blood therefore increased end systolic volume and pressure, increased end diastolic LV pressure, increased pulmonary venous pressure, pumonary oedema, dyspnoea, cardiogenic shock, heart failure
- Rheumatic fever, congenital bicuspid valve
- Left ventricular enlargement and eccentric hypertrophy, initially ejection fraction okay but eventually it reduces and end systolic pressure increases eventually LV dyspnea, lower coronary perfusion, ischaemia. necrosis and apoptosis , heart failure
- Pulmonary oedema, tachycardia, cardiogeic shock, blue tinged lips - cyanosis
- Wild pulse pressure, pistol shot pulse (Traube sign)
- Transthroacic echocardiogram, cardiac catherisation, cardiac mri, ecg chest x ray
- Valve replace and treat cardiogenic shock first - vasodilators
- a. drugs and reassurance b. avr and vasodilators
Mitral stenosis:
What does it lead to final progression?
What are the main causes (9)?
Describe the pathophysiology
How does this effect physiology?
Presentation (8)
Investigations to carry (5)
Management
- Pulmonary hypertension and therefore right heart failure
- Rheumatic fever, Carcinoid syndrome, SLE, congenital defect of heart, calcification caused by ageing, ergot/serotonergic drugs, rheumatoid arthiritis, whipple disease, amyloidosis
- Many years after rheumatic fever, eventually leads to formation of multiple foci and infiltrates the endo and myocardium, gets thickened, calcified and contracted
- initially moderate exericse, tachycardia causes dyspnea on exertion, overtime transudation of fluid into lung interstitium so dyspnea at rest, haemoptysis if bronial vein ruptures due to increased pressure, reduced cardiac output pulmonary hypertension,
- Mid diastolic murmur, dyspnea, orthodyspnea, heamoptysis, history of rheumatic fever, loud P2, neck vein distension, 40 -50 yrs age
- ECG, chest x ray, cardiac MRI, transthoracic echocardiogrma, cardiac catherisation
- Asymptomatic leave it alone, severe asymptomatic adjuvant balloon valvotomy, symptomatic adjuvant balloon valvotomoy, diuretics, valve replacement, repair adjunt beta blockers
Mitral regurgitation:
Causes of acute MR (5)
Causes of chronic MR (5)
Describe the pathophysiology
How does this affect heart physiology?
Presentation (7)
Investigation (5)
Management
- Rheumatic heart disease, Infective endocarditis, mitral valve proplapse, valvular surgery, prosthetic mitral valve dysfunction
- Rheumatic heart disease, SLE, Scleroderma, Hypertrophic cardiomyopathy, Drug related
- Following infective endocarditis or rheumatic heart disease - leaflet perforation, vegetation along cusps, damage to chordae tendinae, abscess formation and others. Eventually leads to back flow of blood to atrium, this causes increased volume of ventricle during diastole , this leads to lv dilation remodelling leading to reduced LV systolic function, back pressure in left atria and eventually pulmonary congestion, at the same time decreased stroke volume and cardiac output so congestive heart failure
- Dilated LV
- dyspnoea, holosystolic murmur , S3 sounds, congestive heart failure, peripheral oedema
- ECG, transthoracic echocardiogram, chest x ray, cardiac cathrisation, cardiac MRI
- Acute MR- straight to surgery, prosthetic ring
CHronic asymptomatic - watchful waiting
<60% EF surgery
CHronic symptomatic - <30 % EF intra aortic balloon counterpulsation
Firts line surgery + meds
What drugs can be used to manage the symptoms of Dilated cardiomyopathy?
Arrythmia- Amiodarone
Heart failure- ACEi, b-blockers
2nd line: ARB, Diuretics
What kind of abnormalities can ECG tell us about?
- Conduction
- Structural (e.g. ventricular hypertrophy)
- Perfusion (whether the muscle is ischaemic or infarct e.g. MI)
Deflections in cardiac vectors denotion
Steepness of deflection denotes the ‘velocity’ of action potential
Width of the deflection denotes the ‘duration’ of the event
Downward deflections are towards the –ve electrode
Upward deflections are towards the +ve electrode
Describe what each little part of the ECG indicates:
P wave -
Isoelectric line following p wave -
Isoelectric line before Q peak
Q peak
R peak
S peak
Isoelectric line after S
T peak
Sino atrial node
Atrioventricular node
Bundle of His
Bundle branches
Ventricular contraction
Late ventricular contraction
Fully depolarised ventricles
Ventricle repolarisation
- Rule of Ls for limb leads
Lead I (1 L) → Right arm to Left arm
Lead II (2 Ls) → Right arm to Left Leg
Lead III (3 Ls) → Left arm to Left Leg
What does aVL read?
Compares the electrical activity between a positive electrode on the left arm with the average electrical activity between the right arm and left leg (lead II)
What does aVR read?
Compares the electrical activity between a positive electrode on the right arm with the average electrical activity between the left arm and left leg (lead III)
What does aVF read?
Compares the electrical activity between a positive electrode on the left leg with the average electrical activity between the right arm and left arm (lead I)
