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Cardiology Flashcards

1
Q

What is Cardiac Tamponade?

A

A cardiac emergency caused by an accumulation of blood in the pericardial sac, constricting the heart and preventing it from relaxing during diastole.

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2
Q

What happens if Cardiac Tamponade is left untreated?

A

Patients die from obstructive shock.

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3
Q

What are common causes of Cardiac Tamponade?

A

Blunt or penetrating trauma to the chest, with penetrating trauma being more common.

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4
Q

What are the clinical features of Cardiac Tamponade?

A

Beck’s triad: hypotension, distended neck veins, and muffled heart sounds, along with pulsus paradoxus and shock.

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5
Q

What is Beck’s triad?

A

A clinical feature of Cardiac Tamponade consisting of hypotension, distended neck veins, and muffled heart sounds.

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6
Q

What is the treatment for Cardiac Tamponade?

A

Immediate pericardiocentesis under ECG monitoring, followed by thoracotomy if the patient does not respond.

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7
Q

What is Cardiogenic Shock?

A

Reduced CO due to an intrinsic cardiac disorder

also known as CARDIAC SHOCK, happens when your heart cannot pump enough blood and oxygen to the brain and other vital organs

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8
Q

What are the mechanisms of Cardiogenic Shock?

A
  1. Inefficient contractility of the myocardium 2. Abnormal cardiac rhythm 3. Structural disorders of the cardiomyocytes.
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9
Q

What is Dilated Cardiomyopathy?

A

A primary disease of the heart characterized by ventricular dilation and systolic abnormality.

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10
Q

What are the clinical features of Dilated Cardiomyopathy?

A

Difficulty breathing, tiredness, and pedal edema.

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11
Q

How is Dilated Cardiomyopathy diagnosed?

A

Clinically and supported by biochemical tests (Natriuretic Peptides), radiologic investigations like chest X-ray, MRI, and echocardiography.

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12
Q

What is the treatment for Dilated Cardiomyopathy?

A

Supportive management and definitive treatment for the underlying cause, including heart transplant and cardiac resynchronization therapy.

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13
Q

What is Hypertrophic Cardiomyopathy?
Afterload of hypertrophic cardiomyopathy is

A

A genetic disorder of the heart that is thickened, dysfunction of diastole. Afterload is NOT INCREASED
A common cause of sudden death in younger athletes.

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14
Q

What are the clinical features of Hypertrophic Cardiomyopathy?

A

Difficulty breathing, chest pain, fainting, and sudden death.

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15
Q

What is a typical finding on auscultation for Hypertrophic Cardiomyopathy?

A

A systolic murmur that can be more pronounced with the Valsalva maneuver.

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16
Q

What is Restrictive Cardiomyopathy?

A

A primary cardiac disorder characterized by unyielding, stiff ventricular walls that do not easily expand during diastole.

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17
Q

What are the clinical features of Restrictive Cardiomyopathy?

A

Tiredness and dyspnea on exertion.

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18
Q

How is Restrictive Cardiomyopathy diagnosed?

A

Radiologically by cardiac catheterization and echocardiography.

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19
Q

What is Takotsubo Cardiomyopathy? Stress induced cardiomyopathy & Broken Heart syndrome

A

characterized by transient alteration of wall motion in the left ventricle, mimicking acute coronary syndrome.

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20
Q

Who is most affected by Takotsubo Cardiomyopathy?

A

Most patients are women, especially postmenopausal.

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21
Q

What are the triggers for Takotsubo Cardiomyopathy?

A

Psychological triggers (panic, fear, anxiety, etc.) and physical triggers (physical activity, comorbidities, procedures).

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22
Q

What is the mechanism behind Takotsubo Cardiomyopathy?

A

Unknown, but significant release of catecholamines and the subsequent adrenergic response may play a role (from stressful triggers)

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23
Q

What is the most common form of Takotsubo cardiomyopathy?

A

The apical type, which accounts for the majority of cases.

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24
Q

What are the characteristics of the apical type of Takotsubo cardiomyopathy?

A

It is characterized by apical ballooning and mid-ventricular hypokinesis, while the basal segments of the left ventricle show hyperkinesis.

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25
What is the less common form of Takotsubo cardiomyopathy?
The basal or inverse type.
26
What are the characteristics of the basal or inverse type of Takotsubo cardiomyopathy?
hypokinesis of the basal and mid-ventricular segments with preserved or hypercontractile apical segments.
27
What conditions can Takotsubo cardiomyopathy be related to?
conditions such as pheochromocytoma and subarachnoid hemorrhage.
28
How can Takotsubo cardiomyopathy be diagnosed?
Diagnosis can be guided by echocardiography and cardiac magnetic resonance imaging (MRI).
29
What biomarker is usually elevated in Takotsubo cardiomyopathy?
Brain natriuretic peptide is usually elevated.
30
What is the focus of treatment for Takotsubo cardiomyopathy?
The treatment focuses on the management of acute heart failure and the provision of supportive measures.
31
What are structural heart procedures performed for?
They are performed to manage structural heart diseases, such as septal defects, valvular stenosis, valvular regurgitation, and hypertrophic cardiomyopathy.
32
What is Transcatheter Aortic Valve Replacement (TAVR)?
TAVR, also known as TAVI, is a minimally invasive procedure employed to treat aortic valve stenosis.
33
Most common valvular dysfunction
Aortic stenosis and is often associated with age.
34
What are the contraindications for TAVR?
Contraindications include difficult access and extreme annulus size.
35
What is the most common access site for TAVR?
The most common access site is the femoral artery, other (transcarotid, transcaval, transaxillary)
36
Who is TAVR recommended for?
TAVR is recommended for most symptomatic, medium-risk and high-risk patients with a life expectancy greater than one year.
37
How is TAVR viewed in relation to open-heart surgery?
TAVR is safe and effective, and it has become an alternative to open-heart surgery for many patients with aortic stenosis.
38
What is Transcatheter Mitral Valve Replacement (TMVR)?
TMVR is a minimally invasive procedure employed to treat mitral valve regurgitation.
39
Inefficient contractility of the myocardium caused by
MI, Myocardial ischemia, and myocarditis Drugs inducing arrhythmias
40
What is natruiretic peptides? And 2 types?
Hormones that regulate cardiovascular BP and affects renal 1. Atrial natriuretic peptide (ANP) 2. B-type natriuretic peptide (BNP) are secreted by ventricles ANP signals in an endocrine and paracrine manner to decrease blood pressure and cardiac hypertrophy. BNP acts locally to reduce ventricular fibrosis
41
BNP levels in blood tests
Protein level used to help confirm or rule out HF in people who have symptoms >100 pg/mL is abnormal
42
Hypertrophic cardiomyopathy diagnosis
Radiological: MRI or Echocardiography
43
Hypertrophic Cardiomyopathy treatment
Beta blockers Calcium channel blockers Surgical removal of obstructive tract
44
Restrictive cardiomyopathy which ventricle is MOST affected
Left ventricle
45
Restrictive cardiomyopathy treatment
Surgical treatment is more useful than pharmaceuticals
46
What is echocardiography used for?
Echocardiography is employed to determine the etiology, severity, and reparability of the mitral valve.
47
What are the two types of mitral valve conditions?
The condition may be primary when there is damage to the components of the mitral valve or secondary when caused by left ventricle dysfunction or remodeling.
48
What do patients with acute mitral regurgitation require?
Patients with acute mitral regurgitation require surgical repair or valve replacement.
49
Why is treatment for mitral regurgitation considered high risk?
Treatment is usually considered to be high risk due to age and comorbidities.
50
What percentage of patients with severe mitral regurgitation do not receive standard treatment?
Up to 50% of patients with severe mitral regurgitation do not receive the standard treatment.
51
What is TMVR?
TMVR is a less invasive procedure, which may be viable for patients with high surgical risk.
52
What is the main device approved by the FDA for mitral regurgitation?
The main device approved by the U.S. Food and Drug Administration (FDA) is MitraClip.
53
What is MitraClip used for?
MitraClip is employed to treat patients with symptomatic and severe primary mitral regurgitation who have a high surgical risk or contraindications for surgery.
54
Who may be eligible for the MitraClip procedure?
Patients with secondary moderate to severe mitral regurgitation and develop signs of heart failure may be eligible for the procedure.
55
What is alcohol septal ablation?
a surgical procedure employed to treat patients with hypertrophic cardiomyopathy.
56
What is hypertrophic cardiomyopathy?
Hypertrophic cardiomyopathy is an autosomal dominant disorder that affects 1 in 500 people.
57
What symptoms may hypertrophic cardiomyopathy result in?
The condition may be asymptomatic, but may eventually result in various cardiovascular symptoms, such as angina and dyspnea.
58
How is hypertrophic cardiomyopathy usually managed?
Most of the time, the condition is managed with pharmacologic therapy.
59
What surgical treatments may be needed for hypertrophic cardiomyopathy?
Patients may need surgical treatment, such as a surgical myectomy or alcohol septal ablation.
60
When is alcohol septal ablation indicated?
-patients with a NYHA class III to IV, a left ventricle outflow tract obstruction gradient ≥30 mmHg at rest or ≥50 mmHg on exertion - presence of systolic anterior motion of the mitral valve leaflet - a septal thickness ≥16 mm
61
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62
How is alcohol septal ablation performed?
US guided, a catheter is employed for vascular access and alcohol injection, which results in the controlled destruction of the hypertrophic wall.
63
What is used to guide the alcohol septal ablation procedure?
Ultrasound is used to guide the procedure.
64
What common complication can occur during alcohol septal ablation? What must be done?
Transient or permanent AV block is a potential complication. Pacemaker maybe needed (90% success rate)
65
What are atrial septal defects (ASD)?
common type of congenital heart defect, most cases inter-arterial communication is due to ostium secundum.
66
What are the types of ASDs?
The types of ASDs include ostium secundum, ostium primum, sinus venosus defects, and coronary sinus defects.
67
What are the potential consequences of untreated isolated ASDs in children?
Untreated isolated ASDs may be asymptomatic in children but can lead to long-term left-to-right shunt, right ventricle failure, and pulmonary hypertension.
68
What is the recommended treatment for ostium secundum defects in the pediatric population?
Transcatheter closure is recommended for hemodynamically relevant ostium secundum defects in the pediatric population.
69
What treatment methods are recommended for ostium secundum defects in adults?
Both surgical and transcatheter closure methods are recommended for adults with ostium secundum defects.
70
What type of closure is recommended for other types of ASDs?
Only surgical closure is recommended for other types of ASDs.
71
How is transcatheter closure of ASDs performed?
Transcatheter closure is guided by transesophageal echocardiography and fluoroscopy, with common femoral access.
72
What long-term therapy do patients receive after ASD closure?
Patients receive long-term (>6 months) antiplatelet therapy and prophylaxis for endocarditis.
73
What are ventricular septal defects (VSDs)?
Ventricular septal defects (VSDs) are a very common type of structural heart disease, septum opening between ventricles 5 to 50 cases seen per 1,000 live births
74
What are the main types of VSDs?
1. perimembranous (75-80%) 2. muscular, inlet, and outlet (or infundibular).
75
What is the clinical presentation of VSDs related to?
The clinical presentation of VSDs is related to the size of the defect and the degree of hemodynamic compromise, often resulting in a left-to-right shunt. Patients present with: PANSYSTOLIC murmur (louder in smaller defects) - small defects may close permanently in the first year of life
76
What is the most common treatment for VSDs in the United States?
Surgical closure is still the most common treatment for VSDs in the United States.
77
When is transcatheter closure employed for VSDs?
Transcatheter closure is employed to treat muscular VSDs, but it is very difficult for other types of VSD.
78
How is the procedure for VSD closure guided?
The procedure is guided by fluoroscopy and ultrasound, with common femoral access.
79
What is the closure rate for muscular defects using the Amplatzer muscular VSD Occluder?
Closure of muscular defects with the Amplatzer muscular VSD Occluder has a closure rate of greater than 90%.
80
What are potential complications of the VSD closure procedure?
Generally safe procedure but Device-related complications may occur, such as infection, hemolysis, or embolization.
81
What are the actions of cardiomyocytes?
The cardiomyocytes can depolarize and repolarize, producing electrical activity that results in coordinated contractility.
82
What generates the initial electrical impulse for depolarization in the heart?
The initial electrical impulse is generated from the pacemaker cells located in the sinoatrial nodes in the right atrium.
83
What is the role of the atrioventricular node (AVN)?
The AVN conducts impulses from the atria into the ventricles.
84
What is the significance of the delay in the AVN?
A delay of about 0.1 seconds allows the ventricles to contract after the atria have contracted.
85
What is the Bundle of His?
The Bundle of His is a group of specialized cells in the ventricles that transport the cardiac impulse.
86
What do the Purkinje fibers do?
The Purkinje fibers transfer the cardiac impulse to the apex of the heart and then to the lateral aspects.
87
What phases characterize the cardiac cycle?
The cardiac cycle is characterized by atrial systole, atrial diastole, ventricular systole, and ventricular diastole.
88
How are the opening and closing of the heart valves regulated?
The opening and closing of the valves are regulated by the rising and falling of pressure in the heart chambers.
89
What is the pressure difference between the left and right sides of the heart?
The pressure on the left side of the heart is higher than that on the right.
90
What occurs during atrial systole?
During atrial systole, there is a filling of the ventricles as blood flows into the atria due to a drop in pressure.

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