Cardiology

Question 1

What oedema do you get with left-sided HF and right-sided HF?

Answer 1

Left-sided: pulmonary oedema due to congestion of blood in pulmonary circulation, organ ischaemia and less blood to body.

Right-sided: peripheral oedema, congestion of organs, ascites and pleural effusion

Question 2

What is HF (CCF)?

Answer 2

Failure in the heart’s pump mechanism. Usually due to systolic function failure where it cannot contract enough, occasionally diastolic failure were chambers are unable to stretch and fill with blood.

Adaptive mechanisms to prevent or postpone total HF relate to Starling’s Law so - action to increase preload and contractile force. There is hypertrophy due to increase in myocyte size, increase in chamber size - dilation - increases preload, activation of neurohormonal mechanisms such as NA to increase HR, activation of RAAS and ANP to increase BP through fluid retention

Question 3

What is hypertensive heart disease?

Answer 3

What happens to your heart due to HTN which causes hypertrophy.

Systemic hypertension = left-sided
Pulmonary hypertension= cor pulmonale - right-sided

Diagnosed through concentric left ventricular hypertrophy and evidence of HTN. Can present with AF, CCF or asymptomatic ECG screening.

No dilation of chambers unlike CCF, increase in wall thickness - circumferential LV hypertrophy, no dilation of LV and heart weight. Thickened wall impairs diastolic function

Question 4

What is Cor Pulmonale?

Answer 4

Pulmonary hypertensive heart disease affecting the right heart. Secondary to pulmonary hypertension.

Acute or chronic.

Question 5

What are the 3 main forms of valvular disease?

Answer 5

Stenosis
Regurgitation (incompetence)
Functional regurgitation - valve incompetent due to dilation of ventricle

Question 6

Common cause of mitral stenosis

Answer 6

rheumatic fever - acute immunological inflammatory disease a few weeks after infection with group A haemolytic streptococcal pharyngitis.

Question 7

Common cause of valvular stenosis

Answer 7

Usually underlying valve abnormality so usually chronic.

Valvular calcification is a form of stenosis that can affect aortic and mitral valves

Question 8

Which valves most commonly affected by infective endocarditits?

Answer 8

Aortic, mitral and tricuspid valves

Question 9

3 main cardiomyopathies

Answer 9

1. Dilated cardiomyopathy (90%)
2. Hypertrophic cardiomyopathy
3. Restrictive cardiomyopathy

Question 10

3 main categories of congenital heart disease

Answer 10

1. Right-Left shunts: blood is shunted from pulmonary to systemic circulation reducing oxygenation of blood causing cyanosis. Can be due to teratology of fallot, transposition of great vessels, persistent truncus arteriosus, tricuspid atresia, total anomalous pulmonary venous connection.
2. Left-Right shunts: systemic to pulomnary leads to increase in pulmonary flow –> pulmonary hypertension. With time the shunt reverses
3. Obstructive: block flow due to abnormal narrowing of a chamber, valve or blood vessel. E.g. coarctation of the aorta

Question 11

What are arterial/cardiac thrombi mainly composed of?

Answer 11

Mainly from Platelets and clotting factors

Question 12

What are venous thrombi mainly composed of?

Answer 12

Mainly RBCs and clotting factors

Question 13

Main complications of arterial or venous thrombi?

Answer 13

Arterial - infarction/ischaemia

Venous - embolism