Cardiomyopathy and Pediatric Heart Flashcards
1
Q
Most common heart disease
A
IHD
2
Q
Most common cause of most common heart disease (and cause of that)
A
CAD and atherosclerosis
3
Q
second most common heart disease
A
valvular disease
4
Q
most common valvular disease
A
AVS
5
Q
second most common valvular disease
A
MVP
6
Q
what is cardiomyopathy
A
disease of cardiac muscle EXCLUDING ischemia and valvular disease
7
Q
Most common type of IHD
A
stable angina
8
Q
Most common type of cardiomyopathy
A
dilated
9
Q
Sign of cardiomyopathy
A
cardiomegaly
10
Q
What is dilated cardiomyopathy
A
big, stretched, weakened and floppy heart
11
Q
how is dilated cardiomyopathy diagnosed
A
chest x-ray (more than 1/2 lung field)
12
Q
cause of dilated cardiomyopathy
A
idiopathic
13
Q
associated conditions of dilated cardiomyopathy
A
infection
metabolic disease
toxins/drugs
14
Q
most common “cause” of dilated cardiomyopathy and it’s types
A
infection (myocarditis) viral - most common bacterial - more severe fungal parasitic - Chagan's disease in Latin America
15
Q
metabolic diseases associated with dilated cardiomyopathy
A
hyperthyroidism - hypermetabolic state weakens heart
hypothyroidism - not enough work results in weak heart
hemachromatisis - Fe deposits damage heart
16
Q
toxins and drugs associated with dilated cardiomyopathy
A
alcohol - damage via toxic myopathy
heavy metals
chemotherapy
17
Q
presentation of dilated cardiomyopathy (9)
A
big, stretched, weakened floppy heart loss of muscle strength diminished SYSTOLIC function ischemia (underperfusion) synchope limited physical activities pulmonary congestion and edema chest pain dyspnea
18
Q
population dilated cardiomyopathy effects
A
young adults
19
Q
MAJOR complications of dilated cardiomyopathy
A
ischemia
pulmonary edema
arrhythmia
20
Q
treatment of dilated cardiomyopathy
A
heart transplant
21
Q
2nd most common type of cardiomyopathy
A
hyperthrophic
22
Q
what is hypertrophic cardiomyopathy?
A
enlarged heart (not as big as dilated) more muscle small chambers "beef heart" cant fill well effects DIASTOLIC function
23
Q
what causes hypertrophic cardiomyopathy
A
genetic
familial
inherited (autosomal dominant)
24
Q
what is hypertrophic cardiomyopathy similar to?
A
LVH in AVS
25
Differences between secondary LVH and primary LVH
AVS vs hypertrophic cardiomyopathy
asymmetric concentric vs symmetric eccentric
LV even thickening vs LV septal thickening
26
Clinical presentation of hypertrophic cardiomyopathy
SUDDEN DEATH (young athlete)
arrhythmia
high QRS on EKG
27
What is restrictive cardiomyopathy
idiopathic fibrous cardiomyopathy
anatomically normal heart size, shape and thickness but abnormal composition
fibrous tissue in heart muscle
results in stiff muscle
28
what kind of dysfunction does restrictive cardiomyopathy cause?
dual dysfunction - SYSTOLIC and DIASTOLIC
| cant contract and cant relax
29
Clinical presentation of restrictive cardiomyopathy
```
arrhythmia
UNDERPERFUSION
normal on chest x-ray
normal on echo
small QRS on EKG
```
30
symptoms patient presents with restrictive cardiomyopathy
```
chest pain
fatigue
synchope
pain in legs
pulmonary edema
high pulse
arrhythmia
dyspnea
pressure abnormalities
```
31
how is biopsy of the heart performed and in what cases?
to diagnose infectious (viral) myocarditis or for restrictive cardiomyopathy via IJV
32
possible causes of restrictive cardiomyopathy
hemachromatosis (fortification of the wall)
| amyloid ("gluing" of the wall)
33
what is restrictive cardiomyopathy similar to in physiology
tamponade (but its chronic)
34
what is trauma
mechanical event
35
what are two types of trauma and which one is more common
blunt - more common
| sharp - more severe
36
what happens with blunt trauma
compression of the heart
increase in pressure
may cause arrhythmia
may cause cardiomortis
37
what is cardiomortis
sudden death from severe blunt trauma/compression to the heart
38
what happens in sharp trauma
damage to chest and wall
penetration of tissue
hemothorax - bleeding in pleural cavity
tamponade
39
major complications of sharp trauma
hemothorax - bleeding in pleaural cavity
seen as collapsed, white lung on chest x-ray
tamponade
40
what type of trauma does MVA cause
inertial
| aortic transection
41
what is aortic transection
ripping of all layers of aortic wall
| usually post MVA
42
what is major complication of aortic transection
tamponade
43
risk factors for atherosclerosis (CAD and IHD)
age over 50
gender - male
smoking
44
what age population is considered to be children?
fetuses, birth to young teens (20s)
45
most common heart disease in children
congenital defects
46
what are congenital defects and when do they happen
abnormal structural changes during 1st trimester (3-8 weeks)
47
most common congenital defect
cardiac congenital defects
48
what organs does placenta function as in a fetus
lungs
kidneys
liver
49
which way does fetal circulation work?
right to left
50
which way does adult circulation work
left to right
51
why is O2 concentration lower in fetal heart than adult
because of mixing of oxygenated and deoxygenated blood
52
pathway fo fetal circulation
```
umbilical vein from placenta (oxygenated)
ductus venosus (bypass liver)
IVC
RA
foramen oval to LA
LV and RV
pulmonary artery and aorta
shunted from pulmonary artery to aorta via ductus arteriosus
Aorta
umbilical arteries
```
53
what are three shunts present in fetal circulation
foramen ovale
ductus venosus
ductus arteriosus
54
how does fetus survive with lower O2 concentration in the heart
fetal RBC have different hemoglobin that can release more O2
55
where is O2 concentration the highest in fetal circulation
umbilical vein and ductus venosus
56
major differences between fetuses and adults (4)
placenta
flow direction
hemoglobin
shunts
57
what events happen at birth (5)
```
umbilical vein and ductus venosus collapse
lungs are airated
LA pressure increases
foramen ovale closes
ductus arteriosus closes within 1-3 days
```
58
what are three fetal shunts and what do they become?
foramen ovale - fossa ovale
ductus arteriosus - ligamentum arteriosum
ductus venosus - ligamentum teres
59
2 types of congenital defects (and their types)
Shunts (left to right and right to left)
| obstructive
60
most common congenital defect
Atrial Septal Defect (ASD)
| Ventricular Septal Defect (VSD)
61
Explain ASD and VSD (and PDA)
blood is shunted from left to right via shunt
lung volume increases
Pulmonary Edema
lungs restructure but pressure increases
PULMONARY HYPERTENSION
backward flow - HYPERTROPHY OF RV
pressure in RV can shunt blood back to the left
62
non-cyanotic shunts
ASD
VSD
AVSD
PDA
63
what will kids with ASD, VSD, and PDA suffer from
limited physical activities due to pulmonary hypertension
64
What is AVSD
atrioventricular septal defect
65
what is AVSD associated with
Down's syndrome
66
presentation of AVSD
```
septal defect in atria and ventricle resulting in ONE LARGE VALVE
pulmonary hypertension
increased pressure and backward flow
RVH
reversal of shunt
poorly oxygenated blood in systemic circulation
cyanosis - discolocation
+- Arrhythmia and heart failure
```
67
what do all congenital defects have in common?
they produce extra heart sounds
68
what is ToF
Tetrology of Fallot
69
what is the most common right to left shunt
ToF
70
What 4 things happen in ToF
1. pulmonary valve stenosis
2. RVH
3. Overriding aorta - low systemic [O2]
4. Shunt (PDA, VSD or ASD)
71
what are complications of ToF
```
cyanotic changes (underoxygenation)
exertional limitations
```
72
what is TGV
transposition of great vessels (Aorta and Pulmonary valve switched)
73
Presentation of TGV
infant turns blue and can't breathe within 15 minutes of birth
2 separate systems
Connection via PDA (and maybe a septal defect) after birth
want to keep PDA open until surgery
CYANOTIC
74
what is TVA
tricuspid valve atresia
75
what is atresia
complete absence/closure
76
mechanism of TVA
underdeveloped RV - RV HYPOPLASIA
RA dilation (parachuting)
PDA and Septal defect
atrilization of ventricle (prolapsing)
77
presentation/complications of TVA
cyanosis - blue nails and skin
| exertional limitations
78
name all cyanotic conditions
right to left shunts
ToF
TGV
TVA
PT
79
what is PT
persistent truncus
80
what is the most common tricuspid valve defect
TVA
81
what happens in PT
```
common vessel trunk
one valve (similar to AVSD)
frog heart
CYANOTIC
(mixing of blood in common trunk)
```
82
what are the obstructive congenital diseases
bicuspid aortic valve (AVS causing LVH)
AVA (aortic valve atresia)
Aortic Coarctation
83
what is the most common obstructive congenital disease
AVS due to bicuspid valve
84
what is AVA
aortic valve atresia
absence of aortic valve
ASD or VSD
PDA
hypoplasia of LV
Left to right but cyanotic
85
what is obstruction of aorta called
coarctasion
86
what are two types of coarctation
proximal and distal
87
which type of coarctation is more severe
proximal
88
what is coarctation associated with
turners syndrome (absence of one x chromosome in women)
89
who is more likely to have coarctasion
men
90
presentation of coarctation
pressure in pre-stenotic aorta increase
high blood pressure (in arms)
low blood pressure (underperfusion) in legs
can have collaterals
91
how are congenital heart defects treated?
surgically
92
how are ischemic diseases treated?
medically
