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Pathophysiology 2 > Cardiomyopathy and Pediatric Heart > Flashcards

Cardiomyopathy and Pediatric Heart Flashcards

1
Q

Most common heart disease

A

IHD

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2
Q

Most common cause of most common heart disease (and cause of that)

A

CAD and atherosclerosis

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3
Q

second most common heart disease

A

valvular disease

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4
Q

most common valvular disease

A

AVS

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5
Q

second most common valvular disease

A

MVP

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6
Q

what is cardiomyopathy

A

disease of cardiac muscle EXCLUDING ischemia and valvular disease

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7
Q

Most common type of IHD

A

stable angina

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8
Q

Most common type of cardiomyopathy

A

dilated

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9
Q

Sign of cardiomyopathy

A

cardiomegaly

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10
Q

What is dilated cardiomyopathy

A

big, stretched, weakened and floppy heart

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11
Q

how is dilated cardiomyopathy diagnosed

A

chest x-ray (more than 1/2 lung field)

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12
Q

cause of dilated cardiomyopathy

A

idiopathic

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13
Q

associated conditions of dilated cardiomyopathy

A

infection
metabolic disease
toxins/drugs

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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
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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

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16
Q

toxins and drugs associated with dilated cardiomyopathy

A

alcohol - damage via toxic myopathy
heavy metals
chemotherapy

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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
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18
Q

population dilated cardiomyopathy effects

A

young adults

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19
Q

MAJOR complications of dilated cardiomyopathy

A

ischemia
pulmonary edema
arrhythmia

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20
Q

treatment of dilated cardiomyopathy

A

heart transplant

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21
Q

2nd most common type of cardiomyopathy

A

hyperthrophic

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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
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23
Q

what causes hypertrophic cardiomyopathy

A

genetic
familial
inherited (autosomal dominant)

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24
Q

what is hypertrophic cardiomyopathy similar to?

A

LVH in AVS

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25
Q

Differences between secondary LVH and primary LVH

A

AVS vs hypertrophic cardiomyopathy
asymmetric concentric vs symmetric eccentric
LV even thickening vs LV septal thickening

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26
Q

Clinical presentation of hypertrophic cardiomyopathy

A

SUDDEN DEATH (young athlete)
arrhythmia
high QRS on EKG

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27
Q

What is restrictive cardiomyopathy

A

idiopathic fibrous cardiomyopathy
anatomically normal heart size, shape and thickness but abnormal composition
fibrous tissue in heart muscle
results in stiff muscle

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28
Q

what kind of dysfunction does restrictive cardiomyopathy cause?

A

dual dysfunction - SYSTOLIC and DIASTOLIC

cant contract and cant relax

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29
Q

Clinical presentation of restrictive cardiomyopathy

A 
arrhythmia
UNDERPERFUSION 
normal on chest x-ray
normal on echo
small QRS on EKG
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30
Q

symptoms patient presents with restrictive cardiomyopathy

A 
chest pain
fatigue
synchope
pain in legs
pulmonary edema
high pulse
arrhythmia
dyspnea
pressure abnormalities
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31
Q

how is biopsy of the heart performed and in what cases?

A

to diagnose infectious (viral) myocarditis or for restrictive cardiomyopathy via IJV

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32
Q

possible causes of restrictive cardiomyopathy

A

hemachromatosis (fortification of the wall)

amyloid (“gluing” of the wall)

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33
Q

what is restrictive cardiomyopathy similar to in physiology

A

tamponade (but its chronic)

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34
Q

what is trauma

A

mechanical event

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35
Q

what are two types of trauma and which one is more common

A

blunt - more common

sharp - more severe

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36
Q

what happens with blunt trauma

A

compression of the heart
increase in pressure
may cause arrhythmia
may cause cardiomortis

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37
Q

what is cardiomortis

A

sudden death from severe blunt trauma/compression to the heart

38
Q

what happens in sharp trauma

A

damage to chest and wall
penetration of tissue
hemothorax - bleeding in pleural cavity
tamponade

39
Q

major complications of sharp trauma

A

hemothorax - bleeding in pleaural cavity
seen as collapsed, white lung on chest x-ray
tamponade

40
Q

what type of trauma does MVA cause

A

inertial

aortic transection

41
Q

what is aortic transection

A

ripping of all layers of aortic wall

usually post MVA

42
Q

what is major complication of aortic transection

A

tamponade

43
Q

risk factors for atherosclerosis (CAD and IHD)

A

age over 50
gender - male
smoking

44
Q

what age population is considered to be children?

A

fetuses, birth to young teens (20s)

45
Q

most common heart disease in children

A

congenital defects

46
Q

what are congenital defects and when do they happen

A

abnormal structural changes during 1st trimester (3-8 weeks)

47
Q

most common congenital defect

A

cardiac congenital defects

48
Q

what organs does placenta function as in a fetus

A

lungs
kidneys
liver

49
Q

which way does fetal circulation work?

A

right to left

50
Q

which way does adult circulation work

A

left to right

51
Q

why is O2 concentration lower in fetal heart than adult

A

because of mixing of oxygenated and deoxygenated blood

52
Q

pathway fo fetal circulation

A 
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
Q

what are three shunts present in fetal circulation

A

foramen ovale
ductus venosus
ductus arteriosus

54
Q

how does fetus survive with lower O2 concentration in the heart

A

fetal RBC have different hemoglobin that can release more O2

55
Q

where is O2 concentration the highest in fetal circulation

A

umbilical vein and ductus venosus

56
Q

major differences between fetuses and adults (4)

A

placenta
flow direction
hemoglobin
shunts

57
Q

what events happen at birth (5)

A 
umbilical vein and ductus venosus collapse
lungs are airated
LA pressure increases
foramen ovale closes
ductus arteriosus closes within 1-3 days
58
Q

what are three fetal shunts and what do they become?

A

foramen ovale - fossa ovale
ductus arteriosus - ligamentum arteriosum
ductus venosus - ligamentum teres

59
Q

2 types of congenital defects (and their types)

A

Shunts (left to right and right to left)

obstructive

60
Q

most common congenital defect

A

Atrial Septal Defect (ASD)

Ventricular Septal Defect (VSD)

61
Q

Explain ASD and VSD (and PDA)

A

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
Q

non-cyanotic shunts

A

ASD
VSD
AVSD
PDA

63
Q

what will kids with ASD, VSD, and PDA suffer from

A

limited physical activities due to pulmonary hypertension

64
Q

What is AVSD

A

atrioventricular septal defect

65
Q

what is AVSD associated with

A

Down’s syndrome

66
Q

presentation of AVSD

A 
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
Q

what do all congenital defects have in common?

A

they produce extra heart sounds

68
Q

what is ToF

A

Tetrology of Fallot

69
Q

what is the most common right to left shunt

A

ToF

70
Q

What 4 things happen in ToF

A
  1. pulmonary valve stenosis
  2. RVH
  3. Overriding aorta - low systemic [O2]
  4. Shunt (PDA, VSD or ASD)
71
Q

what are complications of ToF

A 
cyanotic changes (underoxygenation)
exertional limitations
72
Q

what is TGV

A

transposition of great vessels (Aorta and Pulmonary valve switched)

73
Q

Presentation of TGV

A

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
Q

what is TVA

A

tricuspid valve atresia

75
Q

what is atresia

A

complete absence/closure

76
Q

mechanism of TVA

A

underdeveloped RV - RV HYPOPLASIA
RA dilation (parachuting)
PDA and Septal defect
atrilization of ventricle (prolapsing)

77
Q

presentation/complications of TVA

A

cyanosis - blue nails and skin

exertional limitations

78
Q

name all cyanotic conditions

A

right to left shunts

ToF
TGV
TVA
PT

79
Q

what is PT

A

persistent truncus

80
Q

what is the most common tricuspid valve defect

A

TVA

81
Q

what happens in PT

A 
common vessel trunk
one valve (similar to AVSD)
frog heart
CYANOTIC
(mixing of blood in common trunk)
82
Q

what are the obstructive congenital diseases

A

bicuspid aortic valve (AVS causing LVH)
AVA (aortic valve atresia)
Aortic Coarctation

83
Q

what is the most common obstructive congenital disease

A

AVS due to bicuspid valve

84
Q

what is AVA

A

aortic valve atresia
absence of aortic valve

ASD or VSD
PDA
hypoplasia of LV
Left to right but cyanotic

85
Q

what is obstruction of aorta called

A

coarctasion

86
Q

what are two types of coarctation

A

proximal and distal

87
Q

which type of coarctation is more severe

A

proximal

88
Q

what is coarctation associated with

A

turners syndrome (absence of one x chromosome in women)

89
Q

who is more likely to have coarctasion

A

men

90
Q

presentation of coarctation

A

pressure in pre-stenotic aorta increase
high blood pressure (in arms)
low blood pressure (underperfusion) in legs
can have collaterals

91
Q

how are congenital heart defects treated?

A

surgically

92
Q

how are ischemic diseases treated?

A

medically

Pathophysiology 2 (2 decks)

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