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brs (phase 1b) > (cardioresp) structural heart disease > Flashcards

(cardioresp) structural heart disease Flashcards

1
Q

what is the tricuspid valve?

A

the valve that allows blood to flow from the right atrium to the right ventricle

prevents blood from flowing backward

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2
Q

where is the tricuspid valve found?

A

attached to the walls of the right ventricles via the chordae tendinae (three cusps)

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3
Q

what is the mitral valve?

A

the valve that allows blood to flow from the left atrium to the left ventricle

prevents blood from flowing backward

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4
Q

where is the mitral valve found?

A

attached to the walls of the left ventricles via the chordae tendinae (two cusps)

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5
Q

how many cusps does the tricuspid valve have?

A

three

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6
Q

how many cusps does the mitral valve have?

A

two

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7
Q

what are the semi-lunar valves?

A

pulmonary valve (right ventricle)

atrial valve (left ventricle)

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8
Q

when does blood move past the semi-lunar valves?

A

when the ventricles contract, blood is pushed past the semi-lunar valves to either the lungs for oxygenation OR to the rest of the body

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9
Q

what is the heart made up of?

A

myocardium

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10
Q

what are the layers of the heart?

A

epicardium (epithelial cells)
myocardium
endocardium

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11
Q

define systole

A

contraction

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12
Q

define diastole

A

relaxation

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13
Q

what are the two main categories of structural heart disease?

A

congenital (from birth)

acquired (happen later in life)

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14
Q

what are examples of congenital structural heart diseases?

A

atrial septal defect (ASD)

ventricular septal defect (VSD)

coarctation of aorta (part of the aorta being narrower)

patent foramen ovale (PFO - opening bw two atria in atrial septum)

patent ductus arteriosus (extra blood vessel between aorta and pulmonary artery)

tetralogy of fallot (TFO)

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15
Q

what are examples of acquired structural heart diseases?

A

valvular dysfunctions (atrial/mitral stenosis or regurgitation)

cardiomyopathies

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16
Q

what is ventricular septal defect?

A

wall between two ventricles fails to develop properly so mixing of oxygenated and deoxygenated blood

17
Q

how does ventricular septal defect present?

A

poor weight gain, palpitations, poor feeding

18
Q

how is ventricular septal defect treated?

A

either if hole is small enough = closes on its own

OR

cardiac catherisation/open heart surgery

19
Q

what are the congenital defects in TFO?

A

tetralogy of Fallot

1) ventral septal defect (VSD)
2) pulmonary valve stenosis
3) misplaced aorta
4) right ventricular hypertrophy

20
Q

what is atrial septal defect?

A

hole in the septum between the atria

can occur during embryonic development if the two atria fail to develop properly

21
Q

what is coarctation of the aorta?

A

narrowing of wall of aorta SO blood has to force through a narrower exit

= so ventricle has to work harder to push blood out to the rest of the body (can lead to LVH)

22
Q

which heart valves are most commonly affected by stenosis or regurgitation?

A

aortic valve (1)

mitral valve

23
Q

define stenosis

A

narrowing

24
Q

define regurgitation

A

incompetence leading to backflow

25
Q

what is the most common valvular disease requiring treatment?

A

aortic stenosis

second most frequent cause of cardiac surgery

26
Q

what precedes aortic stenosis?

A

aortic sclerosis = aortic valve thickening without flow limitation

27
Q

what is aortic stenosis?

A

narrowing of the aortic valve

28
Q

how is aortic stenosis suspected?

A

auscultating heart of patient = early-peaking, shrill, systolic ejection murmur

confirmed by echocardiography

29
Q

why does aortic stenosis cause an early-peaking systolic ejection murmur?

A

due to aortic sclerosis (thickening of the aortic valve)

30
Q

what are the causes of aortic stenosis?

A

rheumatic heart disease

congenital heart disease

calcium build-up (age-related)

31
Q

what are the risk factors for aortic stenosis?

A

hypertension

high LDL levels

smoking

elevated CRP

congenital bicuspid valves (aortic valves have two instead of three cusps)

CKD

radiotherapy

old age

32
Q

what is bicuspid aortic valve disease and why is it a risk factor for aortic stenosis?

A

instead of having three cusps, the aortic valve has two cusps

1 = automatic narrowing (stenosis) of the aortic valve 
2 = more prone to wear and tear and infection (can lead to stenosis)

(can also cause aortic regurgitation)

33
Q

describe the pathophysiology of aortic stenosis

A

abnormal blood flow across the valve (e.g. due to bicuspid aortic valve) OR an unknown trigger

= vascular endothelium is damaged
= endocardial injury

= inflammatory process initiated (similar to atherosclerosis)
= leaflet fibrosis + deposition of calcium on the valve

= progressive fibrosis and calcium deposition limit aortic leaflet mobility
= aortic stenosis

34
Q

describe the pathophysiology of aortic stenosis caused by rheumatic disease

A

Streptococcus infection targets the valvular endothelium

= autoimmune inflammatory reaction
= calcification
= limits aortic leaflet mobility
= aortic stenosis

35
Q

what is rheumatic heart disease?

A

rheumatic heart disease starts as a sore throat from a bacterium called Streptococcus pyogenes

sometimes = repeated strep infections

= cause the immune system to react against the tissues of the body i.e. inflaming and scarring the heart valves

= rheumatic fever

(so rheumatic heart disease results then from the inflammation and scarring of heart valves caused by rheumatic fever)

36
Q

what is rheumatic fever?

A

when there are repeated strep infections cauing the body to produce an immune response against the body’s own tissues

= inflammation + scarring of the heart valves

37
Q

what are the complications of untreated or poorly managed aortic stenosis?

A

left ventricular hypertrophy

systolic heart failure

38
Q

how does aortic stenosis lead to left ventricular hypertrophy?

A

aortic stenosis blocks left ventricular outflow

the left ventricle needs to generate excess pressure to pump out sufficient amounts of blood

afterload increases

heart responds by increasing muscle muscle to allow the increased pressure requirements to be met

= LVH

39
Q

how does left ventricular hypertrophy lead to systolic heart failure?

A

long-standing, increased afterload = LVH

if aortic stenosis continues to worsen after this
= still increased afterload
= adaptive mechanism of LVH fails
= left ventricular wall stress increases

LVW stress increase causes systolic function to decline

= systolic heart failure

brs (phase 1b) (71 decks)

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