Cardiovascular Diseases 2

Question 1

What is the pathogenesis of LSHF?

Answer 1

1) Hypertension, valvular disease & MI lead to inc cardiac work by pressure or vol overload
2) Leads to inc wall stress
3) Leads to cell stretch
4) Leads to hypertrophy &/or dilation- inc heart size&mass, fibrosis, abnormal proteins, inadequate vasculature
5) Results in cardiac dysfunction-HF, arrhythmias, neurohumoral stimulation

Question 2

What can LSHF affect?

Answer 2

• Kidneys= Na&fluid retention
• Brain=irritability, dec attention, stupor,coma
• Lungs=pulmonary congestion & oedema, heart failure cells

Question 3

How would congestive left heart failure present?

Answer 3

• Dyspnoea
• Orthopnoea
• PND
• Blood tinged sputum
• Cyanosis
• Elevated pulmonary pressure

Question 4

What are the signs & symptoms of right sided heart failure?

Answer 4

• Liver & spleen= passive congestion, nutmeg liver, ascites, congestive splenomegaly
• Kidneys
• Pleura/pericardium- transudates, pleural & pericardial effusions
• Peripheral tissues= elevated peripheral venous pressure
• Fatigue
• Oedema
• Cyanosis

Question 5

How does RSHF occur?

Answer 5

• Result of left heart failure

- Cor Pulmonale

Question 6

What are features of chronic heart failure?

Answer 6

• Cardiomegaly
• Chamber dilatation
• Hypertrophy of myocardial fibres

Question 7

What are the 2 types of valvular heart disease?

Answer 7

• Opening problems: Stenosis

- Closing problems: Regurgitation or incompetence

Question 8

What are the main causes of aortic & mitral stenosis?

Answer 8

• A= calcification of a deformed valve, rheumatic HD

- M= Rheumatic HD

Question 9

What is rheumatic heart disease?

Answer 9

• Hypersensitivity reaction
• Follows a group A strep infection
• Antibodies directed against M proteins of strep
• Cross reaction for pharynx to heart cells by CD4+ T cells producing cytokines that activate macrophages
• Leads to pancarditis: endo/myo/pericarditis

Question 10

What are signs of acute & chronic valvular HD?

Answer 10

• Acute= inflammation, Aschoff bodies, anitschkow cells, pancarditis, vegetation on chordae tendinae at leaflet junctions
• Chronic= thickened valves, commissary fusion, which, short chordae tendinae

Question 11

Describe aortic stenosis

Answer 11

• x2 gradient pressure
• left V hypertrophy (no hypertension)
• Ischaemia
• Cardiac decompensation
• Angina
• CHF

Question 12

What is mitral annular calcification?

Answer 12

• Calcification of mitral skeleton
• No dysfunction
• Regurgitation but stenosis possible

Question 13

What are the main causes of aortic & mitral regurgitations?

Answer 13

• A= rheumatic, infectious, aortic dilatations (syphilis, RA, marfan)
• M= mitral valve prolapse, infectious, fen-phen, papillary muscles, calcification of mitral ring

Question 14

What is a mitral valve prolapse associated with?

Answer 14

• Connective tissue disorders (floppy valve)
• Myxomatous degeneration of mitral valve
• Mid-systolic click

Question 15

Name some cardiac congenital malformations

Answer 15

• V/A septal defect
• Pulmonary stenosis
• Patent ductus arteriosus
• Atrioventricular septal defect
• ALL ABOVE L–>R SHUNT= pulmonary hypertension
• Transposition of great arteries
• Truncus arteriosus
• Tricuspid atresia
• ALL ABOVE R–>L SHUNT= cyanosis, venous emboli become systemic

Question 16

What environmental factors can affect the heart?

Answer 16

• Rubella

- Teratogens

Question 17

Describe atrial septal defects

Answer 17

• Not patent foramen oval
• Asymptomatic till adulthood
• Secundum-90%, defective fossa ovalis
• Primum-next to AV valve, mitral cleft
• Sinus venosus: next to SVC

Question 18

Describe ventricular septal defects

Answer 18

• Most common CHD defect
• Tetralogy of ballot
• 90% involve membranous septum
• Muscular septum invloved= multiple holes
• Large progress to pulmonary hypertension

Question 19

Describe a patent ductus arteriosus

Answer 19

• 90% isolated
• Associated with VSD, coarctation of aorta, pulmonary/aortic stenosis
• Continuous harsh machinery-like murmur

Question 20

Describe AVSD

Answer 20

• Defective, inadequate AV valves
• Partial/complete= all 4 chambers communicating freely
• 1/3rd have Down’s syndrome

Question 21

What is tetralogy of fallot?

Answer 21

1) large VSD
2) Obstruction to RV outflow
3) Aorta overrides VSD
4) RVH
- Survival depends on severity of subpulmonic stenosis

Question 22

What is transposition of the great arteries?

Answer 22

• Abnormal formation of truncal & aortopulmonary septa
• Shunt needed for survival
• PDA or PFO= unstable shunt
• RV>LV in thickness

Question 23

What is a truncus arteriosis?

Answer 23

• Developmental failure of separation of truncus arteriosus
• Associated VSD
• Systemic cyanosis & inc pulmonary blood flow

Question 24

What is tricuspid atresia?

Answer 24

• Hypoplastic RV
• High mortality
• Shunt needed ASD, VSD, PDA

Question 25

What is a total anomalous pulmonary venous connection?

Answer 25

• Pulmonary veins do not go into LA but into L innominate vein or coronary sinus
• Hypoplastic LA

Question 26

What are the main types of obstructive CHD?

Answer 26

• Coarctation of aorta

- Pulmonary/aortic stenosis/atresia

Question 27

What are the types of aortic stenosis/atresia?

Answer 27

• Valvular: severe hypoplastic LV= fatal
• Subvalvular: aortic wall thick below cusps
• Supravalvular: aortic wall thick above cusps in ascending aorta

Question 28

What happens to the renin aldosterone/ADH system in patients with heart failure?

Answer 28

Renin-Increase

ADH-inappropriately high causing hyponatraemia