Cardiovascular Diseases- Heart Failure, Common Valvular Disease and common Congenital Heart Diseases Flashcards
What are the main causes of left sided heart failure?
- Hypertension (pressure overload)
- Valvular disease (pressure/volume overload)
- MI - dysfunction with volume overload
What happens to the left side of the heart with left sided heart failure?
Increased wall/cell stretch and cardiac work results in hypertrophy and dilatation, causing cardiac dysfunction
(LOW OUTPUT - effects on subsequent organs)
What are the signs/symptoms of left sided heart failure?
CONGESTION
- Pulmonary congestion and oedema
- heart failure cells
- dyspnea, orthopnea
- paroxysmal nocturnal dyspnea (PND)
- blood tingled sputum
- cyanosis
- increased pulmonary capillary wedge pressure (2-15 mmHg)
What is the cause of right sided heart failure?
Left sided heart failure
What does right sided heart failure cause?
Cor pulmonale (abnormal enlargement of right side of heart)
What are the signs and symptoms of right sided heart failure
- Splenomegaly and hepatomegaly
- ascites - accumulation of fluid in abdominal cavity
- oedema - periphery
- PLEURAL AND PERICARDIAL EFFUSION
- cyanosis
- Distention of jugular veins
What does heart failure present with at autopsy?
Cardiomegaly - enlargement of heart
- Dilatation of chambers
- hypertrophy of cardiac fibres with BOXCAR nuclei
What are the compensatory mechanisms of coronary heart failure?
RAAS - sodium and water retention
Adrenal medulla release of catecholamines (increases HR and therefore cardiac output)
Hypertrophy
What are the two major types of valvular heart disease?
- Stenosis (opening)
- regurgitation/incompetence
Where do most valvular heart diseases occur?
Left side (70% of valvular heart disease)
What is the main cause of aortic stenosis?
Calcification of deformed valve
but can be caused by rheumatic heart disease
Whats the main cause of mitral stenosis
Rheumatic heart disease
What infection is rheumatic heart disease usually caused by?
Group A strep infection
Causes endocarditis, myocarditis and pericarditis
What is endocarditis and how is it characterised?
Inflammation of endocardium, usually involving heart valves
- vegetations (lesions; mass of platelets, fibrin and microorganisms)
What are the macrophages in necrotic regions of rheumatic heart disease?
Anitschkow cells
What are the necrotic regions called
Aschoff bodies
What are the macroscopic signs of rheumatic heart disease?
Thickened valves (aortic and mitral)
Fusion of valves
Thick short chordae tendinae
What is the main cause oaf aortic stenosis?
Calcification of aortic valve
What can happen to the heart with chronic aortic stenosis?
Cardiac decompensation
Angina
Heart failure
What are the major causes of atrial valve regurgitation?
Rheumatic heart disease (stops valve opening and closing)
Infections e.g. endocarditis
Other conditions e.g. syphilis, marfans
What is the major cause of mitral valve regurgitation??
Mitral valve prolapse
What is mitral vale prolapse also known as
Myxomatous degeneration of the mitral valve - ‘floppy valve’ - occurs more in females
What are the clinical features of mitral valve prolapse?
Usually asymptomatic
Mid-systolic click
If regurgitation present, holosystolic murmur
Sometimes chest pain, dyspnea
How do congenital heart defects usually arise and what weeks?
Faulty embryogenesis (weeks 3-8)
What are the main causes of congenital heart defects?
Genetic e.g. trisomy 21, 13, 15, 18 (only 10%)
Environmental e.g. rubella, teratogens
What are the characteristics of Left to right shunt congenital defects?
- All have ‘D’ in their name
- not cyanotic
- Pulmonary hypertension - significant pulmonary hypertrophy is irreversible (worst case scenario)
What are the characteristics of right to left shunt congenital heart defects?
- All have T in their name
- cyanotic
- Venous emboli become systemic - paradoxical
What is ASD?
Atrial septal defect - malformation of atrial septum
- NOT DUE TO PATENT FORAMEN OVALE
- Left to right shunt
What are the three types of ASD and where do they occur?
Secundum - defective fossa ovale (most common)
Primum - next to AV valves, mitral cleft
Sinus venous - SVC with anomalous pulmonary veins draining to SVC or RA
What are the characteristics of Ventricular septal defects?
- Most common
- Occur in muscular or membranous (~90%) regions for he septa
- muscular involve holes - ‘swiss cheese’
- small holes usually close off, large can lead to pulmonary hypertension
What is the cause of patent ductus arteriosus?
Closure failure of the DA between the pulmonary artery to atria, resulting in L to right shunt (usually)
What is the clinical features of a PDA?
Continuous harsh, machinery-like murmur
What is the clinical feature of atrioventricular septal defect
Partial or complete communication between all 4 chambers
- 1/3 people with AVSD have down syndrome
What are the four features of tetralogy of fallot?
- Overriding aorta
- VS defect
- Pulmonary stenosis
- Right ventricular hypertension
What happens with transposition of the great arteries?
Aorta drains the right ventricle, the pulmonary artery drains the left ventricle
With transposition of great arteries, when is postnatal life at all possible?
Patent ductus arteriosus
VSD
What is truncus arteriosis and what is its clinical features?
Failure of truncus arteriosis to separate (common artery)
VSD
blood mixes at VSD
cyanosis and increased pulmonary flow (RVH)
What is tricuspid atresia?
Absent tricuspid valve - requires a VSD, ASD or PDA
What is total anomalous pulmonary venous connection?
Where the pulmonary veins are not connected to the LA (usually SVC)
ASD present (required for life)
What is coarticulation of aorta?
Narrowing of aorta
Infantile form serious, especially if proximal to patent ductus aerteriosus
