Congenital, Valvular, Myocardial and Pericardial Disease Flashcards
What are the common causes of congenital heart disease?
Genetic-environmental interactions (multifactorial inheritance)
Primary genetic factors 10%
Environmental factors 5%
What are the two main subtypes of cengenital heart disease?
Valvular disorders (e.g. PV stenosis) Shunts (acyanotic or cyanotic)
What problems occur in left to right heart shunts?
Can cause volume overload in the right side of the heart which can lead to:
- pulmonary hypertension
- right or left ventricular hypertrophy
- reversal of the shunt
What sort of murmur does a ventricular septal defect create?
It creates a pansystolic murmur that is heard at the left sternal border
What murmur is heard with a patent ductus arteriosus?
It causes a machinery mumur which is heard cotinously throuout systole and diastole
What are the signs of a right left heart shunt?
It causes hypoxic spells and cyanosis
What is the pathogenesis behind rheumatic fever?
Following a group A streptococcal infection antibodies are developed against these.
The antibodies cross react and attack the valves of the heart due to the strep mimicing human tissue
What are the clinical findings in actue rheumatic fever?
Polyarthritis causing pain in large joints however doesn’t cause permanent damage
Carditis -fibrinous pericarditis presents with precordial chest pain
Circular ring rashes
What are the clinical findings in mitral stenosis?
Dyspnea and rust coloured haemoptysis from the pulmonary hypertension and oedema
Atrial fibrillation from atrial dilation
What is the murmur heard in mitral stenosis?
An opening snap followed by a mid diastolic rumble
What are the causes of mitral valve regurgitation?
Mitral valve prolapse
Stetching of the valve by left heart failure
Dysfunction of the muscle following MI
Infective endocarditis
What are the clinical findings in mitral regurgitation?
Dysnea, inspiratory crackles and cough caused by left heart failure
Pansystolic murmur
What are the causes of aortic stenosis?
Calcification of AV in persons >60 years old
Congenital AV stenosis in persons <30 years old
What are the clinical findings in aortic valve stenosis?
SAD - syncope, angina and dyspnea
Harsh ejection systolic murmur heard in the 2nd intercostal space right sternal border
What are the clinical findings in aortic valve regurgitation?
Early diastolic murmur
Collapsing pulse
Quinckes sign
What are the clinical findings in tricuspid regurgitation?
Pansystolic murmur heard at the left parasternal border
Pulsatile liver due to blood returning to the vena cava
Ascites
Pulsating JVP
What are the common microbial causes of acute and subacute infective endocarditis?
Acute form is commonly caused by staphlococcus aureus
Subacute form is most commonly caused by streptococcus (most common cause of endocarditis)
What is the pathogenesis and clinical findings in infective endocarditis?
The bacteria that are infecting the heart cause turbulent flow which damages valves, fibrin and platelets adhere to the damaged areas. These vegetations destroy calce leaflets and this leads to regurgitation murmurs
Clinical findings:
- roth spots on retina
- splinter haemorrhages
- janeway lesions (painless)
- osler nodes (painful)
- Murmurs
How is a diagnosis made and what is the treatment for infective endocarditis?
Duke citeria
Diagnosis is made with a positive blood culture and then echocardiography or transoesphageal echo show the vegetations
Treatment is through broad spetrum antibiotics followed by specific antibiotics when the pathogen is identified
What is the duke criteria for infective endocarditis? (major and minor)
Major criteria - positive blood culture, positive echo
Minor criteria - predisposition, fever, vascular phenomenon
What is pericarditis and what are its main causes?
Inflammation or inflitration of the pericardium caused by: -idopatic (40%) -Infection - adenovirus, HIV -Drugs - cocaine -SLE
What are the clinical findings in pericarditis?
Fever Tachycardia Precordial chest pain Pericardial rub Muffled heart sounds if effusion present
What are cardioyopathies? What are the types
A group of diseases primarily involving the myocardium which cause myocardial dysfunction The types are: -Dilated -Hypertrophic -Restrictive
What are the causes of dilated cardiomyopathy?
General decrease in contractility causes global enlargement of the heart Caused by: Idiopathic (most common) Genetic Previous myocarditis Alcohol - thiamine deficiency Drugs - cocaine
