Congenital, Valvular, Myocardial and Pericardial Disease

Question 1

What are the common causes of congenital heart disease?

Answer 1

Genetic-environmental interactions (multifactorial inheritance)
Primary genetic factors 10%
Environmental factors 5%

Question 2

What are the two main subtypes of cengenital heart disease?

Answer 2

Valvular disorders (e.g. PV stenosis)
Shunts (acyanotic or cyanotic)

Question 3

What problems occur in left to right heart shunts?

Answer 3

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

Question 4

What sort of murmur does a ventricular septal defect create?

Answer 4

It creates a pansystolic murmur that is heard at the left sternal border

Question 5

What murmur is heard with a patent ductus arteriosus?

Answer 5

It causes a machinery mumur which is heard cotinously throuout systole and diastole

Question 6

What are the signs of a right left heart shunt?

Answer 6

It causes hypoxic spells and cyanosis

Question 7

What is the pathogenesis behind rheumatic fever?

Answer 7

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

Question 8

What are the clinical findings in actue rheumatic fever?

Answer 8

Polyarthritis causing pain in large joints however doesn’t cause permanent damage
Carditis -fibrinous pericarditis presents with precordial chest pain
Circular ring rashes

Question 9

What are the clinical findings in mitral stenosis?

Answer 9

Dyspnea and rust coloured haemoptysis from the pulmonary hypertension and oedema
Atrial fibrillation from atrial dilation

Question 10

What is the murmur heard in mitral stenosis?

Answer 10

An opening snap followed by a mid diastolic rumble

Question 11

What are the causes of mitral valve regurgitation?

Answer 11

Mitral valve prolapse
Stetching of the valve by left heart failure
Dysfunction of the muscle following MI
Infective endocarditis

Question 12

What are the clinical findings in mitral regurgitation?

Answer 12

Dysnea, inspiratory crackles and cough caused by left heart failure
Pansystolic murmur

Question 13

What are the causes of aortic stenosis?

Answer 13

Calcification of AV in persons >60 years old

Congenital AV stenosis in persons <30 years old

Question 14

What are the clinical findings in aortic valve stenosis?

Answer 14

SAD - syncope, angina and dyspnea

Harsh ejection systolic murmur heard in the 2nd intercostal space right sternal border

Question 15

What are the clinical findings in aortic valve regurgitation?

Answer 15

Early diastolic murmur
Collapsing pulse
Quinckes sign

Question 16

What are the clinical findings in tricuspid regurgitation?

Answer 16

Pansystolic murmur heard at the left parasternal border
Pulsatile liver due to blood returning to the vena cava
Ascites
Pulsating JVP

Question 17

What are the common microbial causes of acute and subacute infective endocarditis?

Answer 17

Acute form is commonly caused by staphlococcus aureus

Subacute form is most commonly caused by streptococcus (most common cause of endocarditis)

Question 18

What is the pathogenesis and clinical findings in infective endocarditis?

Answer 18

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

Question 19

How is a diagnosis made and what is the treatment for infective endocarditis?

Answer 19

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

Question 20

What is the duke criteria for infective endocarditis? (major and minor)

Answer 20

Major criteria - positive blood culture, positive echo

Minor criteria - predisposition, fever, vascular phenomenon

Question 21

What is pericarditis and what are its main causes?

Answer 21

Inflammation or inflitration of the pericardium
caused by:
-idopatic (40%)
-Infection - adenovirus, HIV
-Drugs - cocaine
-SLE

Question 22

What are the clinical findings in pericarditis?

Answer 22

Fever
Tachycardia
Precordial chest pain
Pericardial rub
Muffled heart sounds if effusion present

Question 23

What are cardioyopathies? What are the types

Answer 23

A group of diseases primarily involving the myocardium which cause myocardial dysfunction
The types are:
-Dilated
-Hypertrophic
-Restrictive

Question 24

What are the causes of dilated cardiomyopathy?

Answer 24

General decrease in contractility causes global enlargement of the heart
Caused by:
Idiopathic (most common)
Genetic
Previous myocarditis
Alcohol - thiamine deficiency
Drugs - cocaine

Question 25

What are the clinical findings in dilated cardiomyopathy?

Answer 25

Signs of heart failure

Arrhythmias

Question 26

What is the pathophysiology behind hypertrophic cardiomyopathy?

Answer 26

Autosomal dominant in 70% of cases
When there is hypertrophy of the interventricular septum, this causes obstruction of the left ventricular outflow tract
Most common cause of sudden death in young athletes

Question 27

What are the clinical findings in hyertrophic cardiomyopathy?

Answer 27

Systolic ejection murmur
Murmur intensity increases with decreased preload e.g. standing
Angina or syncope with exercise

Question 28

What is the treatment for hypertrophic cardiomyopathy?

Answer 28

Avoid strenuous exercise
Avoid drugs that decrease preload e.g. diuretics
Beta blockers are main treatment

Question 29

What is the pathophysiology and causes of restrictive cariomyopathy?

Answer 29

Decreased ventricular compliance caused by:
-amyloidosis
-fibrosis after heard surgery
-sarcoidosis
This causes dilation of the atria due to decreased ventricle compliance

Question 30

What is the most common cadiac tumour?

Answer 30

Myxoma

It is a primary mesenchymal tumour that blocks mitral valve often