CP29 - Cardiovascular System 2

Question 1

what are some common causes for left sided heart failure?

Answer 1

hypertension - pressure overload

valvular disease - pressure and/or volume overload

MI - regional dysfunction with volume overload

Question 2

what is the pathogenesis of left sided heart failure?

Answer 2

one of the 3 common causes

cardiac workload increase

increase stresses on the wall of the heart

cause cell of the heart to stretch

hypertrophy of the heart and/or dilate

over a period of time, cardiac dysfunction

Question 3

what are some effects of left sided heart failure on the rest of the body?

Answer 3

kidney - pre-renal azotemia (retention of nitrogen within the body), salt and fluid retention

brain - irritability, decreased attention, stupor (near unconscious) then coma

lungs

Question 4

what can left sided heart failure cause to the lungs?

Answer 4

pulmonary congestion and oedema,

dyspnea
orthopnea - shortness of breath when lying flat 
PND (paroxysmal Nocturnal Dyspnea) 
blood tinged sputum 
cyanosis 
elevated pulmonary 'WEDGE' pressure

Question 5

what can cause right sided heart failure

Answer 5

left sided failure 
cor pulmonale (right sided heart failure caused by lungs disease)

Question 6

what are some symptoms for right sided heart failure

Answer 6

liver & spleen - passive congestion, congestive splenomegaly, ascites

kidney - insufficient perfusion of kidneys

pleura/pericardium - both effusions, transudates (leaking of fluids out to the pleura/pericardium)

peripheral tissue - increase in peripheral venous pressure

Question 7

what causes valvular heart disease

Answer 7

stenosis of any of the heart valvue

Question 8

what can valvular heart disease lead to?

Answer 8

regurgitation of the heart valvue or incompetence or insufficiency

Question 9

which 2 conditions cause 70% of all VHD?

Answer 9

aortic stenosis & mitral stenosis

Question 10

what can cause aortic stenosis?

Answer 10

calcification of a deformed valve or rheumatic heart disease

Question 11

what can cause mitral stenosis?

Answer 11

rheumatic heart disease

Question 12

what can cause rheumatic heart disease?

Answer 12

group A strep infection

- endocarditis, myocarditis, pericarditis

Question 13

how does rheumatic fever spread to the heart in a theoretical way

Answer 13

infection of group A step in the throat

haematonous spread to the hear through deposition on the coronary heart artery

then through the arteries it enters the heart chambers

Question 14

what are the clinical findings of acute rheumatic fever>

Answer 14

inflammation of the heart valves

Aschoff bodies present
Antischkow cells present
pancarditis
vegetations on chordae tendinae at leaflet junction

Question 15

what are Aschoff bodies ?

Answer 15

nodules of heart tissue characteristic to rheumatic fever

Question 16

what are antischkow cells

Answer 16

enlarged macrophages present in the heart

Question 17

what are some of the clinical features of chronic rheumatic fever?

Answer 17

thickened valves, commisural fusion, thick & short chordae tendinae

Question 18

what are some of the clinical presentation for aortic stenosis?

Answer 18

2X gradient pressure
LVH (but no hypertension)
angina, CHF, ischaemia

Question 19

what is stenosis ?

Answer 19

abnormal narrowing of a part of the body

Question 20

what are the 2 major types of regurgitations

Answer 20

aortic regurgitations & mitral regurgitations

Question 21

what are some of the common cause of aortic regurgitations

Answer 21

rheumatic fever, infections - endocarditis, aortic dilations

Question 22

what are some of the common causes of mitral regurgitation

Answer 22

mitral valve prolapse, infections, calcification on the mitral ring (annulus)

Question 23

what is regurgitation of the heart valve?

Answer 23

the heart valves are not closely adhered to each other leading to back flow of blood

Question 24

what causes mitral valve prolapse?

Answer 24

myxomatous degeneration of the mitral valve - can be associated with connective tissue disorders

Question 25

what can detect mitral valve prolapse?

Answer 25

esaily seen on echocardiogram

Question 26

what are some clinical presentation for mitral valve prolapse

Answer 26

mid-systolic 'click', holosystolic murmur if regurg. present occasional chest pain, dyspnea

Question 27

what environmental factors can cause congenital defect of the heart?

Answer 27

rubella, teratogens (agents which can cause congenital defect)

Question 28

what can happen systematically when L - R shunts happen?

Answer 28

no cyanosis, pulmonary hypertension, SIGNIFICANT pulmonary hypertension is IRREVERSIBLE

Question 29

what can happen systematically when R - L shunts happen?

Answer 29

cyanosis

Question 30

what congenital conditions can cause L - R shunt?

Answer 30

ASD, VSD, AVSD (atrioventricular septum defect), PDA (Patent ductus arteriosus)

Question 31

what causes arterial septum defect?

Answer 31

not patient foramen ovale

Question 32

what causes ventricle septum defect?

Answer 32

ventricular septum defect leading to shunt from L - R

Question 33

what condition does VSD associate with?

Answer 33

tetralogy of fallot

Question 34

what causes Patent ductus arteriosus?

Answer 34

patent of ductus arteriosus - most of the times, isolated from other conditions

Question 35

what other conditions does PDA associate with?

Answer 35

VSD, coarctation of aorta, pulmonary/aortic stenosis

Question 36

what keeps the PDA open

Answer 36

prostaglandin E1

Question 37

what is the cause of atrioventricular septum defects?

Answer 37

defective atrioventricular septum of the heart allowing blood to shunt form L - R

Question 38

what does AVSD associate with?

Answer 38

defective, inadequate AV valves

Question 39

what syndrome can have 1/3 of its cases to have AVSD?

Answer 39

Down syndrome

Question 40

what are some of the conditions which can cause blood to shunt from R - L

Answer 40

``` Tetralogy of Fallot Transposition of great arteries Truncus arteriosus Total anomalous pulmonary venous connection Tricuspid atresia ``` T = R - L

Question 41

what are the 3 major clinical features for tetralogy of fallot?

Answer 41

VSD, large, obstruction to RV outflow aorta overrides the VSD RVH

Question 42

what does TGA stands for?

Answer 42

Transposition of Great Arteries

Question 43

what is the cause of TGA?

Answer 43

So Transposition of the Great Arteries means that the pulmonary artery is where the aorta should be, carrying red blood from the left ventricle to the lungs, and the aorta is where the pulmonary artery should be, carrying blue blood around the body.

Question 44

how can TGA patients survival?

Answer 44

a shunt - PDA, VSD

Question 45

what is the treatment for TGA?

Answer 45

surgical switching of the 2 vessels

Question 46

what is truncus arteriolesis?

Answer 46

it is when there is only one valve for both aorta and pulmonary artery

Question 47

what does truncus arteriosis associate with?

Answer 47

VSD,

Question 48

what does truncus arteriosis cause/

Answer 48

produce systemic cyanosis and increased pulmonary blood flow

Question 49

what are some examples of obstructive congestive heart disease?

Answer 49

coarctation of aorta, pulmonary stenosis/atresia, | aortic stenosis/atresia

Question 50

what is coarctation on aorta?

Answer 50

it is a congenital localised constriction in the diameter of the aorta

Question 51

where is the usual position for coarctation of the aorta occur

Answer 51

just distal to the ductus arteriosus

Question 52

what is the serious/life threatening form of coarctation of aorta?

Answer 52

the coarctation of the aorta is proximal to the PDA