CP8-2 cardiovascular pathology 2

Question 1

What is the cardiac output equation?

Answer 1

heart rate x stroke volume = cardiac output

Question 2

What are two types of heart failure?

Answer 2

Systolic
Diastolic

Question 3

When is systolic heart failure diagnosed?

Answer 3

When ejection fraction is below 40% (between 40 and 60% is borderline)

Question 4

When does a patient have diastolic heart failure?

Answer 4

when they have a normal ejection fraction but reduced preload due to blood being in the ventricle before contraction

Question 5

What is left ventricular heart failure? What is its pathogenesis?

Answer 5

Insufficient left ventricular output due to increased pressure in left ventricle reducing cardiac output, lowering BP. Sympathetic overdrive then stimulates the renin-angiotensin-aldosterone system increasing HR, afterload and preload causing the heart to work harder, ventricular hypertrophy and

Question 6

How do patients with left ventricular heart failure present?

Answer 6

Dyspnoea
Fatigue
Palpitation
Peripheral oedema and ascites

Question 7

What are complications of left ventricular heart failure?

Answer 7

Arrhythmia
Sudden cardiac death

Question 8

What is right ventricular heart failure and what’s its pathogenesis?

Answer 8

Insufficient right ventricular output due to lung disease which causes pulmonary hypertension. This increases the workload of the right side of the heart leading to right ventricular hypertrophy, dilation and failure

Question 9

How do patients with right ventricular heart failure present?

Answer 9

Worsening breathlessness
Peripheral oedema
Existing lung pathology

Question 10

What is aortic stenosis?

Answer 10

Most common valvular heart disease usually due to senile calcification causing narrowing of the aortic valve.

Question 11

What 2 diseases are risk factors for aortic stenosis?

Answer 11

Congenital bicuspid aortic valve
Chronic rheumatic disease

Question 12

How might a patient with aortic stenosis present?

Answer 12

Chest pain
Dyspnoea
Syncope

Question 13

What causes a systolic ejection murmur to be heard in aortic stenosis?

Answer 13

as narrowing and calcification of the aortic valve results in left ventricular outflow obstruction which sounds like a murmur

Question 14

What is aortic regurgitation?

Answer 14

When an incompetent aortic valve causes back flow of blood back into the heart

Question 15

What can causes aortic regurgitation?

Answer 15

Anything that dilates the root of the aorta e.g.
Marfan’s syndrome
Ankylosing spondylitis
Congenital abnormalities

Question 16

How do patients with a aortic regurgitation present?

Answer 16

Dyspnoea
…

Question 17

What is the pathogenesis of mitral valve stenosis?

Answer 17

Reduced blood flow from left atrium to left ventricle increase pressure in left atrium increasing its size. This leads to pulmonary oedema and dyspnoea and increases risk of AF which can lead to clot formation and

Question 18

What is mitral stenosis?

Answer 18

Fusion of cusps of mitral valve

Question 19

When does mitral regurgitation occur?

Answer 19

When there is mitral valve prolapse or IHD
Can also happen in mitral valve prolapse when one leaflet prolapses into the left atrium during systole

Question 20

What is mitral regurgitation?

Answer 20

When blood leaks back through the mitral valve into the left atrium

Question 21

What are some common congenital heart diseases?

Answer 21

Atrial septal defects
Ventricular septal defects
Coarctation of the aorta
Tetralogy of fallout

Question 22

How does the ventricular septum develop?

Answer 22

From the apex of the heart/ventricles and grows caudally

Question 23

How does blood flow change with atrial and ventricular septum defects?

Answer 23

Causes a left to right shunting of blood due to increased pressure in left side of the heart

Question 24

What is the most common atrial septum defect?

Answer 24

Ostium secundum

Question 25

What is pressure like in the aorta around a coarctation of the aorta?

Answer 25

High BP before point of coarctation and low BP below point of coarctation

Question 26

How will a baby with coarctation of the aorta present?

Answer 26

Blue/cyanosed lower half of the body and pink upper half

Question 27

What are the four components of the tetralogy of fallot?

Answer 27

Pulmonary valve stenosis
Right ventricular hypertrophy (as heart has to work harder to pump blood past the stenosed pulmonary valve)
Ventricular septal defect
Overriding aorta - displacement of aorta over the ventricular septal defect