CV Path2

Question 1

what is the definition of heart failure / congestive cardiac failure (CCF)

Answer 1

inability fo 4th heart to pump enough blood needed to meet the metabolic demands of tissue

Question 2

what is the insidious / sudden effect of heart failure

Answer 2

I - chronic workoverlaod such as hypertension and valve disease

s - acute haemodynamic stress such as fluid overload and large MI

Question 3

what are some common causes of heart failure

Answer 3

smoking, obesity, IHD, hypertension, diabetes, high cholesterol

Question 4

what is the pathogenesis of heart failure

Answer 4

increased cardiac work - wall stress - cell stretch - hypertrophy or dilation via frank starling

Question 5

what do the key clinical features of heart failure depend on

Answer 5

whether its left or right sided heart failure

Question 6

what are the key clinical features of left sided heart failure

Answer 6

low CO and hypo perfusion
pulmonary congestion = pulmonary oedema, dysponea, PND, cyanosis
reduced kidney perfusion and RAAS activation

Question 7

what are the key clinical features of right sided heart failure

Answer 7

engorgemont of portal and systemic venous return
liver and spleen congestion = oedema and ascites
systemic venous congestion - pleural and pericardial effusions

Question 8

what are common examples of valvular heart diseases

Answer 8

rheumatic heart disease - aortic stenosis, disorders of valvular regurgitation

Question 9

what is a problem with valvular opening called

Answer 9

stenosis

Question 10

what is acquired aortic stenosis and what doe sit lead to

Answer 10

causes left ventricular hypertrophy (but not hypertension) and ischaemia - leads to cardiac decompensation, angina and CCF

Question 11

what is the most common valvular abnormality and what causes it

Answer 11

calcific aortic stenosis

age related wear and tear

Question 12

what causes acquired mitral stenosis

Answer 12

rheumatic heart disease

group a strep infection (pyogenes)

Question 13

what are the clinical features of rheumatic heart disease

Answer 13

mitral valve stenosis with infective endocarditis and classic pancarditis

Question 14

what is used to diagnosis rheumatic heart disease

Answer 14

the jones criteria

Question 15

what would problems with closing chambers and valves in the heart lead to

Answer 15

regurgitation, incompetence and insufficiency

Question 16

what are some causes of aortic regurgitation

Answer 16

RA
syphillis
marfans syndrome

Question 17

what is a mitral valve prolapse, causes and clinical features

Answer 17

myxomatous degeneration of the mitral valve causing a floppy valve

idiopathic but associated with connective disorder such as marfans

murmur from regurgitation, dyspnoea, chest pain

Question 18

what is the definition of congenital heart diseases

Answer 18

abnormalities of the heart and the great vessels present from birth - may not appear till later in life

Question 19

what are some environmental / sporadic causes of congenital heart diseases

Answer 19

E - rubella, gestational diabetes, teratogens

s - downs syndrome, turners

Question 20

between which weeks do congenital heart defects occur during gestation

Answer 20

faulty embryogenesis from week 3 -8

Question 21

what are 4 examples of L - R shunts in congenital heart defects and what are two common effects

Answer 21

all have D’s in their name
no cyanosis so live longe r
pulmonary hypertension

atrial septal defect (ASD)
ventricular septal defect (VSD)
atrioventricular septum defect (AVSD)
patent ductus arteriosus (PDA)

Question 22

describe an atrial septal defect and the prognosis ,which type is most common

Answer 22

abnormal atrial septum allowing communication of blood between the two atria (not patent foramen ovale)
secumdum - most common
asymp until adult hood - low mortality if treated

Question 23

what is the most common (CHD) congenital heart disease

Answer 23

ventricular septal defect

Question 24

which heart defect would you see swiss cheese septum

Answer 24

congenital heart defect

ventricular septal defect

Question 25

how do yo remember congenital heart defects which shunt from R to L and what is the common feature

Answer 25

all have T’s in their name

cause cyanosis - deoxygenated blood bypasses the lungs into systemic circulation so less circulating O2

Question 26

what are the main types of R - L shunting congenital diseases

Answer 26

tetralogy of fallout 
coarctation of aorta 
aortic stenosis 
pulmonary valve stenosis
(atresias)

Question 27

describe tetralogy of fallout - causes and key clinical features

Answer 27

transposition of great arteries, truncus arteriosus, total anomalous pulmonary venous connection, tricuspid atresia

VSD
sub-pulmonary stenosis
aorta overrides the VSD
RVH

caused by anterosuperior displacement of the infundibular septum during embryogenesis

Question 28

who is affected more by coarctation of aorta

Answer 28

males - females 2:1 but females with turners frequently have it

Question 29

what are the two forms of coarctation of aorta

Answer 29

infantile - (open PDA) cyanosis in lower half of the body

adult - closed ductus )no PDA) hypertension in upper extremities with hypotension in lower = claudication and coldness

Question 30

what is collateral circulation caused by in coarctation of the aorta

Answer 30

intercostal and internal mammary arteries