Heart and Valvular Diseases Flashcards
1
Q
Most common valvular disease
A
Aortic Valve Stenosis (AVS)
2
Q
2nd most common valvular disease
A
Mitral valve prolapse (MVP)
3
Q
Most significant component of the heart
A
muscle
4
Q
What has to be done if IHD/CHD it very severe?
A
invasive treatment
5
Q
What is LUB sound produced by?
A
closing of AV valves
6
Q
Sights of infarct fro septic embolism (5)
A
- spleen 2. kidney 3. eye 4. brain 5. skin
7
Q
Other names for MVP (3)
A
Mitral valve insufficiency Mitral valve incompetence Mitral valve regurgitation
8
Q
What are two theories for RHD?
A
- bacteria spread to heart and damage the valves directly. 2. bacteria are similar in composition to tissue that makes up the valves. Immune system tries to fight bacteria and damages the valves in the process because it can’t tell the difference.
9
Q
Most common cause of AVS in young adults
A
congenital abnormality - bicuspid aortic valve
10
Q
Least common type of angina and population it effects
A
Prinz-Metal Angina usually young people spontaneous spasmic closure of arteries.
11
Q
Most common complication of angina and when does it happen.
A
arrhythmia due to damaged muscular layer and interruption of electrical signals. can happen any time after incident
12
Q
What is MVP and what is the cause?
A
one cusp of mitral valve is much larger than the other. It hangs loose instead of being tight and prolapses during systole, allowing blood back into left atrium thought to be congenital
13
Q
what does most common valvular disease effect
A
left side of the heart
14
Q
Most sensitive modality for evaluation of the heart
A
echocardiography
15
Q
best modality for evaluation of the heart
A
echocardiography
16
Q
most sensitive modality for chest eval
A
chest CT
17
Q
Most common disease in US overall and why
A
AVS because its so common in people over the age of 50 and that age group is a large portion of our population
18
Q
Most common cause of CHD
A
atherosclerosis (narrowing of the artery)
19
Q
Presentation of RHD
A
Mitral Valve Stenosis (MVS)
20
Q
What part of the heart is more commonly effected by RHD?
A
Left heart - mitral valve
21
Q
most common heart disease (in US and world)
A
Ischemic Heart Disease (IHD)
22
Q
most common type of IHD
A
Exertional Ischemia (Stable angina)
23
Q
presentation of AVS (3)
A
- synchopy - loss of consciousness due to insufficient blood supply to the brain 2. cold legs/feet - insufficient blood supply 3. murmur - additional sounds to S1 and S2
24
Q
areas RCA supplies
A
right atrium and ventricle intraventricular septum (posteriorly) electrical system (posteriorly)
25
What structures are seen by chest x-ray
heart and diaphragm
26
classical presentation of unstable angina
chest pain at night
27
Best tool for evaluation of heart valves
echocardiography (TTE or TEE)
28
location of the heart
mediastinum in thoracic cavity. Twisted to the left and turned forward
29
What is diastole?
filling of the heart closed pulmonary/aortic valve at the end of diastole, AV valves close - lub
30
2nd most common heart disease in US
valvular disease
31
#1 cause of death in the US
IHD
32
Presentation of endocarditis
1. fever 2. pain 3. malaise
33
Clinical presentation of IHD (7)
1. Cardiac Angina pressure on chest/dull pain radiates to left shoulder and jaw 2. nausea/vomiting 3. sweating 4. dyspnea (shortness of breath) 5. pale 6. nervous/fear 7. weakness
34
What is a pericardial sac?
space formed by visceral and parietal layers of pericardium allowing smooth motion and contraction
35
what is the narrowest part of heart called and where is it found?
apex. found at the bottom
36
ALL possible complications of angina in chronological order (4)
1. arrhythmia - anytime 2. Mitral Valve Prolapse (MVP) - 2-3 days after damaged papillary muscle can't close mitral valve leads to pulmonary edema 3. Tamponade - 7-10 after rupture through the interface filling of pericardial sac with blood compresses the heart needs to be released immediately 4. Aneurism - years after stretching of ischemic tissue most common in the ventricle
37
What is "rhythm"
interval between contractions/QRS complexes. should be even
38
Young male patient with malaise, fever and chest pain. Differential diagnosis?
Right sided endocarditis due to IVDA
39
life expectancy with untreated unstable angina
3 months
40
what it RHD
Rheumatic Heart Disease - chronic
41
Most common valvular disease in young adults
MVP
42
most common cause of AVS
age (over 50)
43
Complications of endocarditis (4)
1. Valvular incompetence (bacteria eats a hole in the valve) 2. Valvular stenosis (vegetation blocks the valve) 3. Abscess of myocardium (bacteria damages heart walls) 4. Septic Embolism!!!!!!!!! vegetation breaks off and spreads infection plus may cause an infarct
44
size of the heart
size of a fist less than 350g 4% of body weight
45
Mechanism of RHD/MVS (5)
1. dilation of left atrium due to increase in pressure from stenotic valve 2. pulmonary edema after regurgitation to lungs (initially) vasculature of lungs is remodeled to accommodate high volume 3. increased pressure in lungs 4. regurgitation to right ventricle 5. right ventricle hypertrophies
46
how much fluid is found in the pericardial sac?
10cc
47
What are two types of MVP and which one is more common. What are the differences
Chronic - more common. Atrial dilation Acute - less common. Due to prolapse of valve after IHD. Does not have dilation. Immediate flush pulmonary edema. More common in older people because IHD risk factor is age
48
areas left anterior descending artery supplies
anterior left ventricle and intraventricular septum
49
components of electrical circuit of the heart
SA node AV node Bundle of His Perkinje Fibers
50
true/false acute stenosis of a valve is very uncommon
true
51
What is LVH and how can it be diagnosed
Left Ventricle Hypertrophy increase in myocardium surrounding LV in order to force blood out through stenotic valve can be seen as cardiomegaly can be seen as high QRS on EKG leads to IDH because of increased metabolic demand and stagnant supply
52
What is the significance of electrical circuit of the heart?
self-generated reduplicated system (multiple backups)
53
Specific clinical presentation of RHD/MVS
thickness of ventricles is flipped. right ventricle is thicker than left.
54
TEE presentation of endocarditis
vegetation on tricuspid valve
55
what is endocarditis
inflammation of endocardium (including valves) due to infection
56
when does ischemia become irreversible and what is it called?
after 6 hours. Myocardial infarction (MI)
57
Most common modality for chest eval
chest x-ray
58
Arrhythmia
abnormal heartbeat
59
functions of the heart and how they're evaluated (2)
mechanical pump - pulse and auscultation electrical engine - EKG
60
What does an EKG do?
measures electrical activity of the heart
61
Most common type of IHD
Stable Angina
62
evaluation/diagnosis of IHD (4)
1. EKG abnormal T wave 2. Echocardiography damage to heart muscle 3. blood tests increase in troponin 4. chest x-ray
63
treatment of Stable Angina (6)
1. rest 2. oxygen 3. nitroglycerine (NTG) = vasodilator 4. aspirin 5. heparin 6. pain management
64
invasive treatment for atherosclerosis (3)
1. angioplasty 2. tPA 3. coronary bipass
65
What are infarctions zones related to and how can it be seen?
related to effected vessels. can be seen on 12 lead EKG
66
what structures are not seen by chest x-ray
lungs and stomach
67
function of the heart
mechanical pump electrical engine
68
cause of endocarditis
bacteremia! due to pneumonia (special bacteria) due to bad valves (regular bacteria)
69
Diagnostic tool for endocarditis
TEE - shows vegetation growth on valves and walls
70
treatment for endocarditis (2)
1. IV antibiotics (for 6 months) 2. Valve repair
71
what parts of the heart do you seen on chest x-ray?
RA - right RV - bottom LV - left pulmonary veins - upper left out pouches
72
insufficiency/incompetence
can't close completely
73
What population is RHD common in and why
immigrants because developing nations don't always treat strep throat with antibiotics and RHD is a long term complication.
74
What is the heart characterized by?
Rate and Rhythm
75
What is ischemia
insufficient, interrupted or abnormal blood supply
76
layers of the heart
endothelium/endocardium - inside myothelium - middle muscle pericardium/epicardium - outside separated into visceral and parietal layers
77
What do P, QRS complex and T stand for?
P - polarization of atria QRS - polarization of ventricles T - depolarization of ventricles
78
what happens in unstable angina
there is a thrombus causing severe obstruction
79
cause of right sided endocarditis
IVDA - intravenous drug abusers
80
Cause of stable angina
insufficient supply for increase in demand
81
presentation/complication of right sided endocarditis
PULMONARY INFARCT triangular necrosis in the lungs (seen via chest x-ray)
82
What is "rate" of the heart?
number of QRS complexes per minute. Pulse
83
What is the second type of angina (not common)
unstable angina
84
Mechanism of MVP (8)
1. blood regurgitates to left atrium 2. pressure in left atrium increases 3. left atrium dilates 4. blood regurgitates back to lungs via pulmonary veins 5. change in pressure in lungs - pulmonary edema 6. dyspnea 7. rales 8. arrhythmia due to displacement of SA node in atrial dilation
85
Infection of the heart
endocarditis
86
risk factor for AVS
age over 50
87
normal size of heart on chest x-ray
less than half of thoracic/lung field
88
What is systole?
Ventricular polarization Contraction of the ventricles AV valves are closed at the end of systole, pulmonary and aortic valves close - dub
89
Coronary arteries
right coronary artery left coronary artery/left main artery left anterior descending artery circumflex artery
90
What percentage of strep throats progress to RHD?
10% 90% are self-limiting
91
what are the risk factors for IHD
age over 50
92
Most common valvular diseases in order
1. Aortic valve stenosis 2. Mitral valve prolapse 3. Mitral valve stenosis / Rheumatic heart disease
93
mechanism/complications of AVS (4)
1. obstruction of flow through aortic valve results in increased pressure in Left Ventricle 2. LV thickens LVH (left ventricle hypertrophy) 3. increase in metabolic demand in LV can lead to IHD 4. Change in intraventricular septum causes change in electrical circuit and leads to arrhythmia
94
areas Circumflex artery supplies
left atria and base of left ventricle
95
what is stenosis
can't open completely obstruction to flow during systole
96
Most common cause of IHD
Coronary Heart Disease (CHD)
97
risk factors for endocarditis
valvular disease invasive procedures
98
What are coronary arteries embedded in?
epicardial fat
99
Difference between skeletal and cardiac muscle
cardiac- one or two nuclei
skeletal - many nuclei
cardiac - intercalated disks
100
Contractile unit of cardiac muscle
sarcomere
101
basic unit of electrical stimulation
action potential
102
three types of cells in myocardium
pacemaker cells (SA and AV nodes)
rapidly conducting tissue (Purkinje fibers)
cardiac muscle
103
