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Pathophysiology 2 > Heart and Valvular Diseases > Flashcards

Heart and Valvular Diseases Flashcards

1
Q

Most common valvular disease

A

Aortic Valve Stenosis (AVS)

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2
Q

2nd most common valvular disease

A

Mitral valve prolapse (MVP)

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3
Q

Most significant component of the heart

A

muscle

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4
Q

What has to be done if IHD/CHD it very severe?

A

invasive treatment

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5
Q

What is LUB sound produced by?

A

closing of AV valves

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6
Q

Sights of infarct fro septic embolism (5)

A
  1. spleen 2. kidney 3. eye 4. brain 5. skin
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7
Q

Other names for MVP (3)

A

Mitral valve insufficiency Mitral valve incompetence Mitral valve regurgitation

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8
Q

What are two theories for RHD?

A
  1. 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.
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9
Q

Most common cause of AVS in young adults

A

congenital abnormality - bicuspid aortic valve

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10
Q

Least common type of angina and population it effects

A

Prinz-Metal Angina usually young people spontaneous spasmic closure of arteries.

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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

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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

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13
Q

what does most common valvular disease effect

A

left side of the heart

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14
Q

Most sensitive modality for evaluation of the heart

A

echocardiography

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15
Q

best modality for evaluation of the heart

A

echocardiography

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16
Q

most sensitive modality for chest eval

A

chest CT

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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

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18
Q

Most common cause of CHD

A

atherosclerosis (narrowing of the artery)

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19
Q

Presentation of RHD

A

Mitral Valve Stenosis (MVS)

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20
Q

What part of the heart is more commonly effected by RHD?

A

Left heart - mitral valve

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21
Q

most common heart disease (in US and world)

A

Ischemic Heart Disease (IHD)

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22
Q

most common type of IHD

A

Exertional Ischemia (Stable angina)

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23
Q

presentation of AVS (3)

A
  1. 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
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24
Q

areas RCA supplies

A

right atrium and ventricle intraventricular septum (posteriorly) electrical system (posteriorly)

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25
Q

What structures are seen by chest x-ray

A

heart and diaphragm

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26
Q

classical presentation of unstable angina

A

chest pain at night

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27
Q

Best tool for evaluation of heart valves

A

echocardiography (TTE or TEE)

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28
Q

location of the heart

A

mediastinum in thoracic cavity. Twisted to the left and turned forward

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29
Q

What is diastole?

A

filling of the heart closed pulmonary/aortic valve at the end of diastole, AV valves close - lub

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30
Q

2nd most common heart disease in US

A

valvular disease

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31
Q

1 cause of death in the US

A

IHD

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32
Q

Presentation of endocarditis

A
  1. fever 2. pain 3. malaise
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33
Q

Clinical presentation of IHD (7)

A
  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
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34
Q

What is a pericardial sac?

A

space formed by visceral and parietal layers of pericardium allowing smooth motion and contraction

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35
Q

what is the narrowest part of heart called and where is it found?

A

apex. found at the bottom

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36
Q

ALL possible complications of angina in chronological order (4)

A
  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
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37
Q

What is “rhythm”

A

interval between contractions/QRS complexes. should be even

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38
Q

Young male patient with malaise, fever and chest pain. Differential diagnosis?

A

Right sided endocarditis due to IVDA

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39
Q

life expectancy with untreated unstable angina

A

3 months

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40
Q

what it RHD

A

Rheumatic Heart Disease - chronic

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41
Q

Most common valvular disease in young adults

A

MVP

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42
Q

most common cause of AVS

A

age (over 50)

43
Q

Complications of endocarditis (4)

A
  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
Q

size of the heart

A

size of a fist less than 350g 4% of body weight

45
Q

Mechanism of RHD/MVS (5)

A
  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
Q

how much fluid is found in the pericardial sac?

A

10cc

47
Q

What are two types of MVP and which one is more common. What are the differences

A

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
Q

areas left anterior descending artery supplies

A

anterior left ventricle and intraventricular septum

49
Q

components of electrical circuit of the heart

A

SA node AV node Bundle of His Perkinje Fibers

50
Q

true/false acute stenosis of a valve is very uncommon

A

true

51
Q

What is LVH and how can it be diagnosed

A

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
Q

What is the significance of electrical circuit of the heart?

A

self-generated reduplicated system (multiple backups)

53
Q

Specific clinical presentation of RHD/MVS

A

thickness of ventricles is flipped. right ventricle is thicker than left.

54
Q

TEE presentation of endocarditis

A

vegetation on tricuspid valve

55
Q

what is endocarditis

A

inflammation of endocardium (including valves) due to infection

56
Q

when does ischemia become irreversible and what is it called?

A

after 6 hours. Myocardial infarction (MI)

57
Q

Most common modality for chest eval

A

chest x-ray

58
Q

Arrhythmia

A

abnormal heartbeat

59
Q

functions of the heart and how they’re evaluated (2)

A

mechanical pump - pulse and auscultation electrical engine - EKG

60
Q

What does an EKG do?

A

measures electrical activity of the heart

61
Q

Most common type of IHD

A

Stable Angina

62
Q

evaluation/diagnosis of IHD (4)

A
  1. EKG abnormal T wave 2. Echocardiography damage to heart muscle 3. blood tests increase in troponin 4. chest x-ray
63
Q

treatment of Stable Angina (6)

A
  1. rest 2. oxygen 3. nitroglycerine (NTG) = vasodilator 4. aspirin 5. heparin 6. pain management
64
Q

invasive treatment for atherosclerosis (3)

A
  1. angioplasty 2. tPA 3. coronary bipass
65
Q

What are infarctions zones related to and how can it be seen?

A

related to effected vessels. can be seen on 12 lead EKG

66
Q

what structures are not seen by chest x-ray

A

lungs and stomach

67
Q

function of the heart

A

mechanical pump electrical engine

68
Q

cause of endocarditis

A

bacteremia! due to pneumonia (special bacteria) due to bad valves (regular bacteria)

69
Q

Diagnostic tool for endocarditis

A

TEE - shows vegetation growth on valves and walls

70
Q

treatment for endocarditis (2)

A
  1. IV antibiotics (for 6 months) 2. Valve repair
71
Q

what parts of the heart do you seen on chest x-ray?

A

RA - right RV - bottom LV - left pulmonary veins - upper left out pouches

72
Q

insufficiency/incompetence

A

can’t close completely

73
Q

What population is RHD common in and why

A

immigrants because developing nations don’t always treat strep throat with antibiotics and RHD is a long term complication.

74
Q

What is the heart characterized by?

A

Rate and Rhythm

75
Q

What is ischemia

A

insufficient, interrupted or abnormal blood supply

76
Q

layers of the heart

A

endothelium/endocardium - inside myothelium - middle muscle pericardium/epicardium - outside separated into visceral and parietal layers

77
Q

What do P, QRS complex and T stand for?

A

P - polarization of atria QRS - polarization of ventricles T - depolarization of ventricles

78
Q

what happens in unstable angina

A

there is a thrombus causing severe obstruction

79
Q

cause of right sided endocarditis

A

IVDA - intravenous drug abusers

80
Q

Cause of stable angina

A

insufficient supply for increase in demand

81
Q

presentation/complication of right sided endocarditis

A

PULMONARY INFARCT triangular necrosis in the lungs (seen via chest x-ray)

82
Q

What is “rate” of the heart?

A

number of QRS complexes per minute. Pulse

83
Q

What is the second type of angina (not common)

A

unstable angina

84
Q

Mechanism of MVP (8)

A
  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
Q

Infection of the heart

A

endocarditis

86
Q

risk factor for AVS

A

age over 50

87
Q

normal size of heart on chest x-ray

A

less than half of thoracic/lung field

88
Q

What is systole?

A

Ventricular polarization Contraction of the ventricles AV valves are closed at the end of systole, pulmonary and aortic valves close - dub

89
Q

Coronary arteries

A

right coronary artery left coronary artery/left main artery left anterior descending artery circumflex artery

90
Q

What percentage of strep throats progress to RHD?

A

10% 90% are self-limiting

91
Q

what are the risk factors for IHD

A

age over 50

92
Q

Most common valvular diseases in order

A
  1. Aortic valve stenosis 2. Mitral valve prolapse 3. Mitral valve stenosis / Rheumatic heart disease
93
Q

mechanism/complications of AVS (4)

A
  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
Q

areas Circumflex artery supplies

A

left atria and base of left ventricle

95
Q

what is stenosis

A

can’t open completely obstruction to flow during systole

96
Q

Most common cause of IHD

A

Coronary Heart Disease (CHD)

97
Q

risk factors for endocarditis

A

valvular disease invasive procedures

98
Q

What are coronary arteries embedded in?

A

epicardial fat

99
Q

Difference between skeletal and cardiac muscle

A

cardiac- one or two nuclei

skeletal - many nuclei

cardiac - intercalated disks

100
Q

Contractile unit of cardiac muscle

A

sarcomere

101
Q

basic unit of electrical stimulation

A

action potential

102
Q

three types of cells in myocardium

A

pacemaker cells (SA and AV nodes)

rapidly conducting tissue (Purkinje fibers)

cardiac muscle

103
Q
A

Pathophysiology 2 (2 decks)

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