Heart disease Flashcards
which of the following is not a congenital heart disease:
1) Patent ductus arteriosis
2) Coarctation of aorta
3) Patent ductus arteriosus
4) Ventricular septal defects
5) Atrial stenosis
5) Atrial stenosis –> is not a congenital disease
A child and her mother comes into the GP. The child has been having trouble breathing , chest pain ( palpitations) , looks very thin. What does the child have? 1) Asthma 2) Ventricular septal defects 3) Mitral stenosis 4) Ventricular septal defect
What would you advise the mother to do next
Child is likely to have a ventricular septal defect (hole wall of the 2 ventricles)
Symptoms of this include : poor weight gain , decreased appetite , palpitations
Hole may close as child grows
If not offer open heart surgery/ cardiac catheterisation
which one of these is not part of the tetralogy of fallot
1) Ventricular septal defect
2) Overridding aorta
3) Patent formen ovale
4) Pulmonary stenosis
What is the treatment for tetralogy of fallot
3) Patent formen ovale
the tetralogy of fallot includes:
- Ventricular septal defects
- Pulmonary stenosis
- Overriding of aorta
- Right ventricle hypertrophy
Surgery
A young child presents to the emergency room with severe chest pain and difficulty breathing, even when lying down . They have swollen ankles and a very high blood pressure. Upon further examination you have discovered that the child has coarctation of the aorta. How do you explain this pathology to the children’s parents
Narrowing of aorta –> heart must work harder to push out blood –> LV hypertrophy –> heart failure
A 75 year old man with a history of hypertension and CKD presents at the emergency room with chest pain. Upon doing a cardiac exam you find that he has a shrill ejection systolic murmur . You decide that the next best thing is to do an echocardiography. What things would you see on the echocardiography that would allow you to make a diagnosis?
What would be his treatment options ?
A shill ejection systolic murmur is is indicative of aortic stenosis. The 75 yr old man presents with a history of hypertension and CKD which are both risk factors. ( His age is a risk factor as well)
To confirm aortic stenosis you would do a echocardiogram.
LV hypertrophy and thickening would confirm the disease
Medications:
Statins, ACE inhibitors , antihypertensives, balloon aortic valvuloplasty , discuss aortic valve replacement
Pateint comes in presenting with breathlessness on exertion. They also feel breathless when lying down but feel better when sitting or standing. When they were younger they were diagnosed with rheumatic fever
You do a cardiac exam –> what do you expect to find
What would you do to confirm your suspicions and what would you recommend for treatment
This is an example of exertional dyspnoea which may be a complication of mitral stenosis . Other signs pointing to mitral stenosis are the history of rheumatic fever and orthopnoea.
When doing a cardiac exam expect to find a loud S1 and a diastolic murmur. –> if looking at the neck may also present with neck vein distention
investigations:
- ECG , trans echocardiography , chest X ray , cardiac MRI
Treatments: As he is Severe symptomatic
diuretic, balloon valvotomy, valve replacement & repair adjunct b blockers
which of these drugs would you give to a pateint with mitral stenosis
1) Acebutolol
2) Ramipril
3) Metolazone
4) Statins
1) Acebutolol ( b blockers) and metolazone ( thiazide diuretics) are given
ramipril ( ACE inhibitor) and statins are not
A pateint comes in with an austin flint murmur , cyanosis and tachycardia at the emergency room . You screen for endocarditis. Why can endocarditis cause this patient’s presentation
what would you do to treat this pateint
Example of aortic regurgitation
infective endocarditis = infection of the heart . Can cause vegetations of heart valves which can cause incomplete closure / rupture of these valves leading to heart failure
Acute ARI:
Inotropes/vasodilators & valve replacement & repair
See valves replacement in aortic stenosis
Pateint presents with wide pulse pressure , corrigan’s and traube’s sign. Describe how thier ejection fraction would change as this disease progresses?
Wide pulse pressure
Corrigan (wide hammer pulse)
Aka forceful pulse that suddenly collapses
Pistol shot pulse (Traube sign)
Loud cracking sound heard over the stethoscope due to dilation and collapse of aorta .
Signs of chronic aortic regurgitation
Chronic AR
gradually increase in LV volume
LV enlargement and eccentric hypertrophy
Early stages: Ejection fraction normal or slightly increase
After some time: Ejection fraction falls and LV end systolic volume rises
Eventually LV dyspnoea lower coronary perfusion ischemia, necrosis and apoptosis → heart failure
A Patient has mitral regurgitation . What would they present with and what would you do to manage them
Presentation: Dyspnea diminished S1, murmur high pitched , blowing sound Fatigue Orthopnea Chest pain Atrial fibrillation Due to backflow of blood into left atrium
Chronic symptomatic
1st surgery plus medical treatment
If left ventricular ejection fraction is less than 30% 1st line is Intra-aortic balloon counterpulsation
A pateint has dilated cardiomyopathy. What would you see as early compensatory mechanism for this
Early compensatory mechanisms
↑ heart rate and tone of the peripheral vascular system.
Due to neurohumoral activation of the renin-angiotensin aldosterone system → ↑ circulating levels of catecholamines.
↑ levels of natriuretic peptides
Help increase contraction
A Child has died to due heart failure. They were previously healthy and didn’t have any medical conditions.
Before the death the child presented with s3 gallop and syncope. What did this child die of
Hypertrophic cardiomyopathy
Increase in LV wall thickness ( hypertrophy) that is inappropriate, often asymmetrical + occurs in absence of hypertrophy stimulus
LV hypertrophy often occurs in interventricular septum
→ obstruction of flow through the LV outflow tract
Another pateint comes into the hospital with chest pain . They used to be an Olympic athlete and have had no previous medical conditions. What investigations strategies should be implemented
Hemoglobin level: Anemia exacerbates chest pain and dyspnea
Brain natriuretic peptide (BNP)
troponin T levels: Elevated BNP, NT-proBNP, and troponin T levels are associated with a higher risk of cardiovascular events, heart failure, and death
Echocardiography
Chest Xray
Cardiac MRI
A patent has hypertrophic cardiomyopathy. He was given B blockers. He has no allergies and has never experienced side effects from the B blockers yet they have not helped with his chest pain . What is the next step?
1) Switch to verapamil
2) Prescribe disopyramide
3) Consider septal myotomy
4) Do nothing
2) Prescribe disopyramide
see table for explaination
A pateints comes in with chest pain. Upon examination you find that they have an enlarged liver, pitting oedema’s and a high jugular venous pressure and low pulse volume. You suspect he has restrictive cardiomyopathy caused by amyloidosis. What are symptoms of amyloidosis ?
Amyloidosis symptoms Easy bruising periorbital purpura Macroglossia systemic findings: carpal tunnel syndrome,
