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Human Disease > Heart Disease > Flashcards

Heart Disease Flashcards

1
Q

Name valves (inc no of leaflets) and chambers as blood passes through heart from the body

A
  • right atrium
  • tricuspid valve (3) - atrioventricular valve
  • right ventricle
  • pulmonary value (3) - semilumar valve
  • left atrium
  • mitral valve (2) - atrioventricular valve
  • left ventricle
  • aortic valve (3) - semilunar valve
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2
Q

What is systole and diastole?

A 
Systole = contraction
Diastole = relaxation (think dying!)
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3
Q

What is cardiac vascular disease?

A

Functional deficiency of cardiac valves

  • stenosis
  • incompetence / regurgitation
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4
Q

What is narrowing of valves called?

A

valvular stenosis

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5
Q

What is regurgitation at valves called?

A

valvular incompetence

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6
Q

What are main 2 consequences of valvular heart disease?

A
  1. Reduced cardiac output
    - exercise intolerance
    - left ventricular hypertrophy
    - left ventricular failure (sudden death)
  2. Infection
    - infective endocarditis
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7
Q

What are the 4 types of left heart valvular disease?

A
  • mitral stenosis
  • mitral regurgitation
  • aortic stenosis
  • aortic regurgitation
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8
Q

What is mitral stenosis?

A

Narrowing of mitral valve

  • calcification
  • thickens the leaflets
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9
Q

What are causes of mitral stenosis?

A
  • degenerative mitral stenosis (age related calcification)

- rheumatic heart disease

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10
Q

What are complications of mitral stenosis?

A
  • heart failure (oedema- feet/ankles, breathlessness, cyanosis)
  • atrial fibrilation
  • infective endocarditis
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11
Q

What are the causes of mitral regurgitation?

A
  • rheumatic heart disease
  • bacterial endocarditis
  • mitral valve prolapse (floppy valves)
  • Ischemic heart disease (ruptures papillary muscles / chordae tendinae)
  • cardiomyopathy
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12
Q

What % of people in UK have mitral valve prolapse?

A

2-5%

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13
Q

What is cardiomyopathy?

A

enlargement of heart

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14
Q

What type of heart disease can you hear a heart murmur?

A

mitral regurgitation

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15
Q

What are complications of mitral valve regurgitation?

A
  • heart failure
  • atrial fibrillation
  • infective endocarditis
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16
Q

What is aortic stenosis?

A
  • narrowing of aortic valve

- reduced flow to body

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17
Q

What can cause aortic stenosis?

A
  • rheumatic heart disease
  • degenerative calcification (age related)
  • congenital bicuspid valve
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18
Q

What is congenital bicuspid valve?

A

When 2 leaflets of aortic valve fuse together in development, so value only has 2 leaflets / cusps

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19
Q

What is senile aortic stenosis?

A

age related calcification of aortic value = stenosis

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20
Q

What is aortic regurgitation?

A

valve dysfunction / incompetence

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21
Q

What causes aortic regurgitation?

A
  • rheumatic heart disease
  • infective endocarditis
  • hypertension
  • Marfan’s syndrome
  • Syphilis (bacterial infection)
  • Ehler’s Danlos syndrome
  • Osteogenesis imperfecta
  • idiopathic aortic root dilation
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22
Q

Where is the aortic root?

A

Just above the aortic valve

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23
Q

What is syphilis?

A

bacterial infection

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24
Q

What is Ehler’s Danlos syndrome?

A
  • connective tissue disorder
  • inherited disorder
  • issues with collagen
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25
Q

What gene is linked to Marfan’s syndrome?

A

Fibrillin 1 gene

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26
Q

What are symptoms of Marfan’s disease?

A 
Head
- elongated forehead (dolichocephaly)
- cerebral bosselation (pertuberances)
Eye
- subluxation/misalignment of lens
- retinal detachment
- cateract
Heart:
- aortic aneurysm
- floppy valves (prolapse)
Vertebrae deformity
Long fingers (arachnodactyly)
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27
Q

What is dolichocephaly?

A

Longer than normal head

- eg elongated forehead in Marfan’s syndrome

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28
Q

What is arachnodactyly?

A

Long, spider-like fingers

- eg Marfan’s disease

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29
Q

What do people with Marfan’s syndrome usually look like?

A 
Tall
Elongated forehead
Wide skull
Long fingers
eg man from Ghost
30
Q

What valvular diseases are associated with the right side of the heart?

A
  • tricuspid stenosis

- tricuspid regurgitation

31
Q

What causes tricuspid stenosis?

A
  • rheumatic heart disease (most common)
32
Q

What causes tricuspid regurgitation?

A

Right ventricular enlargement, due to:

  • rheumatic heart disease
  • infective endocarditis (due to IV drug abuse)
  • congenital heart disease
33
Q

Which valve is effected by IV drug abuse?

A

Tricuspid valve

- bacteria in blood get to tricuspid valve first on right side of heart

34
Q

Where in the world is rheumatic heart disease most common and why?

A

Developing world

  • poor nutrition
  • overcrowding
35
Q

What causes rheumatic heart disease?

A

acute rheumatic fever

- caused by streptococcus A infection (sore throat)

36
Q

How long after what type of infection, does acute rheumatic fever present?

A

2-3 weeks after streptococcus A infection

37
Q

What age group is most prone to acute rheumatic fever?

A

5-15yrs

38
Q

What environ conditions are associated with acute rheumatic fever?

A
  • poor nutrition
  • overcrowding
    Therefore more common in dev world
39
Q

What are complications of rheumatic heart disease?

A

Antibody cross reactivity with:

  1. Heart: pericarditis, myocarditis, endocarditis
  2. Joints: polyarthritis
  3. Skin: subcutaneous nodules, skin rashes (erythema marginatum)
  4. Arteries: arteritis!
40
Q

What is erythema marginatum?

A

Skin rash

- associated with antibody cross reactivity of rheumatic heart disease

41
Q

What is arteritis?

A

inflam of arteries

42
Q

What are cardiac complications of rheumatic heart disease?

A

Deposition of cross-reactive antibody:

  1. Vegetations - eg attach to mitral valves
  2. Aschoff body - histological hallmark of RHD (swollen eosinophilic collagen, macrophages, lymphocytes)
  3. Fibrinous pericarditis
43
Q

What is antibody cross reactivity?

A

When antibodies bind to other proteins, other than protein intended for.
eg rheumatic heart disease

44
Q

What is an Aschoff body?

A
  • swollen eosinophilic collagen
  • macrophages
  • lymphocytes
  • above visible in a group in histology
  • hallmark of rheumatic heart disease
  • seen in postmortum
45
Q

What is hallmark sign of rheumatic heart disease?

A

Aschoff body

  • swollen eosinophilic collagen
  • macrophages
  • lymphocytes
  • above visible in a group in histology
46
Q

What % recover from acute rheumatic fever?

A

> 95%

47
Q

What % get chronic scarring on mitral valve cusps and over what period does this happen?

A

10-15% over 40-50 years

48
Q

What happens in chronic scarring of mitral valve cusps in rheumatic heart disease?

A
  • scarring thickens cusps and fuses them = stenosis
49
Q

What is infective endocarditis?

A

Acute or chronic infection of endocardium
- valve is usually involved
- could also be inner lining of heart chambers (mural endocardium)
Could be due to congenital defect
- ductus arteriousus
- coarctation of aorta

50
Q

Is infective endocarditis acute or chronic?

A

both

- also subacute

51
Q

What is mural endocardium?

A

inner lining of heart chambers - atrium/ventricles

- can be infected in infective endocarditis

52
Q

What bacteria causes acute infective endocarditis?

A

Staphlococcus aureus

- v viralent organism

53
Q

What is value condition usually like prior to acute infective endocarditis?

A

normal heart valves

54
Q

What is valve condition like prior to subacute infective endocarditis?

A

diseased / abnormal valve(s)

55
Q

What bacteria causes subacute infective endocarditis?

A

Streptococcus viridans

- low viralence

56
Q

Where are 4 main sources of organisms to cause infective endocarditis and give examples?

A

Oropharynx: streptococci (eg Strep viridans)
Respiratory Tract
GI and Urinary Tracts: Streptococcus faecalis (in large intestine - can cause UTI)
- enter blood via cystoscopy or prostatectomy
Skin: Staphlococci (eg S. aureus), yeasts (Candida)
- enter blood via cannulae or venepuncture

57
Q

What is a cystoscopy?

A

to see inside the bladder

58
Q

What bacteria causes 60% cases of infective endocarditis?

A

Streptococcus viridans

59
Q

What % of infective endocarditis cases is caused by streptococcus viridans?

A

60%

60
Q

What are lesions of infective endocarditis called and what do they consist of?

A

Vegetations (grape like nodular masses)

  • platelets, fibrin, (thrombotic debris), bacteria
  • they adhere to cusps
61
Q

What side of the heart is infective endocarditis most common and what valves are affected?
What % of cases occurs on that side?

A

The left side (95% cases)
- mitral valve (bicuspid)
- aortic valve
Mainly in previously damaged valves

62
Q

How does infective endocarditis vegetations form?

A

NB endothelial lining is usually resistant to infection

  • endocardial damage
  • platelets and fibin adhere
  • then infected by bacteria in blood (from focal infection or transient bacteraemia from skin/mucosa)
63
Q

What happens if infective endocarditis vegetations detach / break off?

A

embolism

64
Q

What are the potential complications of infective endocarditis?

A 
Mycotic aneurysm
Stroke
Roth spots in eye
Embolism
Skin - Rod nodules, Purpura
Splinter haemorphages 
Kidney - infection, hemuria
Spleen - infection, abcess
65
Q

What is mycotic aneurysm?

A

Aneurysm from bacterial infection in any artery wall in body

66
Q

What are roth spots?

A

Dark spots with a white/pale centre due to retinal hemorrhage, visible in the back of the eye

67
Q

What is purpura?

A

a rash of purple spots on the skin caused by internal bleeding from small blood vessels.

  • a potential complication of infective endocarditis
  • aka Janeway lesion
  • ie micro-abcesses from vegetation embolism
68
Q

What are splinter haemorphages?

A

brown marks on finger nails

- sign of infective endocarditis

69
Q

What heart medications have oral impacts?

A

Anticoagulants
- bleeding risk

Calcium channel blockers
- gingival hyperplasia

Beta blockers, ACE inhibitors, diuretics

  • oral drug reactions
  • eg lichenoid reactions
70
Q

When might gingival hyperplasia be caused by drugs?

A

if no plaque present

71
Q

What % get bacteraemia following:

  • tooth brushing
  • RSD (perio)
  • XLA?
A

Tooth brushing - 0-26%
RSD - 36-88%
XLA - 51-85%

72
Q

What is aortic coarctation?

A

aorta narrows in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts

Human Disease (10 decks)

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