Heart Disease Flashcards
Name valves (inc no of leaflets) and chambers as blood passes through heart from the body
- 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
What is systole and diastole?
Systole = contraction Diastole = relaxation (think dying!)
What is cardiac vascular disease?
Functional deficiency of cardiac valves
- stenosis
- incompetence / regurgitation
What is narrowing of valves called?
valvular stenosis
What is regurgitation at valves called?
valvular incompetence
What are main 2 consequences of valvular heart disease?
- Reduced cardiac output
- exercise intolerance
- left ventricular hypertrophy
- left ventricular failure (sudden death) - Infection
- infective endocarditis
What are the 4 types of left heart valvular disease?
- mitral stenosis
- mitral regurgitation
- aortic stenosis
- aortic regurgitation
What is mitral stenosis?
Narrowing of mitral valve
- calcification
- thickens the leaflets
What are causes of mitral stenosis?
- degenerative mitral stenosis (age related calcification)
- rheumatic heart disease
What are complications of mitral stenosis?
- heart failure (oedema- feet/ankles, breathlessness, cyanosis)
- atrial fibrilation
- infective endocarditis
What are the causes of mitral regurgitation?
- rheumatic heart disease
- bacterial endocarditis
- mitral valve prolapse (floppy valves)
- Ischemic heart disease (ruptures papillary muscles / chordae tendinae)
- cardiomyopathy
What % of people in UK have mitral valve prolapse?
2-5%
What is cardiomyopathy?
enlargement of heart
What type of heart disease can you hear a heart murmur?
mitral regurgitation
What are complications of mitral valve regurgitation?
- heart failure
- atrial fibrillation
- infective endocarditis
What is aortic stenosis?
- narrowing of aortic valve
- reduced flow to body
What can cause aortic stenosis?
- rheumatic heart disease
- degenerative calcification (age related)
- congenital bicuspid valve
What is congenital bicuspid valve?
When 2 leaflets of aortic valve fuse together in development, so value only has 2 leaflets / cusps
What is senile aortic stenosis?
age related calcification of aortic value = stenosis
What is aortic regurgitation?
valve dysfunction / incompetence
What causes aortic regurgitation?
- rheumatic heart disease
- infective endocarditis
- hypertension
- Marfan’s syndrome
- Syphilis (bacterial infection)
- Ehler’s Danlos syndrome
- Osteogenesis imperfecta
- idiopathic aortic root dilation
Where is the aortic root?
Just above the aortic valve
What is syphilis?
bacterial infection
What is Ehler’s Danlos syndrome?
- connective tissue disorder
- inherited disorder
- issues with collagen
What gene is linked to Marfan’s syndrome?
Fibrillin 1 gene
What are symptoms of Marfan’s disease?
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)
What is dolichocephaly?
Longer than normal head
- eg elongated forehead in Marfan’s syndrome
What is arachnodactyly?
Long, spider-like fingers
- eg Marfan’s disease
What do people with Marfan’s syndrome usually look like?
Tall Elongated forehead Wide skull Long fingers eg man from Ghost
What valvular diseases are associated with the right side of the heart?
- tricuspid stenosis
- tricuspid regurgitation
What causes tricuspid stenosis?
- rheumatic heart disease (most common)
What causes tricuspid regurgitation?
Right ventricular enlargement, due to:
- rheumatic heart disease
- infective endocarditis (due to IV drug abuse)
- congenital heart disease
Which valve is effected by IV drug abuse?
Tricuspid valve
- bacteria in blood get to tricuspid valve first on right side of heart
Where in the world is rheumatic heart disease most common and why?
Developing world
- poor nutrition
- overcrowding
What causes rheumatic heart disease?
acute rheumatic fever
- caused by streptococcus A infection (sore throat)
How long after what type of infection, does acute rheumatic fever present?
2-3 weeks after streptococcus A infection
What age group is most prone to acute rheumatic fever?
5-15yrs
What environ conditions are associated with acute rheumatic fever?
- poor nutrition
- overcrowding
Therefore more common in dev world
What are complications of rheumatic heart disease?
Antibody cross reactivity with:
- Heart: pericarditis, myocarditis, endocarditis
- Joints: polyarthritis
- Skin: subcutaneous nodules, skin rashes (erythema marginatum)
- Arteries: arteritis!
What is erythema marginatum?
Skin rash
- associated with antibody cross reactivity of rheumatic heart disease
What is arteritis?
inflam of arteries
What are cardiac complications of rheumatic heart disease?
Deposition of cross-reactive antibody:
- Vegetations - eg attach to mitral valves
- Aschoff body - histological hallmark of RHD (swollen eosinophilic collagen, macrophages, lymphocytes)
- Fibrinous pericarditis
What is antibody cross reactivity?
When antibodies bind to other proteins, other than protein intended for.
eg rheumatic heart disease
What is an Aschoff body?
- swollen eosinophilic collagen
- macrophages
- lymphocytes
- above visible in a group in histology
- hallmark of rheumatic heart disease
- seen in postmortum
What is hallmark sign of rheumatic heart disease?
Aschoff body
- swollen eosinophilic collagen
- macrophages
- lymphocytes
- above visible in a group in histology
What % recover from acute rheumatic fever?
> 95%
What % get chronic scarring on mitral valve cusps and over what period does this happen?
10-15% over 40-50 years
What happens in chronic scarring of mitral valve cusps in rheumatic heart disease?
- scarring thickens cusps and fuses them = stenosis
What is infective endocarditis?
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
Is infective endocarditis acute or chronic?
both
- also subacute
What is mural endocardium?
inner lining of heart chambers - atrium/ventricles
- can be infected in infective endocarditis
What bacteria causes acute infective endocarditis?
Staphlococcus aureus
- v viralent organism
What is value condition usually like prior to acute infective endocarditis?
normal heart valves
What is valve condition like prior to subacute infective endocarditis?
diseased / abnormal valve(s)
What bacteria causes subacute infective endocarditis?
Streptococcus viridans
- low viralence
Where are 4 main sources of organisms to cause infective endocarditis and give examples?
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
What is a cystoscopy?
to see inside the bladder
What bacteria causes 60% cases of infective endocarditis?
Streptococcus viridans
What % of infective endocarditis cases is caused by streptococcus viridans?
60%
What are lesions of infective endocarditis called and what do they consist of?
Vegetations (grape like nodular masses)
- platelets, fibrin, (thrombotic debris), bacteria
- they adhere to cusps
What side of the heart is infective endocarditis most common and what valves are affected?
What % of cases occurs on that side?
The left side (95% cases)
- mitral valve (bicuspid)
- aortic valve
Mainly in previously damaged valves
How does infective endocarditis vegetations form?
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)
What happens if infective endocarditis vegetations detach / break off?
embolism
What are the potential complications of infective endocarditis?
Mycotic aneurysm Stroke Roth spots in eye Embolism Skin - Rod nodules, Purpura Splinter haemorphages Kidney - infection, hemuria Spleen - infection, abcess
What is mycotic aneurysm?
Aneurysm from bacterial infection in any artery wall in body
What are roth spots?
Dark spots with a white/pale centre due to retinal hemorrhage, visible in the back of the eye
What is purpura?
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
What are splinter haemorphages?
brown marks on finger nails
- sign of infective endocarditis
What heart medications have oral impacts?
Anticoagulants
- bleeding risk
Calcium channel blockers
- gingival hyperplasia
Beta blockers, ACE inhibitors, diuretics
- oral drug reactions
- eg lichenoid reactions
When might gingival hyperplasia be caused by drugs?
if no plaque present
What % get bacteraemia following:
- tooth brushing
- RSD (perio)
- XLA?
Tooth brushing - 0-26%
RSD - 36-88%
XLA - 51-85%
What is aortic coarctation?
aorta narrows in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts
