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Cardiovascular Block > L3 - Vascular heart disease > Flashcards

L3 - Vascular heart disease Flashcards

1
Q

Acute Rheumatic fever

A

Inflammatory condition involving heart, skin and connective tissues.

Carditis in ARF may affect all three layers of the heart

  • pericardium
  • myocardium
  • endocardium
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2
Q

Histology: Aschoff body

What is it?
What will it later become?

A

On histology.

  • an area of focal fibrinoid necrosis surrounded by inflammatory cells.
  • Later resolves to form fibrous scar tissue.
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3
Q

Signs of acute atrial stenosis (5)

A
  • tachycardia
  • decreased LHS ventricular contractility
  • pericardial friction rub
  • transient murmur of mitral
  • aortic regurgitation
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4
Q

Mitral stenosis

What happens to the mitral valves? Any other structures involved?

A
  • Fibrous thickening, calcification of valve leaflets.

- Thickening, shortening of the chordae tendinae

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5
Q

Mitral valve in early diastole (normal)

A
  • mitral valve open
  • blood flows freely from LA to LV.
  • negligible pressure difference
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6
Q

Mitral stenosis obstruction

Would lead to?

A
  • obstruction BF across valve
  • emptying of LA impeded
  • abnormal pressure gradient between LA & LV
  • LA pressure greater than normal
  • elevates pulmonary and RHS heart pressure
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7
Q

In severe cases how might mitral stenosis result in haemoptysis?

A
  • Increased pulmonary venous pressure –causes–> opening of collateral channels
  • high pulmonary vascular pressure may –may—> rupture bronchial vein into lung parenchyma
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8
Q

Consequences of elevation of left atrium pressure in mitral stenosis?

A

Pulmonary hypertension

- passive or reactive

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9
Q

Passive pulmonary hypertension

A

Backward transmission of elevated LA pressure into pulmonary vasculature

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10
Q

Reactive pulmonary hypertension

A
  • Increased arteriolar resistance
  • impedes BF into engorged pulmonary capillary bed
  • reduces capillary hydro static pressure
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11
Q

Chronic pressure overload of the left atrium in mitral stenosis may lead to..

A

Left atrial enlargement.

Stretches atrial conduction fibres, resulting in atrial fibrillation.

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12
Q

Early patient symptoms of mitral stenosis

Severe patient symptoms

What causes hoarseness in voice

A

Early symptoms: dyspnea, reduced exercise capacity

Severe: dyspnea even at rest, increasing fatigue

Compression of recurrent laryngeal nerve by enlarged pulmonary artery or LA.

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13
Q

What might be heard on auscultation of someone with mitral stenosis?

A

1st heart sound S1

- high pitched, opening snap, sudden tension of chordae tendinae

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14
Q

Where would you find Kerley B lines?

What do they result from?

A

Present on CXR

result from oedema within the pulmonary stepa.

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15
Q

Summarise treatment for mitral stenosis (4)

A
  • diuretics for vascular congestion
  • beta blockers for AF
  • anticoagulants
  • percutaneous balloon mitral valvuloplasty
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16
Q

Describe action of verapamil?

A
  • calcium channel agonist with negative chronotropic properties
  • slows the rapid ventricular rate
  • improve LV filling
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17
Q

Percutaneous balloon mitral valvuloplasty

Describe the path and role

A
  • balloon catheter up femoral vein into RA.
  • across atrial septum, balloon rapidly inflated.
  • cracks open the fixed commissures?
18
Q

What has happened to the mitral valves in mitral regurgitation?

A
  • enlarged, redundant leaflet bow extensively into the LA during systole
  • calcification of mitral annulus can occur with normal aging
19
Q

Describe effect of mitral regurgitation on the heart?

A
  • portion of the left ventricle stroke volume is ejected backward into low pressure LA during systole

consequences

  • elevation of LA vol and pressure
  • reduction of forward cardiac output
  • volume related stress on left ventricle
20
Q

What might be a cause of acute MR?

A
  • sudden rupture of chordae tendinae
21
Q

How will LV accommodate during acute MR?

A
  • LV accommodates the increased volume load returning from the left atrium
  • increase in left ventricle stroke volume
22
Q

Chronic MR may be due to…

A

Rheumatic valve disease
–> Leads to LV enlargement and atrial enlargement.

Calcification of the mitral annulus.

23
Q

Compensatory changes occurring in chronic MR?

A
  • LA dilates

- compliance increases to accommodate a larger volume

24
Q

Possible treatment intervention for MR? (2)

A
  • IV diuretics to reduce pulmonary oedema, as many patients with acute MR will present with pulmonary oedema.
  • vasodilator to reduce resistance to forward force
25
Q

Mitral valve prolapse

A

Usually asymptomatic.
Billowing of mitral leaflet into LA during ventricular systole.

note
when blood leaks back into LA during systole this is known as mitral valve regurgitation.

26
Q

Pathology of mitral valve prolapse

A
  • valve leaflets enlarged
  • normal dense collagen and elastic matrix of the valvular fibrosis is fragmented and replaced with loose myxomatous connective tissue
27
Q

Describe age related degenerative atrial stenosis

A
  • cumulative wear and tear of valve motion

- endothelial and fibrous damage, causing calcification of otherwise normal tri-leaflet valve

28
Q

Aortic valve disease as a result of atherosclerosis

A
  • valve tissue of patient with this form of aortic stenosis display cellular proliferation, inflammation, lipid accumulation and increased margination of macrophages and T-lymphocytes.
29
Q

Describe how congenital deformed valve may led to aortic valve disease

A
  • years of turbulent flow
  • will disrupt endothelium and collagen matrix of leaflet
  • resulting in gradual calcium deposition
30
Q

Describe what occurs in rheumatic aortic stenosis?

A
  • endocardial inflammation leads to organisation and fibrosis of valve
  • fusion of commissures
  • formation of calcified masses within aortic cusps.
31
Q

What may lead to secondary ventricular hypertrophy?

A
  • BF across aortic valve is impeded during systole.
  • elevated LV pressure
  • secondary ventricular hypertrophy to cope with elevated pressure
32
Q

How may aortic stenosis lead to angina?

A
  • imbalance between myocardial oxygen supply and demand

- muscle mass of hypertrophied LV is increased

33
Q

How may aortic stenosis lead to syncope?

Syncope
- temporary loss of consciousness during exertion

A
  • ventricle cannot significantly increase cardiac output during exercise
  • due to fixed stenotic aortic orifice
34
Q

Aortic regurgitation

A

Abnormal regurgitation of blood from aorta into LV.

35
Q

Describe compensation in chronic aortic regurgitation

A

Ventricles compensate with chronic dilation, eccentric hypertrophy
- aar volume overload and excessive pressure load

36
Q

Clinical assessment of patient with aortic regurgitation

What might be heard on auscultation?

Bonus
What is an Austin Flint murmur?

A

Diastolic de-crescendo murmur: aortic pressure falls rapidly, LV pressure rises as blood regurgitation into LV from aorta.

Wide pulse pressure

Austin Flint murmur
- low frequency, mid diastolic rumbling sound may be heard at cardiac apex

37
Q

Tricuspid regurgitation

Results from what?
ECG might show?
Where is systolic murmur heard?

A
  • commonly results from RV enlargement
  • prominent v wave in jugular vein
  • lower left sternal border
38
Q

Infective endocarditis

A

Infection of endocardial surface of heart

39
Q

Acute bacterial endocarditis

A

Staph aureus

40
Q

Sub acute bacterial endocarditis

pathogen?

A
  • more insidious

Streptococcus viridan

41
Q

Wide pulse pressure

A

Pulse pressure: difference between systolic and diastolic BP.
LV stroke volume with a reduced aortic diastolic pressure produces a widened pulse pressure.

42
Q

Signs of mitral regurgitation (5)

A
  • pulses paradoxus (abnormally large decrease in stroke volume, systolic BP during insp)
  • irregular pulse
  • displaced apex beat
  • thrill
  • resp crepitations

Cardiovascular Block (16 decks)

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