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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
Mitral valve prolapse
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
Pathology of mitral valve prolapse
- valve leaflets enlarged - normal dense collagen and elastic matrix of the valvular fibrosis is fragmented and replaced with loose myxomatous connective tissue
27
Describe age related degenerative atrial stenosis
- cumulative wear and tear of valve motion | - endothelial and fibrous damage, causing calcification of otherwise normal tri-leaflet valve
28
Aortic valve disease as a result of atherosclerosis
- 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
Describe how congenital deformed valve may led to aortic valve disease
- years of turbulent flow - will disrupt endothelium and collagen matrix of leaflet - resulting in gradual calcium deposition
30
Describe what occurs in rheumatic aortic stenosis?
- endocardial inflammation leads to organisation and fibrosis of valve - fusion of commissures - formation of calcified masses within aortic cusps.
31
What may lead to secondary ventricular hypertrophy?
- BF across aortic valve is impeded during systole. - elevated LV pressure - secondary ventricular hypertrophy to cope with elevated pressure
32
How may aortic stenosis lead to angina?
- imbalance between myocardial oxygen supply and demand | - muscle mass of hypertrophied LV is increased
33
How may aortic stenosis lead to syncope? Syncope - temporary loss of consciousness during exertion
- ventricle cannot significantly increase cardiac output during exercise - due to fixed stenotic aortic orifice
34
Aortic regurgitation
Abnormal regurgitation of blood from aorta into LV.
35
Describe compensation in chronic aortic regurgitation
Ventricles compensate with chronic dilation, eccentric hypertrophy - aar volume overload and excessive pressure load
36
Clinical assessment of patient with aortic regurgitation What might be heard on auscultation? *Bonus* What is an Austin Flint murmur?
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
Tricuspid regurgitation Results from what? ECG might show? Where is systolic murmur heard?
- commonly results from RV enlargement - prominent v wave in jugular vein - lower left sternal border
38
Infective endocarditis
Infection of endocardial surface of heart
39
Acute bacterial endocarditis
Staph aureus
40
Sub acute bacterial endocarditis pathogen?
- more insidious Streptococcus viridan
41
Wide pulse pressure
Pulse pressure: difference between systolic and diastolic BP. LV stroke volume with a reduced aortic diastolic pressure produces a widened pulse pressure.
42
Signs of mitral regurgitation (5)
- 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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