PowerPoint Chapter 18 Flashcards
What is Aortic Stenosis?
Obstruction of flow at the aortic valve from the Left Ventricle
(Slow onset – Decades)
How many people in the US have aortic stenosis?
1.5 million in the US
What symptoms to monitor if someone has aortic stenosis?
Monitor for onset of angina, syncope, heart failure, atrial fib
What is almost always the result of aortic stenosis?
Left Ventricular Hypertrophy
ECG changes with aortic stenosis?
ECG changes – ST segment changes and TWI
What is mitral stenosis?
-Obstruction of flow at the Mitral Valve
-Valve thickening, Fibrosis and stenosis
-Parts of the valve can stick together.
-Link to Rheumatic fever and damage from childhood episode (Occurrences going down in US but elevating in other countries)
What results from mitral stenosis?
Pulmonary hypertension because of left atrial pressure
ECG changes with mitral stenosis?
LAE, LVH, notched P wave in lead II > .12sec
What is hypertrophic cardiomyopathy?
Genetic or Acquired heart disease causing the heart tissue (myocardium) to thicken.
Clinically heterogenous, genetic disorder characterized by myocardial hypertrophy, poorly compliant left ventricular myocardium leading to abnormal diastolic filling and intermittent ventricular outflow obstruction.
What is the rate of hypertrophic cardiomyopathy?
1 in 500 people
600,000 – 1.5M Americans
What are the genetic causes of Hypertrophic Cardiomyopathy?
(All lead to ↓ sarcomere function)
Inheritance: 50% familial, 50% sporadic
Mutation
Chronic Hypertension
Aortic Stenosis
Amyloidosis
In hypertrophic cardiomyopathy Decreased Sarcomere function = Stress on heart resulting in: ?????
Stimulation of myocytes to improve function (function)
Myocytes secrete growth factors (factors)
Increased myocyte growth and thickness (Thickness)
KEY – Asymmetrical hypertrophy
Where are changes observed in hypertrophic cardiomyopathy?
Specifically noted changes are observed in the LV, Mitral Valve, and Cellular myocardium.
How to diagnose HCM (4)?
History: < 35y/o, Family history of SCD, Athlete, Symptomatic
Chest X-ray
12 lead ECG
and Echocardiography
Symptoms of HCM?
Chest Pain, SOB/Fatigue, Syncope, Palpitations, SCD
What to look for in a chest Xray HCM?
LAE
LAH – left atrial hypertrophy
What will an ECG with HCM look like?
LVH
LAE
ST changes
T Wave Inversions
Arrhythmias – Atrial Fib, Vtach, V Fib
Not useful for Diagnosing HCM
What is the best method for diagnosing HCM
Echocardiogram
What will be seen in an echocardiogram with HCM?
-Diameter of Ventricular lumen (↓ ↓)
-Wall thickness
Asymmetrical hypertrophy – IV Septum
-Ejection Fracture – Normal
Diastolic filling ↓, but SV is maintained
-Doppler
Systolic ejection murmur
Mitral valve regurgitation
What does ARVD stand for?
Arrhythmogenic Righ Ventricular Dysplasia
What percent of sudden death occurs come from ARVD?
20%
What is Arrhythmogenic Right Ventricular Dysplasia?
Fibrofatty infiltration and myocardial thinning of the Right Ventricle
What are signs and symptoms of ARVD?
Palpitations, Syncope, Sudden Cardiac Death
What does an ECG appear like with ARVD?
TWI in precordial leads
Epsilon Wave seen in 50% of cases
What is pericardial disease also called?
Inflammation of the Pericardium-Pericarditis
How does pericardial disease present (ECG + Symptom)?
Presents the same as MI with Chest pain and ST seg Elevation
What is cardiac tamponade?
Cardiac Tamponade – increased intrapericardial pressure from pericardial effusion.
Cardiac tamponade occurs only when ____ is exceeding the chamber pressure?
Cardiac tamponade occurs only when pressure is exceeding the chamber pressure
What/where sinus is cardiac tamponade most commonly seen in?
Most common with R Atrium
(increased heart rate)
How does cardiac tamponade appear on an ECG?
Lead II Low voltage or alterations in voltage noted in lead II
