PowerPoint Chapter 18

Question 1

What is Aortic Stenosis?

Answer 1

Obstruction of flow at the aortic valve from the Left Ventricle
(Slow onset – Decades)

Question 2

How many people in the US have aortic stenosis?

Answer 2

1.5 million in the US

Question 3

What symptoms to monitor if someone has aortic stenosis?

Answer 3

Monitor for onset of angina, syncope, heart failure, atrial fib

Question 4

What is almost always the result of aortic stenosis?

Answer 4

Left Ventricular Hypertrophy

Question 5

ECG changes with aortic stenosis?

Answer 5

ECG changes – ST segment changes and TWI

Question 6

What is mitral stenosis?

Answer 6

-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)

Question 7

What results from mitral stenosis?

Answer 7

Pulmonary hypertension because of left atrial pressure

Question 8

ECG changes with mitral stenosis?

Answer 8

LAE, LVH, notched P wave in lead II > .12sec

Question 9

What is hypertrophic cardiomyopathy?

Answer 9

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.

Question 10

What is the rate of hypertrophic cardiomyopathy?

Answer 10

1 in 500 people
600,000 – 1.5M Americans

Question 11

What are the genetic causes of Hypertrophic Cardiomyopathy?

Answer 11

(All lead to ↓ sarcomere function)
Inheritance: 50% familial, 50% sporadic
Mutation
Chronic Hypertension
Aortic Stenosis
Amyloidosis

Question 12

In hypertrophic cardiomyopathy Decreased Sarcomere function = Stress on heart resulting in: ?????

Answer 12

Stimulation of myocytes to improve function (function)
Myocytes secrete growth factors (factors)
Increased myocyte growth and thickness (Thickness)
KEY – Asymmetrical hypertrophy

Question 13

Where are changes observed in hypertrophic cardiomyopathy?

Answer 13

Specifically noted changes are observed in the LV, Mitral Valve, and Cellular myocardium.

Question 14

How to diagnose HCM (4)?

Answer 14

History: < 35y/o, Family history of SCD, Athlete, Symptomatic
Chest X-ray
12 lead ECG
and Echocardiography

Question 15

Symptoms of HCM?

Answer 15

Chest Pain, SOB/Fatigue, Syncope, Palpitations, SCD

Question 16

What to look for in a chest Xray HCM?

Answer 16

LAE
LAH – left atrial hypertrophy

Question 17

What will an ECG with HCM look like?

Answer 17

LVH
LAE
ST changes
T Wave Inversions
Arrhythmias – Atrial Fib, Vtach, V Fib
Not useful for Diagnosing HCM

Question 18

What is the best method for diagnosing HCM

Answer 18

Echocardiogram

Question 19

What will be seen in an echocardiogram with HCM?

Answer 19

-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

Question 20

What does ARVD stand for?

Answer 20

Arrhythmogenic Righ Ventricular Dysplasia

Question 21

What percent of sudden death occurs come from ARVD?

Answer 21

20%

Question 22

What is Arrhythmogenic Right Ventricular Dysplasia?

Answer 22

Fibrofatty infiltration and myocardial thinning of the Right Ventricle

Question 23

What are signs and symptoms of ARVD?

Answer 23

Palpitations, Syncope, Sudden Cardiac Death

Question 24

What does an ECG appear like with ARVD?

Answer 24

TWI in precordial leads
Epsilon Wave seen in 50% of cases

Question 25

What is pericardial disease also called?

Answer 25

Inflammation of the Pericardium-Pericarditis

Question 26

How does pericardial disease present (ECG + Symptom)?

Answer 26

Presents the same as MI with Chest pain and ST seg Elevation

Question 27

What is cardiac tamponade?

Answer 27

Cardiac Tamponade – increased intrapericardial pressure from pericardial effusion.

Question 28

Cardiac tamponade occurs only when ____ is exceeding the chamber pressure?

Answer 28

Cardiac tamponade occurs only when pressure is exceeding the chamber pressure

Question 29

What/where sinus is cardiac tamponade most commonly seen in?

Answer 29

Most common with R Atrium
(increased heart rate)

Question 30

How does cardiac tamponade appear on an ECG?

Answer 30

Lead II Low voltage or alterations in voltage noted in lead II