Structural Cardiac Abnormalities Flashcards
On which side of the heart are murmurs influenced by inspiration?
Right sided - Made louder
Where do cardiac murmurs radiate to?
Aortic stenosis - Carotids
Pulmonary stenosis - Shoulder
Mitral regurgitation - Axilla
Where and when is an innocent murmur hear?
Pulmonary area
Early systole
What are common causes of aortic stenosis?
Congenital bicuspid valve
Age
Rheumatic fever
What are the clinical signs of aortic stenosis?
Slow rising pulse
LV heave
Ejection systolic murmur
What ECG changes can be seen in a patient with aortic stenosis?j
Big complexes in V4-V6
Left axis deviation
(due to LVH)
How is aortic stenosis treated?
Valve replacement
Balloon aortic valvotomy
Transcatheter Aortic Valve Implantation
Which type of valve replacement needs lifelong anticoagulation, mechanical or bioprosthetic?
Mechanical
What are common causes of mitral regurgitation?
Rheumatic fever Endocarditis Chordae rupture Annular dilation Papillary muscle Ischaemia
What are the signs and symptoms of mitral stenosis?
SoB
Ankle oedema
Displaced apex
Pansystolic murmur - radiates to axilla
What are the signs of mitral stenosis?
Malar flush Tapping apex Mid-diastolic murmur Straight left heart border on CXR - LA dilation Can lead to AFib
Treatment options for mitral stenosis?
Diuretics
Beta blockers - lengthen diastole
Digoxin
Warfarin
Patients BP is 120/50
Collapsing pulse is present
Displaced apex and early diastolic murmur in the tricuspid area once sitting up.
Aortic regurgitation
What is the role of the ductus venosus in the foetus?
Allows umbilical blood to bypass liver
Which structure directs blood from the RA to the LA in the foetus?
Foramen ovale
What is the purpose of the ductus arteriosus?
Directs 90% of RV blood into aorta to supply body in the foetus
What do the following become in the postnatal child?
- Umbilical vein
- Ductus arteriosus
- Ductus venosus
- Ligament teres hepatis
- Ligament arteriosum
- Ligament venosus
Baby born healthy
Baby turns blue a few days later
Heart appears “egg-shaped” on CXR
Complete transposition of the great vessels
Newborn baby CXR shows - Small heart - Uptilted apex - Oligaemic lung fields - Pulmonary bay
Tetralogy of Fallot
What are the main features of Tetralogy of Fallot?
RV outflow tract obstruction
Overriding aorta
VSD
RVH - Upright T wave in V1 (and no S wave)
What coloured top bottles are used for negative and positive culture bottles?
Negative - Blue
Positive - Purple
What infections does Staph. epidermidis typically cause?
IV line infection
Prosthetic heart valve infection
Prosthetic joint infection
Why do we take 3 sets of culture at different times?
To rule out any contaminants
Which people are more likely to get infective endocarditis?
People with calcified valves
Rheumatic fever sufferers
IV drug users
People with IV lines
What is the sequence of events in infective endocarditis?
- Heart valve damaged
- Turbulent blood flow
- Platelets deposited
- Bacteraemia
- Microbial vegetation
What are the clinical signs of infective endocarditis?
Fever Murmur Clubbing Splinter haemorrhages Haematuria Splenomegaly Roth spots - retinal haemorrhages Janeway lesions - non tender lesions on palms Osler nodes - tender lesions on finger tips
Should cultures be taken before or after antibiotics?
Before
If an echo is requested, which is better?
Transoesophageal
Transthoracic
Transoesophageal
What organisms tend to cause prosthetic valve endocarditis?
Staph. aureus
Staph. epidermidis
A 27 year old patient has IE of their tricuspid valve. After culture, all 3 sets are found to contain Staph. aureus. What predisposing factor is this patient likely to have?
They are an IV drug user
How do we treat native valve endocarditis?
IV amoxicillin + IV gentamicin
How do we treat prosthetic valve endocarditis?
IV vancomycin + IV gentamicin +/- PO Rifampicin
Or valve replacement
IV flucloxacillin is used to treat IE in which patients and with what causative organism?
IV drug users with Staph. aureus infection
Patient has MRSA IE, what is the treatment?
IV Vancomycin + PO Rifampicin
Benzylpenicillin and IV Gentamicin are used to treat IE caused by which organism?
Strep. viridans
How is IE caused by Enterococcus spp. treated?
Amoxicillin/Vancomycin + IV Gentamicin
How do we treat Staph. epidermidis IE?
IV Vancomycin + IV Gentamicin + PO Rifampicin
How long is antibiotic treatment usually given for?
4-6 weeks
What do we tend to monitor during IE treatment?
Cardiac function
Temperature
CRP
What is the most common type of cardiomyopathy and what are its clinical signs?
Hypertrophic cardiomyopathy Jerky pulse Forceful/Double apical beat Fourth heart sound Mid-systolic murmur - exacerbated by Valsalva manoeuvre
What are the histological Taurus of dilated cardiomyopathy?
Hypertrophy
Oddly shaped nuclei
Myocyte and myofilament loss
Interstitial fibrosis
What type of cardiomyopathy is caused by the muscle being replaced by fibrous and fatty tissue?
Arrhythmogenic RV Cardiomyopathy
What are the characteristic ECG signs of ARVCM?
T-wave inversion beyond V1
QRS in V1 >0.11s
Epsilon waves
What is Brugada syndrome?
Cardiac sodium ion channel mutation
