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JL Cardiovascular > Structural Cardiac Abnormalities > Flashcards

Structural Cardiac Abnormalities Flashcards

1
Q

What is a cardiac murmur due to?

A

Audible turbulence of blood flow

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2
Q

What murmur has 2nd sound splitting?

A

Aortic stenosis

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3
Q

What murmur has a third sound?

A

Aortic regurgitation

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4
Q

What murmur has a fourth sound?

A

Mitral stenosis

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5
Q

What murmum has systolic clicks?

A

Continuous murmur

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6
Q

What murmur is an “innocent murmur”?

A

Tricuspid regurgitation

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7
Q

What murmur is related to pericardial rub?

A

Mitral regurgitation

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8
Q

What are the two types of systolic murmurs?

A

Pansystolic

Ejection systolic

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9
Q

What are the two descriptions for diastolic murmurs?

A

Early diastolic and mid diastolic

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10
Q

When does an early diastolic murmur occur?

A

Just after S2 in a decrecendo manner

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11
Q

When does a mid diastolic murmur occur?

A

After S2 and stops at S1

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12
Q

What kind of murmurs are louder with inspiration?

A

Right-sided murmur

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13
Q

When does an innocent murmur occur?

A

Between S1 and S2

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14
Q

What disease occurs when valves cannot open properly?

A

Valve stenosis

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15
Q

What disease occurs when valves do not close properly?

A

Valve regurgitation

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16
Q

What non invasive and what invasive investigations can be done to assess valve disease?

A

Non invasive - echocardiography

invasive - cardiac catheterisation

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17
Q

Give three causes of aortic stenosis?

A
  1. Congenitally bicuspid valve
  2. Age-related/degenerative
  3. Rheumatic
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18
Q

What is an ejection systolic murmur, maximal in the aortic area and radiating to hte carotids?

A

Aortic stenosis

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19
Q

What is a low volume pulse and slow rising?

A

Aortic stenosis

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20
Q

What murmur has a forceful apex and LV heave?

A

Aortic stenosis

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21
Q

What are 3 treatment options for aortic stenosis?

A
  1. Valve replacement
  2. Balloon Aoritc Valvotomy
  3. Transcatheter Aortic Valve Implantation
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22
Q

Do you need warfarin for biprosthetic valves?

A

Nio

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23
Q

Do you need anticoagulants for mechanical valves?

A

Yes

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24
Q

What is the default procedure for aortic stenosis?

A

Surgery (AVR)

Need for combined CABG

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25
Q

What are three leaflet causes of mitral regurgitation?

A
  1. Rheumatic heart disease
  2. Myxomatous degeneration (floppy mitral valve syndrome)
  3. Endocarditis
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26
Q

What can happen to the chordae to cause mitral regurgitation?

A

Chordal rupture

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27
Q

What can happen to the papillary muscle to cause mitral regurgitation?

A

Ischaemia or infarction

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28
Q

What can happen annular dilatation to cause mitral regurgitation?

A

LV dilatation

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29
Q

What are three symptoms of mitral regurgitation?

A
  1. Breathlessness
  2. Ankle swelling
  3. Fatigue
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30
Q

Where does mitral regurgitation radiate to?

A

Axilla

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31
Q

What murmur is a pansystolic murmur, maximal at apex and has a displaced apex beat?

A

Mitral regurgitation

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32
Q

What two drugs can be given for mitral regurgitation?

A

Diuretics and ACE inhibitors

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33
Q

What two surgical options are there for mitral regurgitation?

A

Valve repair and valve replacement

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34
Q

Give two causes of mitral stenosis?

A

Rheumatic heart disease

Congenital

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35
Q

Give three symptoms of mitral stenosis?

A

Breathlessness, tiredness and palpitations

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36
Q

What is a mid diastolic murmur localised to apex?

A

Mitral stenosis

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37
Q

What murmur has a tapping apex beat?

A

Mitral stenosis

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38
Q

What murmum causes a malar flush and at later stages right heart failure?

A

MITRAL STENOSIS

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39
Q

What murmur can cause AF and a straight left heart border?

A

Mitral stenosis

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40
Q

What are 4 drug treatment options for mitral stenosis?

A
  1. Diuretics
  2. Beta-blockers
  3. Digoxin
  4. Warfarin
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41
Q

What surgical options is available for mitral stenosis?

A

Valve replacement

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42
Q

Give three leaflet causes of aortic regurgitation?

A
  1. Infective endocarditis
  2. Connective tissue disease
  3. Rheumatic heart disease
43
Q

What are two annulus causes of aortic regurgitation?

A

Marfan’s syndrome

Acute aortic dissection

44
Q

What are three symptoms of aortic regurgitation?

A

Breathlessness
Chest pain
Dizziness

45
Q

What murmur has a high volume collapsing pulse?

A

Aortic regurgitation

46
Q

What murmur has a displaced apex and is an early diastolic murmur at the lower left sternal edge?

A

Aortic regurgitation

47
Q

What three drugs can treat aortic regurgitation?

A
  1. ACE inhibitors
  2. ARBs
  3. Diuretics
48
Q

What surgery is available for aortic regurgitation?

A

Valve replacement

49
Q

When is the apex said to be displaced?

A

When it is outside 5th left ICS in the MCL

50
Q

What are Marfans syndrome, myotonic dystrophy, muscular dystrophies, Ehlers-Danlos and Loeys-Dietz all?

A

Inherited Multi-system diseass with cardiac involvement

51
Q

What are 4 genetic predispositions in aquired heart disease?

A
  1. VT/VF in heart failure and in ischaemic heart disease
  2. AF in structural heart disease
  3. Druf aquired long QT syndrome
  4. SCD in left ventricular hypertrophy
52
Q

What are the 4 classifications of cardiomyopathies?

A
  1. Hypertrophic cardiomyopathy
  2. Dialted (idiopathic0 cardiomyopathy
  3. Arrhythmogenic right ventricular cardiomyopathy
  4. Restrictive cardiomyopathy
53
Q

What drug scan cause secondary cardiomyopathies?

A

antracyclines

54
Q

What are endocrine, familial storage disease and infiltrations, deficiency and amyloid all?

A

Metabolic causes of secondary cardiomyopathies

55
Q

What type of cardiomyopathy has a jerky pulse, forceful or double apical impulse, 4th heart sound, mid systole murmur exacerbated by Valsalva manoeuvre is present in 30-40% of cases?

A

Hypertrophic cardiomyopathy

56
Q

What cardiomyopathy has rapid x and y descent of the JVP, loud 3rd and 4th heart sound?

A

Restrictive cardiomyopathy

57
Q

Give 5 investigations you would do for cardiomyopathies?

A
  1. TFT, iron studies
  2. ECG
  3. Echocardiogram
  4. Holter monitor or 24 hour tape
  5. Cardiac MRI
58
Q

What are the three morphologies of hypertrophic cardiomyopathies?

A
  1. Asymmetric Septal hypertrophy
  2. Symmetric or cencentric left ventricular hypertrophy
  3. Apical
59
Q

What type of cardiomyopathy can LVOT obstruction, reduced ejection fraction, mitral reguregitation and rhythm disturbances occur in?

A

Hypertrophic cardiomyopathy

60
Q

What type of cardiomyopathy can common diseases like coronary heart disease, hypertension or heart valve disease cause?

A

Dilated cardiomyopathy

61
Q

Give 4 histological features of dilated cardiomyopathy?

A
  1. Myocardial cell hypertrophy incrfeased length without increased diamter
  2. Large bizarrely shaped nuclei
  3. Myocyte atrophy and myofilament loss
  4. Increased interstitial fibrosis
62
Q

What cardiomyopathy is this: increased systolic and diastolic volume with low ejection fraction, incidence increases with age and men are more commonly affected and it may be idiopathic, familial/genetic, viral, autoimmune or immune-mediated associated with a viral infection?

A

Dilated cardiomyopathy

63
Q

What happens to the heart muscle in arrhythmogenic right ventricular cardiomyopathy (ARVC)?

A

It is replaced by fibrous and fatty tissue

64
Q

What part of the heart does ARVC predominanlty affect?

A

Right ventricle

65
Q

Give the three most common clinical manifestations of ARVC?

A
  1. Ventricular arrhythmias of RV origin, which may lead to sudden death mostly in young people and athletes
  2. ECG changes
  3. Global and/or regional dysfunction and structural alterations of teh RV
66
Q

What age group does ARVC normally occur in?

A

Teens to early 20s

67
Q

Give 3 characteristics of ARVC on ECG?

A
  1. T-wave inversion beyond lead V1
  2. Evidence of right ventricular electrical disturbance is manifest by a QRS duration in V1 > or = 110 msec
  3. Longer QRS duration in the right than left precordial leads
68
Q

What does the evidence of slow fractionated conduction present as on ECG in ARVC?

A

Epsilon waves

69
Q

In ARVC, what may develop secondary to right heart dilatation?

A

Tricuspid regurgitation

70
Q

What type of cardiomyopathy is a disorder of the heart muscle in which the walls of the ventricles become stiff, but not necessarily thickened, such that they resist normal filling with blood?

A

Restrictive cardiomyopathy

71
Q

Give 4 features of restrictive cardiomyopathy?

A
  1. Reduced EDV
  2. Normal ESV
  3. Increased left ventricular filling pressure
  4. Normal EF
72
Q

Give two causes of endomyocardial fibrosis which leads to Restrictive cardiomyopathy?

A

Tropical

Hypereosinophilic syndrome

73
Q

Give two infiltrative disorders which lead to restrictive cardiomyopathy?

A

Amyloidosis

Sarcoidosis

74
Q

Give 4 rare metabolic disorders that lead to restrictive cardiomyopathy?

A
  1. Gaucher’s disease
  2. Mucopolysaccharidoses
  3. Fabry’s disease
  4. Carcinoid syndrome
75
Q

What mutation is present in 2/3 of all hypertrophic cardiomyopathy cases?

A

Sarcomeric genes

76
Q

Is HCM autosomal dominant?

A

YES

77
Q

What is a cardiomyopathy disease which is clinically and genetically heterogenous?

A

DCM

78
Q

What are the main mutations if ARVC?

A

In cardiac ryanodine receptor, which controls electromechanical coupling

79
Q

What are maligant ventricular arrythmia and sudden arrythmic deaths risks of?

A

Primary Electrical Disease

80
Q

What is the most common familial arrythmia linked with SUD?

A

Long QT syndrome

81
Q

What is a congenital disorder that may lead to unexplained syncope, seizures and sudde narrythmic death?

A

LQTS

82
Q

What are some patients with Long QT syndrome prone to?

A

Lethal VT ‘Torsades de Pointes’

83
Q

In congenital long QT syndrome, what 4 factors can trigger arrythmias?

A
  1. High adrenergic tone: physical or emotional stress
  2. Sudden auditory stimuli
  3. Swimming/diving
  4. During sleep
84
Q

Give two features of the mechanism of QT prolongation?

A
  1. Less repolarising currents prolongs ADP

2. More depolarising current prolongs APD

85
Q

What is a condition of cardiac sodium channel mutation?

A

Brugada syndrome

86
Q

What is there a risk of with Brugada syndrome?

A

VT and VF, AF common

87
Q

What syndrome has ST elevation and RBBB in V1-V3?

A

Brugada syndrome

88
Q

Name two drugs that block the cardiac sodium cahnnel?

A

Flecainide

Ajmaline

89
Q

What other 2 features, exclusing RBBB in V1-3 (early repolarisation), would you see in an ECG of Brugada syndrome?

A
  1. Elevated J point

2. Convex or saddle back ST elecation

90
Q

What is the symptomatic treatment for Brugada syndrome?

A

ICD

91
Q

What is the presumed mode of death due to primary electrical disease?

A

Arrythmia

92
Q

Mid diastolic murmur, best heard at apex with patient on left side, accentuated on exertion, low frequency and rumbling in nature?

A

Mitral stenosis

93
Q

Mid-diastolic murmur, best heart at the left sternal edge and louder on inspiration?

A

Tricuspid stenosis

94
Q

Early diastolic murmur, best heart at the left sternbal edge and the apex, with the patient sitting forward in held expiration. It is a blowing high-pitched murmur?

A

Aortic regurgitatiom

95
Q

Best heart on the right of the sternum, in held inspiration. It has a blowing sound and variable pictch?

A

Pulmonary regurgitation

96
Q

What type of mumurs are aortic stenosis, pulmonary stenosis, atrial septal defects, hypertrophic cardiomyopathy, Fallot’s tetralogy, aortic regurgiation and pulmonary regurgitation?

A

Ejection systolic mumurs

97
Q

Pansystolic murmur best heard at the left sternal edge, loud and rough?

A

Ventricular septal defect

98
Q

Pansystolic murmur, best heart at the left sternal edge and low-pitched?

A

Tricuspid regurgitation

99
Q

Murmur, late systolic, best heard on standing, (may also produce ejection systolic)?

A

HOCM

100
Q

Heard at left sternal edge radiating to the back?

A

Coarctation of the aorta

101
Q

What are these cardiac causes of - mitral valve disease, conduction abnormality (WPW), cardiomyopathy, pericardial disease and pericarditis?

A

AF

102
Q

What can these lung diseases cause - carcinoma of bronchus, PE, pneumonia?

A

AF

103
Q

What inheritance is typical in Hypertrophic cardiomyopathy?

A

Autosomal dominant

104
Q

What syndrome is mitral regurgitation floppy valve seen in?

A

Marfans syndrome

JL Cardiovascular (18 decks)

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