Structural Cardiac Abnormalities Flashcards
1
Q
What is a cardiac murmur due to?
A
Audible turbulence of blood flow
2
Q
What murmur has 2nd sound splitting?
A
Aortic stenosis
3
Q
What murmur has a third sound?
A
Aortic regurgitation
4
Q
What murmur has a fourth sound?
A
Mitral stenosis
5
Q
What murmum has systolic clicks?
A
Continuous murmur
6
Q
What murmur is an “innocent murmur”?
A
Tricuspid regurgitation
7
Q
What murmur is related to pericardial rub?
A
Mitral regurgitation
8
Q
What are the two types of systolic murmurs?
A
Pansystolic
Ejection systolic
9
Q
What are the two descriptions for diastolic murmurs?
A
Early diastolic and mid diastolic
10
Q
When does an early diastolic murmur occur?
A
Just after S2 in a decrecendo manner
11
Q
When does a mid diastolic murmur occur?
A
After S2 and stops at S1
12
Q
What kind of murmurs are louder with inspiration?
A
Right-sided murmur
13
Q
When does an innocent murmur occur?
A
Between S1 and S2
14
Q
What disease occurs when valves cannot open properly?
A
Valve stenosis
15
Q
What disease occurs when valves do not close properly?
A
Valve regurgitation
16
Q
What non invasive and what invasive investigations can be done to assess valve disease?
A
Non invasive - echocardiography
invasive - cardiac catheterisation
17
Q
Give three causes of aortic stenosis?
A
- Congenitally bicuspid valve
- Age-related/degenerative
- Rheumatic
18
Q
What is an ejection systolic murmur, maximal in the aortic area and radiating to hte carotids?
A
Aortic stenosis
19
Q
What is a low volume pulse and slow rising?
A
Aortic stenosis
20
Q
What murmur has a forceful apex and LV heave?
A
Aortic stenosis
21
Q
What are 3 treatment options for aortic stenosis?
A
- Valve replacement
- Balloon Aoritc Valvotomy
- Transcatheter Aortic Valve Implantation
22
Q
Do you need warfarin for biprosthetic valves?
A
Nio
23
Q
Do you need anticoagulants for mechanical valves?
A
Yes
24
Q
What is the default procedure for aortic stenosis?
A
Surgery (AVR)
Need for combined CABG
25
What are three leaflet causes of mitral regurgitation?
1. Rheumatic heart disease
2. Myxomatous degeneration (floppy mitral valve syndrome)
3. Endocarditis
26
What can happen to the chordae to cause mitral regurgitation?
Chordal rupture
27
What can happen to the papillary muscle to cause mitral regurgitation?
Ischaemia or infarction
28
What can happen annular dilatation to cause mitral regurgitation?
LV dilatation
29
What are three symptoms of mitral regurgitation?
1. Breathlessness
2. Ankle swelling
3. Fatigue
30
Where does mitral regurgitation radiate to?
Axilla
31
What murmur is a pansystolic murmur, maximal at apex and has a displaced apex beat?
Mitral regurgitation
32
What two drugs can be given for mitral regurgitation?
Diuretics and ACE inhibitors
33
What two surgical options are there for mitral regurgitation?
Valve repair and valve replacement
34
Give two causes of mitral stenosis?
Rheumatic heart disease
| Congenital
35
Give three symptoms of mitral stenosis?
Breathlessness, tiredness and palpitations
36
What is a mid diastolic murmur localised to apex?
Mitral stenosis
37
What murmur has a tapping apex beat?
Mitral stenosis
38
What murmum causes a malar flush and at later stages right heart failure?
MITRAL STENOSIS
39
What murmur can cause AF and a straight left heart border?
Mitral stenosis
40
What are 4 drug treatment options for mitral stenosis?
1. Diuretics
2. Beta-blockers
3. Digoxin
4. Warfarin
41
What surgical options is available for mitral stenosis?
Valve replacement
42
Give three leaflet causes of aortic regurgitation?
1. Infective endocarditis
2. Connective tissue disease
3. Rheumatic heart disease
43
What are two annulus causes of aortic regurgitation?
Marfan's syndrome
| Acute aortic dissection
44
What are three symptoms of aortic regurgitation?
Breathlessness
Chest pain
Dizziness
45
What murmur has a high volume collapsing pulse?
Aortic regurgitation
46
What murmur has a displaced apex and is an early diastolic murmur at the lower left sternal edge?
Aortic regurgitation
47
What three drugs can treat aortic regurgitation?
1. ACE inhibitors
2. ARBs
3. Diuretics
48
What surgery is available for aortic regurgitation?
Valve replacement
49
When is the apex said to be displaced?
When it is outside 5th left ICS in the MCL
50
What are Marfans syndrome, myotonic dystrophy, muscular dystrophies, Ehlers-Danlos and Loeys-Dietz all?
Inherited Multi-system diseass with cardiac involvement
51
What are 4 genetic predispositions in aquired heart disease?
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
What are the 4 classifications of cardiomyopathies?
1. Hypertrophic cardiomyopathy
2. Dialted (idiopathic0 cardiomyopathy
3. Arrhythmogenic right ventricular cardiomyopathy
4. Restrictive cardiomyopathy
53
What drug scan cause secondary cardiomyopathies?
antracyclines
54
What are endocrine, familial storage disease and infiltrations, deficiency and amyloid all?
Metabolic causes of secondary cardiomyopathies
55
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?
Hypertrophic cardiomyopathy
56
What cardiomyopathy has rapid x and y descent of the JVP, loud 3rd and 4th heart sound?
Restrictive cardiomyopathy
57
Give 5 investigations you would do for cardiomyopathies?
1. TFT, iron studies
2. ECG
3. Echocardiogram
4. Holter monitor or 24 hour tape
5. Cardiac MRI
58
What are the three morphologies of hypertrophic cardiomyopathies?
1. Asymmetric Septal hypertrophy
2. Symmetric or cencentric left ventricular hypertrophy
3. Apical
59
What type of cardiomyopathy can LVOT obstruction, reduced ejection fraction, mitral reguregitation and rhythm disturbances occur in?
Hypertrophic cardiomyopathy
60
What type of cardiomyopathy can common diseases like coronary heart disease, hypertension or heart valve disease cause?
Dilated cardiomyopathy
61
Give 4 histological features of dilated cardiomyopathy?
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
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?
Dilated cardiomyopathy
63
What happens to the heart muscle in arrhythmogenic right ventricular cardiomyopathy (ARVC)?
It is replaced by fibrous and fatty tissue
64
What part of the heart does ARVC predominanlty affect?
Right ventricle
65
Give the three most common clinical manifestations of ARVC?
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
What age group does ARVC normally occur in?
Teens to early 20s
67
Give 3 characteristics of ARVC on ECG?
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
What does the evidence of slow fractionated conduction present as on ECG in ARVC?
Epsilon waves
69
In ARVC, what may develop secondary to right heart dilatation?
Tricuspid regurgitation
70
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?
Restrictive cardiomyopathy
71
Give 4 features of restrictive cardiomyopathy?
1. Reduced EDV
2. Normal ESV
3. Increased left ventricular filling pressure
4. Normal EF
72
Give two causes of endomyocardial fibrosis which leads to Restrictive cardiomyopathy?
Tropical
| Hypereosinophilic syndrome
73
Give two infiltrative disorders which lead to restrictive cardiomyopathy?
Amyloidosis
| Sarcoidosis
74
Give 4 rare metabolic disorders that lead to restrictive cardiomyopathy?
1. Gaucher's disease
2. Mucopolysaccharidoses
3. Fabry's disease
4. Carcinoid syndrome
75
What mutation is present in 2/3 of all hypertrophic cardiomyopathy cases?
Sarcomeric genes
76
Is HCM autosomal dominant?
YES
77
What is a cardiomyopathy disease which is clinically and genetically heterogenous?
DCM
78
What are the main mutations if ARVC?
In cardiac ryanodine receptor, which controls electromechanical coupling
79
What are maligant ventricular arrythmia and sudden arrythmic deaths risks of?
Primary Electrical Disease
80
What is the most common familial arrythmia linked with SUD?
Long QT syndrome
81
What is a congenital disorder that may lead to unexplained syncope, seizures and sudde narrythmic death?
LQTS
82
What are some patients with Long QT syndrome prone to?
Lethal VT 'Torsades de Pointes'
83
In congenital long QT syndrome, what 4 factors can trigger arrythmias?
1. High adrenergic tone: physical or emotional stress
2. Sudden auditory stimuli
3. Swimming/diving
4. During sleep
84
Give two features of the mechanism of QT prolongation?
1. Less repolarising currents prolongs ADP
| 2. More depolarising current prolongs APD
85
What is a condition of cardiac sodium channel mutation?
Brugada syndrome
86
What is there a risk of with Brugada syndrome?
VT and VF, AF common
87
What syndrome has ST elevation and RBBB in V1-V3?
Brugada syndrome
88
Name two drugs that block the cardiac sodium cahnnel?
Flecainide
| Ajmaline
89
What other 2 features, exclusing RBBB in V1-3 (early repolarisation), would you see in an ECG of Brugada syndrome?
1. Elevated J point
| 2. Convex or saddle back ST elecation
90
What is the symptomatic treatment for Brugada syndrome?
ICD
91
What is the presumed mode of death due to primary electrical disease?
Arrythmia
92
Mid diastolic murmur, best heard at apex with patient on left side, accentuated on exertion, low frequency and rumbling in nature?
Mitral stenosis
93
Mid-diastolic murmur, best heart at the left sternal edge and louder on inspiration?
Tricuspid stenosis
94
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?
Aortic regurgitatiom
95
Best heart on the right of the sternum, in held inspiration. It has a blowing sound and variable pictch?
Pulmonary regurgitation
96
What type of mumurs are aortic stenosis, pulmonary stenosis, atrial septal defects, hypertrophic cardiomyopathy, Fallot's tetralogy, aortic regurgiation and pulmonary regurgitation?
Ejection systolic mumurs
97
Pansystolic murmur best heard at the left sternal edge, loud and rough?
Ventricular septal defect
98
Pansystolic murmur, best heart at the left sternal edge and low-pitched?
Tricuspid regurgitation
99
Murmur, late systolic, best heard on standing, (may also produce ejection systolic)?
HOCM
100
Heard at left sternal edge radiating to the back?
Coarctation of the aorta
101
What are these cardiac causes of - mitral valve disease, conduction abnormality (WPW), cardiomyopathy, pericardial disease and pericarditis?
AF
102
What can these lung diseases cause - carcinoma of bronchus, PE, pneumonia?
AF
103
What inheritance is typical in Hypertrophic cardiomyopathy?
Autosomal dominant
104
What syndrome is mitral regurgitation floppy valve seen in?
Marfans syndrome
