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CardioRespiratory 2 > Structural heart disease > Flashcards

Structural heart disease Flashcards

1
Q

Give some examples of congenital structural heart diseases?

A

Atrial septal defect - ASD
https://www.osmosis.org/learn/Atrial_septal_defect

Ventricular septal defect - VSD
https://www.osmosis.org/learn/Ventricular_septal_defect

Coarctation of aorta
https://www.osmosis.org/learn/Coarctation_of_the_aorta?from=/md/foundational-sciences/pathology/cardiovascular-system/vascular-disorders/hypertension

patent foramen ovale PFO

Patent ductus arteriosus PDA
https://www.osmosis.org/learn/Patent_ductus_arteriosus

Tetralogy of Fallot TOF
https://www.osmosis.org/learn/tetralogy-of-fallot

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2
Q

Give some examples of structural diseases that can occur later on in life?

A

Due to valvular dysfunctions - atrial stenosis / regurgitation or mascular - cardiomyopathies

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3
Q

Which aortic valvular defects are there?

A

Aortic stenosis

Aortic Regurgitation

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4
Q

What mitral vulvular defects are there?

A

Mitral stenosis

Mitral regurgitation

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5
Q

What is the most common vulvular disease?

A

Aortic stenosis

2nd most frequent cause for cardiac surgery
DIsease of the older people

Preceded by aortic sclerosis

Often suspected by the presense of an early peaking, systolic ejection murmer and confirmed by echocardiography

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6
Q

What is aortic sclerosis?

A

the thickening and calcification of the aortic valve without an obstruction of the ventricular flow of blood

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7
Q

What are the risk factors for aortic stenosis?

A
  • Hypertension
  • LDL
  • Elevated C-reactive protein
  • Congenital bicuspid valves
  • Chronic kidney disease
  • Radiotherapy
  • Older age
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8
Q

What are the causes of aortic stenosis ?

A

Rheumatic heart disease

Congenital heart disease

Calcium build up

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9
Q

How is the valvular endocardium damaged in aortic stenosis?

A

by abnormal blood flow across bicuspid valve, in other valves it is due to an unknown trigger

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10
Q

How does calcium get deposited in the valves in aortic stenosis?

A

endocardial injury initiated inflammatory process –> leaflet fibrosis –> deposition of calcium

or

in rheumatic disease, autoimmune inflammatory reaction triggered by prior steptococcus infection –> targets vulvular endothelium –> inflammation and calcification

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11
Q

How does aortic stenosis cause ventricular hypertrophy?

A

Long-standing pressure overload –> left ventricular hypertrophy LVH

Ventricles should be able to maintain normal wall stress despite pressure overload produced by stenosis –> as it worsens the adaptive mechanisms fails –> left ventricular wall stress increases

Systolic function declines as wall stress increases, with resultant systolic heart failure

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12
Q

What would a px with aortic stenosis present with?

A

Exertion dyspnoea and fatigue

  • chest pain
  • ejection systolic murmur (>3/6 is present with crescendo-decrendo pattern that peaks in mid systole and radiates to the carotid)

H/O Rheumatic fever, high lipoprotein, high LDL, CKD, age >65

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13
Q

What investigation are done for aortic stenosis px?

A

Transthoracic echocardiography

ECG chest X ray

Cardiac catheterisation

Cardiac MRI

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14
Q

What is the management for aortic stenosis?

A

Aortic valve replacement if BNP is elevated or if AS is severe both in symptomatic and asymptomatic px

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15
Q

What types of valves are available for aortic stenosis?

A

Surgical mechanical
Surgical Bioprosthetic
Transcathetar aortic valve implantation device

  • under development : flexible polymeric valve
  • tissue engineered heart valve
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16
Q

What is Aortic regurgitation?

A

Diastolic leakage of blood from the aorta into the left ventricle

AR is not as common as AS and mitral regurgitation

It can be chronic and turn into congestive cardiac failure

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17
Q

What causes aortic regurgitation? (AR)

A

incompetent valve leaflets either from valve disease itself or dilation of the aortic root

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18
Q

What is acute AR?

A

AR can be acute and present as a medical emergency, presenting with sudden onset of pulmonary oedema and hypotension or cardiogenic shock

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19
Q

What are the causes of AR which are congenital and acquired?

A
  • Rheumatic heart disease
  • Infective endocarditis
  • Aortic valve stenosis
  • Congenital heart defects
  • Congenital bicuspid valves
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20
Q

What are the causes of AR which are linked to aortic root dilation?

A
  • Marfan’s syndrome
  • Connective tissue disease / collagen vascular disease
  • Ideio
  • Ankylosing spondilytis
  • Traumatic
21
Q

What can cayuse acute AR?

A

Infective endocarditis can lead to rupture of leaflets or even paravulvular leaks

CHest trauma can cause tear in ascending aorta

22
Q

WHat causes chronic AR?

A

Bicuspid valve

Ruhematic fever

23
Q

How does a px go into cardiogenic shock from acute AR?

A

Increase blood volume in LV during systole –>

LV end diastolic pressure increases –>

Increase in pulomnary venous pressure –>

dyspnea and pulmonary oedema –>

heart failure –> cardiogenic shock

24
Q

How does chronic AR lead to Ischaemia, necrosis and apoptosis?

A

gradula increase in LV volume causes the enlargement of the lV and eccentric hyertrophy

At first ejection fraction is normal or may slightly increase

After some time the ejective fraction falls and LV end systolic volume rises

Leads to eventual LV dyspneoa –> lower cronary perfusion and hence ischaemia

25
Q

How may a px with acute AR present?

A

Cardiogenic shock
Tachycardia
cyanosis
Pulmonary edema

26
Q

How may a px present with chronic AR?

A

wide pulse pressure

pistol shot pulse = traube sign

27
Q

What investigations are done for AR?

A
  • transthoracic echocardiography
  • chest X ray
  • cardiac catherisation
  • cardiac MRI /CT
28
Q

What treatments are given for acute AR?

A

Aortic valve replacement

ionotropes / vasodilator

29
Q

What treatments are given for chronic AR?

A

if asymptomatic = LV function is normal can use drugs or reassurance

If symptomatic : first line is valve replacement with vasodilator therapy

Prevention is key: treat rhuuematic fever and infective endocarditis

30
Q

What is mitral stenosis?

A

Obstruction to left ventricular inflow at the level of mitral valve

due to structural abnormality

31
Q

What is the main cause of mitral stenosis?

A

Rheumatic fever is main cause in developing countries

32
Q

What can progressed mitral stenosis lead to?

A

Pulmonary hypertension and right heart failure

33
Q

What are the other causes of mitral stenosis?

A

carnicoid syndrome

use of ergot/seroternergic drugs

SLE

mitral annular calcification due to ageing

Amyloidosis

RA

congenitcal valve deformity

34
Q

What is the initial pathophysiology of mitral stenosis?

A

Dysponea experienced due to an increased left atrial pressure during activities like moderate excersize

35
Q

How does mitral stenosis cause dyspnoea at rest as well as exertion?

A

increased left atrial pressure, transudation of fluid into the lung interstitium –> this can then cause pulmonary hypertension

  • hemoptysis is bronchial vein rupture
36
Q

What happens to cardiac output in mitral stenosis?

A

the restricted orifice limits filling of left ventricle limiting cardiac output

37
Q

How may a px with mitral stenosis present?

A
  • H/0 of Rheumatic fever
  • Dyspnoea
  • orthopnoea
  • Diastolic murmur
  • Loud P2
  • Neck vein distention
  • Hemoptysis
  • 40-50 age
38
Q

What investigations will be done to check for mitral stenosis?

A 
ECG
Transthoracic echocardiography
Chest X ray 
Cardiac catheterisation
Cardiac MRI/CT Scan
39
Q

How to manage progressive but asymptomatic mitral stenosis?

A

no therapy

40
Q

How to manage severe asymptomatic mitral stenosis?

A

no therapy generally required

adjuvant balloon valvotomy

41
Q

How to manage severe symptomatic mitral stenosis?

A

diuretic, balloon valvotomy, valve replacement & repair adjunct b blockers

42
Q

What causes acute mitral regurgitation?

A

mitral valve prolapse

rheumatic heart disease

infective endocarditis

can occur following valvular surgery

prosthetic mitral valve dysfunction

43
Q

What are the causes for chronic mitral regurgitation?

A

Rhuematic heart disease

SLE

scleroderma

hypertrophy cardiomyopathy

drug related

44
Q

What is the pathophysiology of infectious endocarditis?

A

abscess formation

vegetations

rupture of chordae tendieae

leaflet performation

45
Q

How does mitral regurgitation cause an increase in end diastolic volume and a decrease in end systolic volume

A

progression in chronic MR leads to hypertrophy

Leads to the elongation of fibres

increased left end diastolic volume

increase in preload and a decrease in afterload

causes increase in EDC and decrease in ESV

46
Q

how would a px with MR present?

A
  • Dyspnea
  • diminished S1, murmur high
  • Fatigue
  • pitched, blowing xx
  • Orthopnea
  • Chest pain
  • Atrial fibrillation
47
Q

How is acute Mitral regurgitation managed?

A

emergency surgery adjunct preoperative diuretics adjunct intra-aortic balloon counterpulsation

48
Q

How is chronic asymptomatic mitral regurgitation managed?

A

1st : ACE inhibitors

beta blockers if left ventricular ejection fraction is less than 60%

49
Q

How is chronic symptomatic mitral regurgitation managed?

A

1st : surgery plus medical treatment

if ventricular EF is less than 30% 1st line is : intra aortic balloon counter pulsation

CardioRespiratory 2 (12 decks)

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