Structural heart disease Flashcards
Give some examples of congenital structural heart diseases?
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
Give some examples of structural diseases that can occur later on in life?
Due to valvular dysfunctions - atrial stenosis / regurgitation or mascular - cardiomyopathies
Which aortic valvular defects are there?
Aortic stenosis
Aortic Regurgitation
What mitral vulvular defects are there?
Mitral stenosis
Mitral regurgitation
What is the most common vulvular disease?
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
What is aortic sclerosis?
the thickening and calcification of the aortic valve without an obstruction of the ventricular flow of blood
What are the risk factors for aortic stenosis?
- Hypertension
- LDL
- Elevated C-reactive protein
- Congenital bicuspid valves
- Chronic kidney disease
- Radiotherapy
- Older age
What are the causes of aortic stenosis ?
Rheumatic heart disease
Congenital heart disease
Calcium build up
How is the valvular endocardium damaged in aortic stenosis?
by abnormal blood flow across bicuspid valve, in other valves it is due to an unknown trigger
How does calcium get deposited in the valves in aortic stenosis?
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
How does aortic stenosis cause ventricular hypertrophy?
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
What would a px with aortic stenosis present with?
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
What investigation are done for aortic stenosis px?
Transthoracic echocardiography
ECG chest X ray
Cardiac catheterisation
Cardiac MRI
What is the management for aortic stenosis?
Aortic valve replacement if BNP is elevated or if AS is severe both in symptomatic and asymptomatic px
What types of valves are available for aortic stenosis?
Surgical mechanical
Surgical Bioprosthetic
Transcathetar aortic valve implantation device
- under development : flexible polymeric valve
- tissue engineered heart valve
What is Aortic regurgitation?
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
What causes aortic regurgitation? (AR)
incompetent valve leaflets either from valve disease itself or dilation of the aortic root
What is acute AR?
AR can be acute and present as a medical emergency, presenting with sudden onset of pulmonary oedema and hypotension or cardiogenic shock
What are the causes of AR which are congenital and acquired?
- Rheumatic heart disease
- Infective endocarditis
- Aortic valve stenosis
- Congenital heart defects
- Congenital bicuspid valves
What are the causes of AR which are linked to aortic root dilation?
- Marfan’s syndrome
- Connective tissue disease / collagen vascular disease
- Ideio
- Ankylosing spondilytis
- Traumatic
What can cayuse acute AR?
Infective endocarditis can lead to rupture of leaflets or even paravulvular leaks
CHest trauma can cause tear in ascending aorta
WHat causes chronic AR?
Bicuspid valve
Ruhematic fever
How does a px go into cardiogenic shock from acute AR?
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
How does chronic AR lead to Ischaemia, necrosis and apoptosis?
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
