structural heart disease Flashcards

1
Q

what is the tricuspid valve and where is it found

A

atrioventricular valve on right side of heart

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2
Q

what is the mitral valve

A

bicuspid valve found on left side of heart

an atrioventricular valve

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3
Q

what are some examples of congenital heart disease

A
atrial septal defect
ventricular septal defect
patent foramen ovale
patent ductus arteriosus
tetralogy of fallot
coarctation of aorta
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4
Q

what is ventricular septal defect

A

birth defect of heart where there is a hole in septum

wall fails to form

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5
Q

what are the symptoms of vsd in children

A

poor weight gain
palpitations
poor feeding esp if hole is large

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6
Q

how can you treat ventricular septal defect

A

open heart surgery

or cardiac catherisation

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7
Q

what is tetralogy of fallot

A

4 effects together:

  • hole between ventricles
  • pulmonary stenosis (pulmonary trunk removed)
  • widening of aortic valve - also causing mixing of blood
  • right ventricular hypertrophy
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8
Q

what is another name given to cardiac muscle

A

myocardium

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9
Q

what is the outer layer that covers muscular layer called

A

epicardium

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10
Q

what do you call epithelial cells on inner side of cardiac muscle

A

endocardium

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11
Q

what is atrial septal defect

A

hole between atria

walls fail to develop normally

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12
Q

what is coarctation of aorta

A

narrowing of aorta
causes ventricle to work harder and push more blood each cycle which can lead to thickening of ventricles or heart failure
needs urgent repair

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13
Q

what are some valvular heart defects

A

aortic stenosis - narrowing
aortic regurgitation - backflow
mitral stenosis
mitral regurgitation

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14
Q

what is aortic stenosis

A

most common valvular disease

preceded by aortic sclerosis

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15
Q

how do you suspect aortic stenosis

A

presence of early peaking, systolic ejection murmur and confirmed by ecg

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16
Q

What are some risk factors for aortic stenosis

A
hypertension
ldl levels
smoking
elevated crp
congenital bicuspid valves
chronic kidney disease
radiotherapy
older age
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17
Q

cause of aortic stenosis

A

rheumatic heart disease
congenital heart disease
calcium build up

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18
Q

pathophysiology of aortic stenosis

A

valvular endocardium damaged as result of abnormal blood flow(in case of bicuspid valve) or by unknown trigger
injury initiates inflammatory process leading to leaflet fibrosis and deposition of calcium - limiting mobility

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19
Q

what is rheumatic heart disease

A

autoimmune inflammatory reaction

triggered by prior strept infection - targets valvular endothelium - leads to inflame and calcification

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20
Q

what does aortic stenosis cause

A

Long standing pressure overload in lv leading to hypertrophy
as stenosis worsens adaptive mechanism fails
left ventricular wall stress increases
systolic function declines
= systolic heart failure

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21
Q

how do you diagnose aortic stenosis

first:

A
history and presentation:
exertion dyspnoea
chest pain
ejection systolic murmur
rheumatic fever, high ldl,ckd, above 65 yrs
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22
Q

how do you diagnose aortic stenosis

second:

A

transthoracic ecg
ecg chext xray
cardiac catherterisation
cardiac mri

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23
Q

what is the management of aortic stenosis

A
aortic valve replacement - treatment for asymptomatic patients with severe as with rapid progression, abnormal exercise test and high bop levels
balloon aortic valvuloplasty
antihypertensives
acei
statins
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24
Q

aetiology of aortic regurgitation

A

occurs due to incompetence of valve leaflets from intrinsic heart disease or dilation aortic root

causes diastolic leakage of blood from aorta into left ventricle

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25
Q

what can chronic aortic regurgitation cause

A

congestive cardiac failure

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26
Q

what can acute aortic regurgitation cause

A

medical emergency

present with sudden onset of pulmonary oedema and hypotension or cardiogenic shock

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27
Q

what are some congenital and acquired cause of aortic regurgitation

A

rheumatic heart disease

infective endocarditis

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28
Q

what are the aortic root dilation cause of aortic regurgitation

A
marfans syndrome
connective tissue disease
idiopathic
ankylosing spondylitis 
trauma
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29
Q

what is the abnormal physiology in acute ar

A
increase blood volume in lv during systole
lv end diastolic pressure increase
increase in pulmonary venous pressure
dyspnoea and pulmonary oedema
heart failure
cardiogenic shock
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30
Q

what is the abnormal physiology in chronic ar

A

gradual increase in lv vol
lv enlargement and eccentric hypertrophy
in early stages the ejection fraction slightly increases and then falls and lv end systolic volume rises
eventual lv dyspnoea
lower coronary perfusion
inchaemia necrosis and apoptosis

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31
Q

how to diagnose acuteaortic regurgitation

A

acute - cardiogenic shock
tachycardia
cyanosis
pulmonary oedema

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32
Q

how to diagnose chronic aortic regurgitation

A

wide pulse pressure

pistol shot pulse - trauma sign

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33
Q

what are the investigations for ar

A

transthoracic ecg
cxr
cardiac catherisation
cardiac mri/ct

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34
Q

how can we manage acute ar

A

ionotropes/vasodilators

valve replacement and repair

35
Q

how can we manage chronic ar

A

if lv function is normal - can be managed by drugs/reassurance
if symptomatic - first line is valve replacement with adjunct vasodilator therapy

36
Q

what else is important in management of ar

A

prevention is key

treat rheumatic fever and infective endocarditis

37
Q

what is mitral stenosis

A

obstruction to left ventricular inflow at level of mitral valve due to structural abnormality

as disease progresses leads to pulmonary hypertension and right heart failure

38
Q

what is the main cause of mitral stenosis

A

rheumatic fever

39
Q

what are some other causes of mitral stenosis

A
rheumatic fever
carcinoid syndrome
use of ergot/serotonergic drugs
sle
mitral annular calcification due to ageing
amyloidosis
rheumatoid arthritis
Whipple disease
congenital deformity of valve
40
Q

pathophysiology of mitral stenosis

A

acute insult leads to formation of multiple foci and infiltrates in endo and myocardium and along walls of valves

with time becomes thickened,calcified and contracted

41
Q

how is physiology of heart affected by mitral stenosis initially

A

initially - moderate exercise/tachycardia results in exertional dyspnoea due to increase in left atrial pressue

42
Q

what does mitral stenosis cause in severe cases

A

increase in left arterial pressure
transudation of fluid into lung interstitium leading to dyspnoea at rest
pulmonary hypertension
limited filling of left ventricle limits cardiac output
hemoptysis. if bronchial vein ruptures

43
Q

how do we diagnose mitral stenosis

A
rheumatic fever
dyspnoea
orthopnoea
diastolic murmur
loud p2
neck vein distention
hemoptysis
40-50yrs
44
Q

what investigations can we do to check for mitral stenosis

A
ecg
transthoracic ecg
cxr
cardiac catherterisation
cardiac mri/ scan
45
Q

how can we manage mitral stenosis

A

progressive asymptomatic - no therapy required
severe asymptomatic - adjuvant balloon valvotomy
severe symptomatic - diuretic, balloon valvotomy, valve replacement and repair adjunct b blockers

46
Q

what is mitral regurgitation

A

abnormal reversal of blood flow from left ventricle to left atrium
caused by disruption in any part of mitral valve apparatus

47
Q

what are some acute causes of mitral regurgitation

A
mitral valve prolapse
rheumatic heart disease
infective endocarditis
following valvular surgery
prosthetic mitral valve dysfunction
48
Q

what are some chronic causes of mitral regurgitation

A
rheumatic heart disese
sle
scleroderma
hypertrophic cardiomyopathy
drug related
49
Q

infective endocarditis leads to

A

abscess formation, vegetations, rupture of chord tendinae and leaflet perforation

50
Q

what does chronic mr lead to

A

progression leads to eccentric hypertrophy leading to elongation of myocardial fibres and increased left end diastolic vol

prolonged vol overload leads to left ventricular dysfunction and increased left ventricular endsysytolic diameter

51
Q

how can we diagnose mitral regurgitation using history and presentation

A
dyspnoea
murmur
fatigue
orthopnea
chest pain
atrial fibrillation
diminished s1
pitched blowing xx
52
Q

how can we diagnose mitral regurgitation using investigations

A
ecg
transthoracic ecg
cxr
cardia catherterisation
cardiac mri/ct
53
Q

how can we manage acute mr

A

emergency surgery
adjunct preoperative diuretics
adjunct intra aortic balloon counterpulsation

54
Q

how can we manage chronic mr

A

if chronic asymptomatic - ACE inhibitors
b blockers of ef less than 60%
chronic symptomatic - surgery and meds
if left ventricular ef is less than 30% 1st line is intra aortic balloon counter pulsation

55
Q

what is a cardiomyopathy

A

disease of heart muscle that makes it harder for heart to pump blood to rest of body

56
Q

what can cardiomyopathies lead to

A

heart failure

57
Q

what are the main types of cardiomyopathies

A

dilated
hypertrophic
restrictive

58
Q

what happens to ventricles in hypertrophic cardiomyopathy

A

size of left ventricle exponentially reduces

59
Q

what happens to ventricles in dilated cardiomyopathy

A

left ventricle is very enlarged

60
Q

what happens to ventricles in restrictive cardiomyopathy

A

stiffness of ventricle wall

61
Q

what % of dilated cardiomyopathy is due to familial causes

62
Q

what is a primary cause of dilated cardiomyopathy

A

without familial history

idiopathic

63
Q

what are some secondary causes of dilated cardiomyopathy

A
heart valve disease
after child birth
thyroid disease
myocarditis
alcoholism
autoimmune disorders
ingestion of drugs
mitochondrial disorders
64
Q

what is the pathophysiology of dilated cardiomyopathy

A

ventricular chamber enlargement and systolic dysfunction with normal left ventricular wall thickness

65
Q

how does abnormal physiology affect normal function of the heart

A

-enlargement of left ventricle
lower ef and increase in ventricular wall stress and end systolic volumes
- early compensatory mechanisms = increase in hr and tone of peripheral vascular system
- neurohumoral activation of renin-angiotensin aldosterone system and increase in circulating catecholamines
- levels of natriuretic peptides are increased
- eventually compensatory mechanisms become overwhelmed and heart fails

66
Q

how can we diagnose dilated cardiomyopathy using history and presentation

A
dyspnoea
murmur
fatigue
angina
pulmonary congestion
low cardiac output 
displaced apex beat, s3/ systolic
67
Q

how can we diagnose dilated cardiomyopathy using investigations

A
genetic testing
viral serology
ecg
cxr
cardiac catheterisation
echocardiography
cardiac mri/ct
exercise stress test
68
Q

how can we manage dilated cardiomyopathy

A

counselling is very important as condition is lifelong

treat according to problems

69
Q

what is hypertrophic cardiomyopathy

A

genetic cvd
defined by increase in left ventricular wall thickness
occurs as autosomal dominant medelian inherited disease in approx 50% of cases

70
Q

most patients with hcm are asymptomatic what could the first clinical manifestations be

A

sudden death

likely from ventricular tachycardia or fibrillation

71
Q

where does hypertrophy frequently occur

A

intraventricular septum which results in obstruction of flow through left ventricular outflow tract

72
Q

what does abnormal physiology do to heart

A

causes abnormal diastolic function
impairs ventricular filling and increases filling pressure
abnormal calcium kinetics and subendocardial ischaemia

73
Q

how can we use history and presentation to diagnose hypertrophic cardiomyopathy

A
sudden cardiac death
syncope
presyncope
congestive heart failure
dizziness
palpitations
angina
double carotid artery impulse s3
ejection systolic murmur
74
Q

what investigations can we do to detect hypertrophic cardiomyopathy

A
hemoglobin levels - anaemia exacerbates chest pain and dyspnoea
bnp
troponin levels
echocrdiography
cxr
cardiac mri
75
Q

how can we manage hypertrophic cardiomyopathy with symptoms

A

beta blockers or verapamil

76
Q

aetiology of restrictive cardiomyopathy

A

diastolic dysfunction with restrictive ventricular physiology
atrial enlargement occurs due to impaired ventricular filling during diastole

77
Q

causes of restrictive cardiomyopathy

A

idiopathic
familial
associated with various systemic disorders e.g haemochromatosis, amyloidosis,sarcoidosis,fabrys disease, carcinoid syndrome, scleroderma, fabrys disease

78
Q

how are infiltrative cardiomyopathies characterised

A

deposition of abnormal substances i.e amyloid proteins, non caseating granulomas within heart tissue
infiltration causes ventricular wall to stiffen
leading to diastolic dysfunction

79
Q

what can adverse remodelling lead to

A

systolic dysfunction and ventricular arrhythmias in advanced cases

80
Q

what abnormal physiology occurs in rcm

A
increases stiffness
ventricular pressure increase
filling occurs in early diastole and terminates abruptly at end of rapid folling phase
reduced comliance
reduced filling
reduced cardiac output
81
Q

how can history diagnose restrictive cardiomyopathy

A
frequent acsites
pitting oedema of lower extremities
enlarges liver with fluid
weight loss
cachexia
easy brusing
macroglossia
increased jugular venour pressue
pulse vol decreased
82
Q

investigations for restricitve cardiomyopathy

A
cbc
serology
amyloidosis
cxr
ecg
echocardiography
catheterisation
mri/biopsy
83
Q

management of rcm

A
heart failure med
acei 
arbs
antiarrythmic therapy
immunosupression - steroids
pacemaker 
cardiac transplantation