structural heart disease Flashcards
1
Q
what is the tricuspid valve and where is it found
A
atrioventricular valve on right side of heart
2
Q
what is the mitral valve
A
bicuspid valve found on left side of heart
an atrioventricular valve
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
4
Q
what is ventricular septal defect
A
birth defect of heart where there is a hole in septum
wall fails to form
5
Q
what are the symptoms of vsd in children
A
poor weight gain
palpitations
poor feeding esp if hole is large
6
Q
how can you treat ventricular septal defect
A
open heart surgery
or cardiac catherisation
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
8
Q
what is another name given to cardiac muscle
A
myocardium
9
Q
what is the outer layer that covers muscular layer called
A
epicardium
10
Q
what do you call epithelial cells on inner side of cardiac muscle
A
endocardium
11
Q
what is atrial septal defect
A
hole between atria
walls fail to develop normally
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
13
Q
what are some valvular heart defects
A
aortic stenosis - narrowing
aortic regurgitation - backflow
mitral stenosis
mitral regurgitation
14
Q
what is aortic stenosis
A
most common valvular disease
preceded by aortic sclerosis
15
Q
how do you suspect aortic stenosis
A
presence of early peaking, systolic ejection murmur and confirmed by ecg
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
17
Q
cause of aortic stenosis
A
rheumatic heart disease
congenital heart disease
calcium build up
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
19
Q
what is rheumatic heart disease
A
autoimmune inflammatory reaction
triggered by prior strept infection - targets valvular endothelium - leads to inflame and calcification
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
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
22
Q
how do you diagnose aortic stenosis
second:
A
transthoracic ecg
ecg chext xray
cardiac catherterisation
cardiac mri
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
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
25
what can chronic aortic regurgitation cause
congestive cardiac failure
26
what can acute aortic regurgitation cause
medical emergency
| present with sudden onset of pulmonary oedema and hypotension or cardiogenic shock
27
what are some congenital and acquired cause of aortic regurgitation
rheumatic heart disease
| infective endocarditis
28
what are the aortic root dilation cause of aortic regurgitation
```
marfans syndrome
connective tissue disease
idiopathic
ankylosing spondylitis
trauma
```
29
what is the abnormal physiology in acute ar
```
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
```
30
what is the abnormal physiology in chronic ar
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
31
how to diagnose acuteaortic regurgitation
acute - cardiogenic shock
tachycardia
cyanosis
pulmonary oedema
32
how to diagnose chronic aortic regurgitation
wide pulse pressure
| pistol shot pulse - trauma sign
33
what are the investigations for ar
transthoracic ecg
cxr
cardiac catherisation
cardiac mri/ct
34
how can we manage acute ar
ionotropes/vasodilators
| valve replacement and repair
35
how can we manage chronic ar
if lv function is normal - can be managed by drugs/reassurance
if symptomatic - first line is valve replacement with adjunct vasodilator therapy
36
what else is important in management of ar
prevention is key
| treat rheumatic fever and infective endocarditis
37
what is mitral stenosis
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
what is the main cause of mitral stenosis
rheumatic fever
39
what are some other causes of mitral stenosis
```
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
pathophysiology of mitral stenosis
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
how is physiology of heart affected by mitral stenosis initially
initially - moderate exercise/tachycardia results in exertional dyspnoea due to increase in left atrial pressue
42
what does mitral stenosis cause in severe cases
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
how do we diagnose mitral stenosis
```
rheumatic fever
dyspnoea
orthopnoea
diastolic murmur
loud p2
neck vein distention
hemoptysis
40-50yrs
```
44
what investigations can we do to check for mitral stenosis
```
ecg
transthoracic ecg
cxr
cardiac catherterisation
cardiac mri/ scan
```
45
how can we manage mitral stenosis
progressive asymptomatic - no therapy required
severe asymptomatic - adjuvant balloon valvotomy
severe symptomatic - diuretic, balloon valvotomy, valve replacement and repair adjunct b blockers
46
what is mitral regurgitation
abnormal reversal of blood flow from left ventricle to left atrium
caused by disruption in any part of mitral valve apparatus
47
what are some acute causes of mitral regurgitation
```
mitral valve prolapse
rheumatic heart disease
infective endocarditis
following valvular surgery
prosthetic mitral valve dysfunction
```
48
what are some chronic causes of mitral regurgitation
```
rheumatic heart disese
sle
scleroderma
hypertrophic cardiomyopathy
drug related
```
49
infective endocarditis leads to
abscess formation, vegetations, rupture of chord tendinae and leaflet perforation
50
what does chronic mr lead to
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
how can we diagnose mitral regurgitation using history and presentation
```
dyspnoea
murmur
fatigue
orthopnea
chest pain
atrial fibrillation
diminished s1
pitched blowing xx
```
52
how can we diagnose mitral regurgitation using investigations
```
ecg
transthoracic ecg
cxr
cardia catherterisation
cardiac mri/ct
```
53
how can we manage acute mr
emergency surgery
adjunct preoperative diuretics
adjunct intra aortic balloon counterpulsation
54
how can we manage chronic mr
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
what is a cardiomyopathy
disease of heart muscle that makes it harder for heart to pump blood to rest of body
56
what can cardiomyopathies lead to
heart failure
57
what are the main types of cardiomyopathies
dilated
hypertrophic
restrictive
58
what happens to ventricles in hypertrophic cardiomyopathy
size of left ventricle exponentially reduces
59
what happens to ventricles in dilated cardiomyopathy
left ventricle is very enlarged
60
what happens to ventricles in restrictive cardiomyopathy
stiffness of ventricle wall
61
what % of dilated cardiomyopathy is due to familial causes
25%
62
what is a primary cause of dilated cardiomyopathy
without familial history
| idiopathic
63
what are some secondary causes of dilated cardiomyopathy
```
heart valve disease
after child birth
thyroid disease
myocarditis
alcoholism
autoimmune disorders
ingestion of drugs
mitochondrial disorders
```
64
what is the pathophysiology of dilated cardiomyopathy
ventricular chamber enlargement and systolic dysfunction with normal left ventricular wall thickness
65
how does abnormal physiology affect normal function of the heart
-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
how can we diagnose dilated cardiomyopathy using history and presentation
```
dyspnoea
murmur
fatigue
angina
pulmonary congestion
low cardiac output
displaced apex beat, s3/ systolic
```
67
how can we diagnose dilated cardiomyopathy using investigations
```
genetic testing
viral serology
ecg
cxr
cardiac catheterisation
echocardiography
cardiac mri/ct
exercise stress test
```
68
how can we manage dilated cardiomyopathy
counselling is very important as condition is lifelong
| treat according to problems
69
what is hypertrophic cardiomyopathy
genetic cvd
defined by increase in left ventricular wall thickness
occurs as autosomal dominant medelian inherited disease in approx 50% of cases
70
most patients with hcm are asymptomatic what could the first clinical manifestations be
sudden death
| likely from ventricular tachycardia or fibrillation
71
where does hypertrophy frequently occur
intraventricular septum which results in obstruction of flow through left ventricular outflow tract
72
what does abnormal physiology do to heart
causes abnormal diastolic function
impairs ventricular filling and increases filling pressure
abnormal calcium kinetics and subendocardial ischaemia
73
how can we use history and presentation to diagnose hypertrophic cardiomyopathy
```
sudden cardiac death
syncope
presyncope
congestive heart failure
dizziness
palpitations
angina
double carotid artery impulse s3
ejection systolic murmur
```
74
what investigations can we do to detect hypertrophic cardiomyopathy
```
hemoglobin levels - anaemia exacerbates chest pain and dyspnoea
bnp
troponin levels
echocrdiography
cxr
cardiac mri
```
75
how can we manage hypertrophic cardiomyopathy with symptoms
beta blockers or verapamil
76
aetiology of restrictive cardiomyopathy
diastolic dysfunction with restrictive ventricular physiology
atrial enlargement occurs due to impaired ventricular filling during diastole
77
causes of restrictive cardiomyopathy
idiopathic
familial
associated with various systemic disorders e.g haemochromatosis, amyloidosis,sarcoidosis,fabrys disease, carcinoid syndrome, scleroderma, fabrys disease
78
how are infiltrative cardiomyopathies characterised
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
what can adverse remodelling lead to
systolic dysfunction and ventricular arrhythmias in advanced cases
80
what abnormal physiology occurs in rcm
```
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
how can history diagnose restrictive cardiomyopathy
```
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
investigations for restricitve cardiomyopathy
```
cbc
serology
amyloidosis
cxr
ecg
echocardiography
catheterisation
mri/biopsy
```
83
management of rcm
```
heart failure med
acei
arbs
antiarrythmic therapy
immunosupression - steroids
pacemaker
cardiac transplantation
```
