Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 Cardio > Structural Heart Disease > Flashcards

Structural Heart Disease Flashcards

1
Q

What are the determinants of cardiac stroke volume?

A

Starling’ law of the heart (length tension)
Cardiac contractility
Arterial pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What influences cardiac contractility?

A

Synthetic tone

Adrenaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the after load?

A

Pressure in the aorta

Force per unit area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is preload?

A

Stretching of the myocardium allowing the generation of forces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the law of laplace?

A

P + 2T/r

Internal pressures generated inside a chamber is directly proportional to the tensions and inversely proportional to the radius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why is the law of laplace significant?

A

when radius of chamber increases pathologically

cannot generate sufficient pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the two classification of valvular disease?

A

Stenotics

Dilatations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are two types of stenotic lesions?

A

Aortic stenosis

Mitral stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is aortic stenosis?

A

Aortic valve becomes significantly narrowed

Severe is area is less than 1cm^2 or if speed of blod flow is greater that 4 metres per second

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the causes of aortic stenosis?

A

Bicuspid aortic valve - Congenital
Degeneration of valve with age
Rheumatic heart disease
Infective endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What cause mitral stenosis?

A 
Rheumatic fever
Congential
Rheumatic arthritis
Lupus
Whipples disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the consequence of atrial stenosis?

A

Increased afterload on the left ventricle

Causing hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the consequence of mitral stenosis?

A

Increased pressure on the left atrium
Increased strain causes atrial dilation
Can lead to AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What causes mitral regurgitation?

A

Rheumatic fever
Infective endocarditis
Mitral valve prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the consequence of mitral regurgitation?

A

Less cardiac output to aorta

Reduces organ perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What causes aortic regurgitation?

A

Biscuspid aortic valve
Marfaans syndrome
hypertension
Infective endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the consequence of aortic regurgitation?

A

Volume overload to left ventricle as blood goes back

Causing dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does mitral regurgitation present?

A

systolic murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does aortic regurgitation present?

A

Diastolic murmur
Collapsing pulse
Quincke’s sign - nailbed pulsations
Previous history of rheumatic heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the three main types of cardiomyopathy?

A

Hypertrophic
Dilated
Arrhythmogenic right ventricular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the result of dilated cardiomyopathy?

A

Chambers have poor contractility

Wall tension does not generate effective pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What can cause dilated cardiomyopathy?

A

Stress
Post partum
Sarcodosis
Auto-immune diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What happens in arrhthmogenic right ventricular cardiomyopathy?

A

Abnormal right ventricle radius
Cannot work effectively
Also effect left ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How can you treat valve issues?

A

Valve replacement
But must treat consequences of valve failure
Aim to replace before the issues has other effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the pros and cons of different valves?

A

Metallic valves

  • last longer
  • need to be on warfarin

Prosthetic valves

-only last 20 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Why is the mitral valve not often replaced?

A

The arrangement of the mitral valve means that it isn’t easy to replace

increased emphasis on repairing the existing valves

This avoids open heart surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Define cardiogenic shock?

A

Impairment of cardiac systolic function resulting in reduced cardiac output causing end organ dysfunction

28
Q

Why is it so important to identify cardiogenic shocl?

A

Treatment is very different to other types of shock
e.g. dangerous to give more fluid
reduces contractile function

29
Q

How is cardiogenic shock treated?

A

Early coronary angiography
PCI or CABG
Reassess haemodynamic/tissue perfusion

30
Q

What are inotropes?

A

Dopamine etc.
Increase height and leftward shift of pressure volume loop
Augmentation of end diastollic volume
Increase in stroke work and stroke volume

31
Q

What are the features of mechanical support devices?

A

Used when ionotropic drugs are ineffective

IABP
Impella recover
TandemHeart
VA-ECMO

32
Q

How do you calculate cardiac output?

A

Stroke volume x Heart rate

33
Q

How do you calculate ejection fraction?

A

Stroke volume divided by end diastolic volume

34
Q

How do you calculate mean arterial pressure?

A

MAP = Cardiac output x total peripheral resistance

MAP = Diastolic blood pressure + 1/3 Pulse Pressure

MAP = 2/3 Diastolic blood pressure + 1/3 Systolic Pressure

35
Q

What is infective endocarditis?

A

Infection of the endocardium (inner lining of the heart). Commonly caused by bacteria.

36
Q

How do you diagnose infective endocarditis?

A

Dukes criteria
Major: positive blood cultures/evidence of endocardium involvement
Minor: predisposing factors, pyrexia, vascular phenomena, immunological phenomena, microbioloigcal evidence
Blood cultures
ECG
ECHO

37
Q

Which part of the heart does infective endocarditis affect particularly?

A

Heart valves, normally left aortic and mitral valves

Right sided occurs less frequently

38
Q

What are some features of decompensation?

A

Weight loss

Difficulty breathing

Leg/Foot Swelling

Fatigue

39
Q

What is the relationship between IV drug use and infective endocarditis?

A

Higher risk of developing infective endocarditis

Can be right sided involving the tricuspid

40
Q

Define dilated cardiomyopathy

A

Ventricle stretches and thins and is no longer able to pump efficiently

41
Q

What are some common causes of dilated cardiomyopathy?

A 
Heart disease
Poorly controlled hypertension
Infection
Genetics
Peri-partum
Toxins
Auto-immune
Endocrine
Metabolic disorders
42
Q

What genes have been implicated in the diagnosis of dilated cardiomyopathy?

A

MYH7, MYBPC3, TNNT2, and TNNI3

ACBC1, ACBC 2

43
Q

How is dilated cardiomyopathy managed?

A

Medication: Diuretics, ACEi, Beta Blockers, Anti-coagulants, ARBs

Pacemaker

Surgical: LVAD (Left ventricular assist device) or Heart transplant

44
Q

What are the implications of dilated cardiomyopathy?

A

High risk of heart failure
Needs to manage BP
Lower alcohol intake, stop smoking, minimise salt and caffeine

45
Q

What are causes of aortic regurgitation?

A

Valvular: Rheumatic fever
Infective endocarditis
Connective tissue disease e.g. RA/SLE
Bicuspid aortic valve

Other: Aortic dissection
Spondylarthropathies
HTN
Syphilis
Marfan's, Ehler-Danlos syndrome
46
Q

What are RFs for infective endocarditis?

A 
Previous episode
Prosthetic valves
Congenital heart defects
IVDUs
Recent piercings
47
Q

What is the most common causative organism for infective endocarditis?

A

Staph A

48
Q

What is management of infective endocarditis dependent on?

A

Causative organism

Prosthetic or Native valve

49
Q

What initial blind therapy is used in infective endocarditis?

A 
Native = Amoxicillin
Prosthetic = Vancomycin + Rifampicin + low dose gentamicin
50
Q

What is the management for IE caused by staphylococi?

A

Flucloxacilin

Vanc + Rif if pen allergy

51
Q

What are indication for surgery in infective endocarditis?

A

severe valvular incompetence
aortic abscess (often indicated by a lengthening PR interval)
resistant infections
cardiac failure refractory to standard medical treatment
recurrent emboli after antibiotic therapy

52
Q

What are signs of tricuspid regurgitation?

A 
pan-systolic murmur 
louder on inspiration
prominent/giant V waves in JVP
pulsatile hepatomegaly
left parasternal heave
53
Q

What are causes of tricuspid regurgitation?

A 
right ventricular infarction
pulmonary hypertension e.g. COPD
rheumatic heart disease
infective endocarditis (especially intravenous drug 
carcinoid syndrome
54
Q

What causes mitral regurgitation?

A

CAD or MI
Mitral valve prolapse
Infective endocarditis
Rheumatic fever

55
Q

What are symptoms of mitral regurgitation?

A

Asymptomatic
Can present as fatigue, SOB and oedema
Caused by LV failure, arrhythmias or pulmonary HTN

56
Q

What are signs of mitral regurgitation?

A

Pan-systolic murmur
Apex and radiates to axilla
S1 might be quiet because of incomplete valve closure

57
Q

What is the management for mitral regurgitation?

A 
Increase CO:
Nitrates
Diuretics
Inotropes
Intra-aortic ballon pump

If HF: ACEi, Betablockers and spironolactone

If acute, severe: surgical repair or replacement

58
Q

What is mitral stenosis?

A

obstruction of blood flow across the mitral valve from the left atrium to the left ventricle

increases in pressure within the left atrium, pulmonary vasculature and right side of the heart

59
Q

What are the presenting features of mitral stenosis?

A 
mid-late diastolic murmur (best heard in expiration)
loud S1, opening snap
low volume pulse
malar flush
atrial fibrillation
L. atrial enlargement maybe on CXR
60
Q

What is the management for mitral stenosis?

A

With AF: Warfarin
Asypmto: Monitor with reg echos
Sympto: Percutaneous mitral balloon valvotomy
Mitral valve surgery (repair or replacement)

61
Q

What are the presenting features of aortic stenosis?

A

chest pain
dyspnoea
syncope / presyncope (e.g. exertional dizziness)
murmur
an ejection systolic murmur, radiates to carotids

62
Q

What are some causes of aortic stenosis?

A

degenerative calcification (most common cause in older patients > 65 years)

bicuspid aortic valve (most common cause in younger patients < 65 years)

post-rheumatic disease

HOCM

63
Q

What is the management of aortic stenosis?

A

Asympto: Observe
Sympto: Valve replacement

64
Q

What are the surgical options?

A

Aortic Valve replacement

  1. Surgical
    - young low/medium risk operative pts
    - CVD may coexist
    - angiogram done prior to surgery
  2. Transcatheter
    - high operative risk

Balloon valvuloplasty

  • in children
  • or adults not fit for replacement
65
Q

What is a cause of sudden death in HOCM?

A

Young, fit athletes

Ventricular arrhythmia

Year 3 Cardio (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions