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Cardiology > Structural Heart Disease > Flashcards

Structural Heart Disease Flashcards

1
Q

Cardiac cycle

A

Image

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2
Q

Tetralogy of Fallot

A

Widen aorta (overriding)
Narrow pulmonary artery (stenosis)
Thicken right ventricular wall (hypertrophy)
Septal defect

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3
Q

AS causes

A

Rheumatic heart disease
Calcium build up

Hypertension
LDL

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4
Q

AS pathophysiology

A

Endocardial injury
Inflammation
Calcification
Stenosis

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5
Q

AS investigations

A

Transthoracic echocardiogram

Chest X ray

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6
Q

AS management

A

Aortic valve replacement - symptomatic, asymptomatic with LVEF <50%

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7
Q

AR causes

A

Rheumatic heart disease
Infective endocarditis
Valve stenosis

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8
Q

AR pathophysiology

A

Trauma, IE lead to rupture of leaflets in acute cases

RF, bicuspid aortic valves lead to retraction of leaflets and leak

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9
Q

AR investigation

A

Transthoracic echocardiogram

Chest X-ray

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10
Q

AR management

A

Acute - ionotropes/vasodilator and valve replacement

Chronic asymptomatic- if LV function is normal can be managed with drugs

Chronic symptomatic- valve replacement with vasodilator

Prevention is key

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11
Q

MS causes

A

Rheumatic fever
SLE
Rheumatoid arthritis
Carcinoid syndrome

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12
Q

MS pathophysiology

A

Insult to endometrium lead to formation of infiltrates, calcification and stenosis

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13
Q

MS investigation

A

ECG

Transthoracic echocardiogram

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14
Q

MS management

A

Asymptomatic- none
Severe asymptomatic- none, adjuvant balloon valvotomy
Severe symptomatic- diuretic, balloon valvotomy, valve replacement and adjunct b blocker

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15
Q

MR cause

A

Acute

  • mitral valve prolapse
  • rheumatic heart disease
  • infective endocarditis

Chronic

  • rheumatic heart disease
  • SLE
  • scleroderma
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16
Q

MR pathophysiology

A

Disruption of any part of mitral leaflets, perforations etc lead to abnormal reversal of blood

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17
Q

MR investigation

A

ECG

Transthoracic echocardiogram

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18
Q

MR management

A

Acute - emergency surgery with diuretics and intraaortic balloon counterpulsation

Chronic asymptomatic - ACE inhibitor, beta blocker. If LVEF less than 60% - surgery

Chronic symptomatic - surgery plus medicine. If LVEF less than 30% then intraaortic balloon counterpulsation

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19
Q

Dilated cardiomyopathy cause

A

Heart valve disease
Myocarditis
Autoimmune
Primary with and without family history

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20
Q

DC pathophysiology

A

Ventricular chamber enlargement with normal LV wall function

21
Q

DC presentation

A

Dyspnoea
Systolic murmur
Angina
Low CO

22
Q

DC investigations

A

Genetic testing
Viral serology
ECG

23
Q

DC management

A 
Diet
Underlying immune - immunosuppressant 
ACEi and BB
Heart transplant or medicine 
Warfarin
24
Q

HC cause

A

Genetic
Increase in LV wall thickness not explained by abnormal loading conditions
Sudden death

25
Q

HC pathophysiology

A

Myocardial hypertrophy that is inappropriate and occurs in absence of hypertrophy stimulus

26
Q

HC presentation

A 
Sudden cardiac death 
Dizziness
Palpitations
Ejection systolic murmur 
Angina
27
Q

HC investigations

A

Haemoglobin level - anemia exacerbate chest pain and dyspnoea
BNP elevated

28
Q

HC management

A

Beta blocker or verapamil
Add disopyramide
Pacemaker or septal myectony or ablation

29
Q

RC cause

A

Diastolic dysfunction with restrictive ventricular physiology, but systolic function, volume and wall thickness normal

30
Q

RC pathophysiology

A

Increases stiffness cause ventricular pressure to rise with small increase in volume
Reduced compliance and cannot fill adequately
Reduced CO

31
Q

RC presentation

A

Comfortable in sitting position because of fluid in abdo
Enlarged liver
Weight loss and cardiac cachexia
Easy bruising
Increases jugular venous pressure
Pulse volume decreased and decreased stroke volume and CO

32
Q

RC investigations

A

CBC
Serology
ECG

33
Q

RC management

A 
ACEi or angiotensin receptor ii blocker, diuretics and aldosterone inhibitor in patients with reduced LV for heart failure 
Antiarrhythmic therapy
Immunosuppression - steroids 
Pacemaker
Transplant
34
Q

Ejection systolic murmur

A

AS

35
Q

Early diastolic murmur

A

AR

36
Q

Mid diastolic murmur

A

MS

37
Q

Pansystolic murmur

A

MR

38
Q

AS feature

A

Pressure overload
LV hypertrophy
If stenosis worsen - systolic function decline leading to systolic heart failure

39
Q

AR feature

A

LV end diastolic pressure increase
Increase in LV venous pressure
Pulmonary congestion and cardiogenic shock in acute AR

40
Q

MS feature

A

Increase in left atrial pressure
pulmonary hypertension
Right heart failure

41
Q

MR feature

A

Chronic MR

  • enlargement of LA
  • LV enlargement and eccentric hypertrophy
  • compensation fails
  • heart failure
42
Q

DC feature

A

LV enlargement
Increased heart rate and PVR
Eventually compensation fail and heart fail

43
Q

HC feature

A

Abnormal diastolic
Impair ventricular filling
Increase filling pressure despite normal or small ventricular cavity

44
Q

RC feature

A

Reduced compliance
LV cannot fill adequately
Reduced LV volume - reduced CO

45
Q

Atrial fibrillation

A

MR

46
Q

Neck vein distention

A

MS

47
Q

Austin Flint murmur

A

Acute AR

48
Q

Traube sign

A

Chronic AR

49
Q

Wate hammer sign

A

Chronic AR

Cardiology (7 decks)

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