Structural Heart Disease Flashcards
Cardiac cycle
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Tetralogy of Fallot
Widen aorta (overriding)
Narrow pulmonary artery (stenosis)
Thicken right ventricular wall (hypertrophy)
Septal defect
AS causes
Rheumatic heart disease
Calcium build up
Hypertension
LDL
AS pathophysiology
Endocardial injury
Inflammation
Calcification
Stenosis
AS investigations
Transthoracic echocardiogram
Chest X ray
AS management
Aortic valve replacement - symptomatic, asymptomatic with LVEF <50%
AR causes
Rheumatic heart disease
Infective endocarditis
Valve stenosis
AR pathophysiology
Trauma, IE lead to rupture of leaflets in acute cases
RF, bicuspid aortic valves lead to retraction of leaflets and leak
AR investigation
Transthoracic echocardiogram
Chest X-ray
AR management
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
MS causes
Rheumatic fever
SLE
Rheumatoid arthritis
Carcinoid syndrome
MS pathophysiology
Insult to endometrium lead to formation of infiltrates, calcification and stenosis
MS investigation
ECG
Transthoracic echocardiogram
MS management
Asymptomatic- none
Severe asymptomatic- none, adjuvant balloon valvotomy
Severe symptomatic- diuretic, balloon valvotomy, valve replacement and adjunct b blocker
MR cause
Acute
- mitral valve prolapse
- rheumatic heart disease
- infective endocarditis
Chronic
- rheumatic heart disease
- SLE
- scleroderma
MR pathophysiology
Disruption of any part of mitral leaflets, perforations etc lead to abnormal reversal of blood
MR investigation
ECG
Transthoracic echocardiogram
MR management
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
Dilated cardiomyopathy cause
Heart valve disease
Myocarditis
Autoimmune
Primary with and without family history
DC pathophysiology
Ventricular chamber enlargement with normal LV wall function
DC presentation
Dyspnoea
Systolic murmur
Angina
Low CO
DC investigations
Genetic testing
Viral serology
ECG
DC management
Diet Underlying immune - immunosuppressant ACEi and BB Heart transplant or medicine Warfarin
HC cause
Genetic
Increase in LV wall thickness not explained by abnormal loading conditions
Sudden death
HC pathophysiology
Myocardial hypertrophy that is inappropriate and occurs in absence of hypertrophy stimulus
HC presentation
Sudden cardiac death Dizziness Palpitations Ejection systolic murmur Angina
HC investigations
Haemoglobin level - anemia exacerbate chest pain and dyspnoea
BNP elevated
HC management
Beta blocker or verapamil
Add disopyramide
Pacemaker or septal myectony or ablation
RC cause
Diastolic dysfunction with restrictive ventricular physiology, but systolic function, volume and wall thickness normal
RC pathophysiology
Increases stiffness cause ventricular pressure to rise with small increase in volume
Reduced compliance and cannot fill adequately
Reduced CO
RC presentation
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
RC investigations
CBC
Serology
ECG
RC management
ACEi or angiotensin receptor ii blocker, diuretics and aldosterone inhibitor in patients with reduced LV for heart failure Antiarrhythmic therapy Immunosuppression - steroids Pacemaker Transplant
Ejection systolic murmur
AS
Early diastolic murmur
AR
Mid diastolic murmur
MS
Pansystolic murmur
MR
AS feature
Pressure overload
LV hypertrophy
If stenosis worsen - systolic function decline leading to systolic heart failure
AR feature
LV end diastolic pressure increase
Increase in LV venous pressure
Pulmonary congestion and cardiogenic shock in acute AR
MS feature
Increase in left atrial pressure
pulmonary hypertension
Right heart failure
MR feature
Chronic MR
- enlargement of LA
- LV enlargement and eccentric hypertrophy
- compensation fails
- heart failure
DC feature
LV enlargement
Increased heart rate and PVR
Eventually compensation fail and heart fail
HC feature
Abnormal diastolic
Impair ventricular filling
Increase filling pressure despite normal or small ventricular cavity
RC feature
Reduced compliance
LV cannot fill adequately
Reduced LV volume - reduced CO
Atrial fibrillation
MR
Neck vein distention
MS
Austin Flint murmur
Acute AR
Traube sign
Chronic AR
Wate hammer sign
Chronic AR
