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Cardiovascular & Respiratory Medicine > Structural Heart Disease > Flashcards

Structural Heart Disease Flashcards

1
Q

What gives rise to the p wave on an ecg?

A

Atrial contractions.

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2
Q

What gives rise to the QRS complex?

A

Heart depolarising

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3
Q

What gives rise to the first sound after the first contraction?

A

Closing of the tricuspid and mitral valve.

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4
Q

Give congenital heart defect examples.

A

-Atrial septal defect (ASD)
-Ventricular septal defect (VSD)
-Tetralogy of Fallot (TOF)
-Coarctation of the aorta

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5
Q

What is tetralogy of fallot TOF? 4 things:

A

4 things:
- Ventricular septal defect- hole in wall between ventricles
- Pulmonary stenosis- where pulmonary valve is stenosed (narrowed down)
- Widening of aortic valve so that it sits in both left and right ventricle and allows for mixing of blood between them and into aorta
- Right ventricular hypertrophy- thickening of wall of right ventricle

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6
Q

What is Coarctation of the aorta?

A
  • Narrowing of aorta
  • Blood has to force its way through the narrowing so ventricle has to work harder to push more blood through that narrowing
  • Leads to thickening of ventricles or heart failure
  • Serious condition and needs urgent repair
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7
Q

Give examples of structural heart disease that develop later in life.

A

Valvular dysfunctions:
-Aortic stenosis
-Aortic regurgitation
Muscular dysfunctions: e.g cardiomyopathies.

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8
Q

What is aortic stenosis and regurgitation.

A

Aortic stenosis: Narrowing of the aortic valve.
Aortic regurgitation: Incompetence of aortic valve

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9
Q

Does rheumatic heart disease prevail highly in the younger or older population.

A

Younger population.

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10
Q

What comes before aortic stenosis?

A

Aortic sclerosis, (aortic valve thickening without flow limitation so patients can’t tell they have it).

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11
Q

How is aortic stenosis suspected?

A

By presence of an early-peaking systolic ejection murmurs and confirmed by echocardiography (where you see heart walls and can see thickening)

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12
Q

Risk factors for Aortic stenosis (8).

A
  • Hypertension
  • high LDL
  • Smoking
  • Elevated C-reactive protein
  • Congenital bicuspid valves
  • Chronic kidney disease
  • Radiotherapy
  • Older age
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13
Q

What are the causes of aortic stenosis?

A
  • Rheumatic heart disease- commonest cause in developing countries
  • Congenital heart disease
  • Calcium build up
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14
Q

Describe the pathophysiology of aortic stenosis

A

Valvular endothelial damage stimulates inflammatory process which leads to deposition of calcium and leaflet fibrosis.

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15
Q

What changes in the heart does aortic stenosis then lead to?

A

Long standing pressure overload in left ventricle leading to left ventricular hypertrophy (LVH)

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16
Q

What happens in rheumatic heart disease?

A

It’s an autoimmune inflammatory reaction triggered by prior Streptococcus infection that targets the valvular endothelium, leading to inflammation and eventually calcification of valve

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17
Q

How do aortic stenosis patients present? (3)

A
  • Exertional dyspnoea and fatigue
  • Chest pain
  • Systolic ejection murmur- more than 1/2 present with a crescendo-decrescendo pattern that peaks in mid-systole and radiates to the carotid
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18
Q

What do aortic stenosis patients usually have a history of?

A
  • Rheumatic fever
  • High lipoprotein
  • High LDL
  • CKD
  • Age >65
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19
Q

What investigations are done for aortic stenosis?

A
  • Transthoracic echocardiography- to see structure of heart
  • ECH Chest X ray- to check for LVH
  • Cardiac catheterisation
  • Cardiac MRI
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20
Q

What kind of murmur does aortic regurgitation cause?

A

Early diastolic ejection murmur

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21
Q

What does aortic regurgitation cause if its chronic?

A

Congestive heart failure

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22
Q

What is aortic root dilation

A

Widening of the aorta

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23
Q

What can the causes of aortic regurgitation be divided into?

A

-Congenital causes and acquired.
-Aortic root abnormalities (dilation)

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24
Q

What are some examples of aortic root abnormalities that can cause aortic regurgitation?

A

Marfan syndrome, Ehlers-Danlos syndrome, and aortic dissection.

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25
Q

What are some examples of congenital abnormalities that can cause aortic regurgitation?

A

Bicuspid aortic valve, which is a condition where the aortic valve has only two leaflets instead of three.

26
Q

What are some examples of acquired abnormalities that can cause aortic regurgitation?

A

Rheumatic fever
Infective endocarditis
Trauma to the chest
Connective tissue disorders (e.g. lupus).

27
Q

What are the symptoms of aortic regurgitation?

A

Shortness of breath, fatigue, chest pain.

28
Q

What happens in acute aortic regurgitation?

A

There is an increase in blood volume in the left ventricle during systole.
This leads to an increase in left ventricular end diastolic pressure and pulmonary venous pressure.

29
Q

What does a person with acute aortic regurgitation experience?

A

The person experiences dyspnea and pulmonary edema.

30
Q

What happens in chronic aortic regurgitation?

A

-There is a gradual increase in left ventricular volume, leading to left ventricular enlargement and eccentric hypertrophy.
-In the early stages, ejection fraction may be normal or slightly increased.
After some time, ejection fraction falls and left ventricular end systolic volume rises.

31
Q

What can chronic aortic regurgitation eventually lead to?

A

Eventually, the person experiences dyspnea due to lower coronary perfusion, which can lead to ischemia, necrosis, and apoptosis.

32
Q

What is eccentric hypertrophy?

A

A type of heart muscle growth where the heart chamber enlarges while the thickness of the heart muscle remains the same. This is a common adaptation in chronic aortic regurgitation.

33
Q

How does acute AR present?

A
  • Cardiogenic shock (heart can’t pump enough oxygenated blood to body esp brain)
  • Tachycardia
  • Cyanosis (skin/lips turning blue)
  • Pulmonary oedema
34
Q

How does chronic AR present? (2)

A
  • Wide pulse pressure (big difference between systolic and diastolic bp)
  • Pistol shot pulse (Traube sign)
    -eccentric hypertrophy of lv
35
Q

What investigations are done for AR? (4)

A
  • Transthoracic echocardiography
  • Chest X ray
  • Cardiac catheterisation
  • Cardiac MRI/CT scan
36
Q

What is the main way of treating symptomatic AR chronic and acute.

A

Valve replacement and vasodilators.

37
Q

What is mitral stenosis?

A

Mitral stenosis is a heart condition characterized by narrowing of the mitral valve, which controls blood flow between the left atrium and left ventricle of the heart.

38
Q

What are the symptoms of mitral stenosis?

A

Symptoms of mitral stenosis include shortness of breath, fatigue, chest pain, and heart palpitations

39
Q

What is the most common cause of mitral stenosis?

A

The most common cause of mitral stenosis is rheumatic fever, a complication of untreated streptococcal throat infections.

40
Q

What are the potential causes of mitral stenosis?

A

Other potential causes of mitral stenosis include congenital heart defects, calcification of the valve, and certain medications.

41
Q

How do you treat severe asymptomatic and severe symptomatic Mitral stenosis

A

-Severe asymptomatic: Balloon valvotomy

-Severe symptomatic: diuretic, balloon valvotomy, valve replacement & repair adjunct b blockers

42
Q

What is mitral regurgitation?

A

Abnormal reversal of blood flow from left ventricle to left atrium

Most frequent valvular heart disease.

43
Q

What are causes of acute mitral regurgitation? (5)

A
  • Rheumatic heart disease
  • Infective endocarditis
  • Following valvular surgery
  • Mitral valve prolapse
  • Prosthetic mitral valve dysfunction
44
Q

What are the 3 main types of cardio myopathies from most common to least?

A

-Dilated cardiomyopathy
-Hypertrophic Cardiomyopathy
-Restrictive cardiomyopathy

45
Q

What happens to the heart in Dilated cardiomyopathy?

A

The heart becomes enlarge and weak.

46
Q

What are some common causes of DCM?

A

DCM can be caused by viral infections, alcohol abuse, genetic factors, or other diseases.

47
Q

Is HCM a genetic or acquired condition? (hypertrophic)

A

Genetic condition

48
Q

What happens to the heart muscle in HCM?

A

In HCM, the heart muscle thickens, making it harder to pump blood effectively.

49
Q

What can HCM lead to, especially in young athletes?

A

HCM can lead to arrhythmias and sudden cardiac arrest, especially in young athletes.

50
Q

What happens to the heart muscle in RCM? (restrictive)

A

Ventricular walls are stiff and atria become enlarged. (Stiff heart)

51
Q

What are causes of acute mitral regurgitation?

A

-Rheumatic heart disease
-Infective endocarditis
-Following valvular surgery
-Mitral valve prolapse
-prosthetic mitral valve dysfunction

52
Q

What are causes of chronic mitral regurgitation? (5)

A

-Rheumatic heart disease
-Infective endocarditis
-SLE
-Scleroderma (autoimmune attack of connective tissues)
-Hypertrophic cardiomyopathy
-Drugs

53
Q

What do you find on auscultation in people with Mitral regurgitation?

A

Diminished S1

54
Q

What is S1?

A

The first heart sound, the “lub”

55
Q

What kind of heart murmur to you get in mitral regurgitation?

A

Pansystolic murmur

56
Q

How do we manage acute MR?

A

-1st line is emergency surgery
-Adjunct pre op diuretics
-Adjunct intra-aortic balloon counterpulsation

57
Q

How do we manage chronic asymptomatic MR?

A

-1st ACE inhibitors
-Beta blockers, if left ventricular ejection fraction is <60% then surgery is first line

58
Q

How do we manage chronic symptomatic MR? What do we do when ejection fraction is below a certain number and what is that number?

A

-First line is surgery plus medical treatment
-If ejection fraction is below <30% then 1st line is intra-aortic balloon counterpulsation

59
Q

What is restrictive cardiomyopathy characterised by?

A

Diastolic dysfunction with normal systolic function,
Atrial enlargement occurs due to impaired ventricular filling during diastole (due to stiffening of ventricular walls), volume and thickness are normal

60
Q

How do patients with restrictive cardiomyopathy present?

A

Comfortable when sitting, pitting oedema of extremities.
Increased jugular venous pressure.
Pulse volume is decreased.

Cardiovascular & Respiratory Medicine (12 decks)

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