structural heart disease

Question 1

2 divisions of heart disease (causes)

Answer 1

congenital (present at birth)

later in life (caused by infection etc)

Question 2

2 divisions of heart disease developed later in life

Answer 2

valvular dysfunction (atrial stenosis/ regurgitation)
muscular (cardiomyopathies)

Question 3

explain what ventricular septal defect is

Answer 3

congenital
hole in septum causing mixing of deoxy and oxygenated blood
right hand heart failure due to high volume of blood

Question 4

what is atrial septal defect

Answer 4

congenital
hole in atrial septum causing mixing of blood
right hand heart failure due to high volume of blood

Question 5

explain tetralogy of fallot

Answer 5

congenital
4 things happen:
1. ventricle septal defect
2. overriding aorta (blood from RV+LV go into aorta )
3. ventricular hypertrophy
4. pulmonary stenosis (narrowing of the veins)

Question 6

types of valvular defects

Answer 6

aortic stenosis/ regurgitation
mitral stenosis/ regurgitation

Question 7

types of valvular defects

Answer 7

aortic stenosis/ regurgitation
mitral stenosis/ regurgitation

Question 8

main causes for stenosis/ regurgitation

Answer 8

1. rheumatic heart disease
2. calcific aortic valve disease
3. degenerative mitral valve disease

Question 9

which is more prevalent: mitral or aortic valve disease?

Answer 9

mitral

Question 10

risk factors for aortic stenosis (causes)

Answer 10

hypertension (rheumatic heart disease)
low density lipoprotein levels (congenital heart disease)
smoking
elevated c-reactive protein (calcium build up)
congenital bicuspid valves
chronic kidney disease
radiotherapy
old age

Question 11

explain the pathophysiology of aortic stenosis

Answer 11

long standing pressure overload –> left ventricular hypertrophy

adaptive mechanism: ventricle maintains normal wall stress (afterload) despite the pressure overload produced by stenosis

as the stenosis worsens, the mechanism fails and LV wall stress increases.

Question 12

what happens to systolic function in aortic stenosis?

Answer 12

declines as wall stress increases –> systolic heart failure

Question 13

history and presentation of aortic stenosis

Answer 13

exertional dyspnoea and fatigue
cheats pain
ejection systolic murmur (≥3/6 is present with a crescendo-decrescendo pattern that peaks in mid-systole and radiates to the carotid)​

H/O:
rheumatic fever
high lipoprotein
high LDL
CKD
age >65

Question 14

investigations for aortic stenosis

Answer 14

transthoracic echocardiography
ECG chest x-ray (LVH)
cardiac catheterization (angiography)
cardiac MRI

Question 15

management of aortic stenosis

Answer 15

aortic valve replacement:
symptomatic AS
asymptomatic severe AS with LVEF <50% or cardiac surgery
asymptomatic patients with severe AS with rapid progression, abnormal exercise test, elevated BNP levels

other options:
balloon aortic valvuloplasty

antihypertensive

ACE inhibitor

statins

Question 16

what is BNP

Answer 16

B-natriuretic peptide

It’s made inside the pumping chambers of your heart when pressure builds up from heart failure.

Question 17

aortic regurgitation causes

Answer 17

rheumatic heart disease
infective endocarditis
aortic valve stenosis
congenital heart defects
congenital bicuspid valves

can also be caused by aortic root dilation:
Marfan’s syndrome
connective tissue disease collagen vascular disease
ankylosing spondylitis
traumatic

Question 18

ankylosing spondylitis

Answer 18

Ankylosing spondylitis (AS) is a long-term condition in which the spine and other areas of the body become inflamed. It’s a type of axial spondyloarthritis.

Question 19

pathophysiology of acute AR

Answer 19

increased blood volume in LV during systole
LV end diastolic pressure increases
increase in pulmonary venous pressure
dyspnoea and pulmonary oedema
heart failure
cardiogenic shock

Question 20

pathophysiology of chromic AR

Answer 20

gradually increase in LV volume
LV enlargement and eccentric hypertrophy​
Early stages: Ejection fraction normal or slightly increase
after some time Ejection fraction falls and LV end systolic volume rises​

Eventually LV dyspnoea lower coronary perfusion
ischemia, necrosis and apoptosis

Question 21

Austin flint murmur

Answer 21

a rumbling diastolic murmur

Question 22

history and presentation of acute AR

Answer 22

Cardiogenic shock​

Tachycardia​

Cyanosis​

Pulmonary edema​

Austin flint murmur

Question 23

history and presentation of chronic AR

Answer 23

Wide pulse pressure​

Corrigan (wate hammer pulse)​

Pistol shot pulse (Traube sign)

Question 24

wide pulse pressure

Answer 24

high difference between top and bottom pulse pressure numbers

Question 25

corrigan pulse

Answer 25

A pulse that is forceful and then suddenly collapses

Question 26

pistol shot pulse

Answer 26

loud, cracking sound heard by the stethoscope over an artery in which there is distension followed by an abrupt collapse, as classically occurs in large arteries in aortic regurgitation

Question 27

investigations for AR

Answer 27

Transthoracic echocardiography​

Chest X ray ​

Cardiac catheterisation​

Cardiac MRI/CT Scan​

Question 28

management for AR

Answer 28

Acute AR; Ionotropes/vasodilators & valve replacememt & repair​

​

Chronic asymptomatic:
If LV function is normal can be managed by drugs or reassurance​

​

Chronic symptomatic: First line is valve replacement with adjunct vasodilator therapy​

Prevention is key: Treat Rheumatic fever and infective endocarditis.​

Question 29

what is AR

Answer 29

Aortic regurgitation (AR) is the diastolic leakage of blood from the aorta into the left ventricle.​

​

It occurs due to incompetence of valve leaflets resulting from either intrinsic valve disease or dilation of the aortic root​

Question 30

what is mitral stenosis

Answer 30

Obstruction to left ventricular inflow at the level of mitral valve due to structural abnormality of the mitral valve​

Question 31

causes if mitral stenosis

Answer 31

rheumatic fever (amyloidosis)
carcinoid syndrome (rheumatoid arthirits)
use of ergot/serotonergic drugs (whipple disease)
Systemic lupus erythematosus (SLE) (congenital deformity of the valve)
mitral annular calcification due to aging

Question 32

ergot

Answer 32

drug that increases serotonin

Question 33

whipple disease

Answer 33

Whipple disease is a rare bacterial infection that most often affects your joints and digestive system. Whipple disease interferes with normal digestion by impairing the breakdown of foods, and hampering your body’s ability to absorb nutrients, such as fats and carbohydrates

Question 34

mitral stenosis pathophysiology