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Endo, Cardio and Neuro > Structural heart disease > Flashcards

Structural heart disease Flashcards

1
Q

what is structural heart disease?

A

defects affecting the valves and chambers of the heart and aorta

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2
Q

what is ventricular septal defect? (VSD)

A

congenital hole between ventricles causing the mixing of blood

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3
Q

what is the tetralogy of fallot?

A

combination of VSD, pulmonary stenosis, widening of the aortic wall and right vetricle hypertrophy

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4
Q

what is atrial septal defect? (ASD)

A

congenital hole between atria

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5
Q

what is a coarctation of the aorta?

A

narrowing of aorta at downward arc

blood struggles to push through, may develop HF

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6
Q

what are the 4 valvular defects?

A

aortic and mitral stenosis

aortic and mitral regurgitation

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7
Q

what is valve stenosis?

A

narrowing of a valve

problem when blood passes through, not when shut

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8
Q

what is valvular regurgitation?

A

incompetence of a valve causing backflow from said valve

problem when meant to be shut not when open

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9
Q

what is the epidemiology of mitral valve disease?

A

greatest rates in 70+ and females

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10
Q

what is the epidemiology of aortic stenosis?

A

most common valvular disease in UK

70-80s most commonly

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11
Q

what is aortic stenosis commonly preceded by?

A

aortic sclerosis

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12
Q

when is aortic sclerosis often suspected?

A

the presence of early peaking, shrill systolic ejection murmur

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13
Q

how does aortic stenosis cause abnormal physiology?

A

long-standing pressure overload leads to left ventricular hypertrophy in order to maintain normal afterload
as stenosis worsens, adaptive mechanism fails and LV wall stress increases, declines systolic function
results in systolic heart failure

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14
Q

what is the typical history of someone with aortic stenosis?

A

exertional dyspnoea and fatigue
chest pain
history of rheumatic fever, high lipoprotein, LDL, over 65

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15
Q

what pathology presents with an ejection-systolic murmur?

A

aortic stenosis

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16
Q

what pathology presents with a mid-diastolic murmur?

A

mitral stenosis

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17
Q

what pathology presents with an early diastolic murmur?

A

aortic regurgitation

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18
Q

what pathology presents with a pansystolic murmur?

A

mitral regurgitation

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19
Q

what type of murmur is an S4 sound and what pathology?

A

ejection systolic

aortic stenosis

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20
Q

what does an aortic stenosis murmur sound like?

A

crescendo decrescendo
loudest over aortic area
radiates to carotid
ejection systolic (between lub and dub)

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21
Q

what does a mitral stenosis murmur sound like?

A

loudest over apex
and in expiration
lub-dub-whoooosh
mid diastolic murmur

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22
Q

what does an aortic regurgitation murmur sound like? AR

A

loudest at sternal edge
and when leaning forward
after dub
eARly diastolic murmur

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23
Q

what does a mitral regurgitation murmur sound like?

A

loudest over mitral area, radiates to axilla (left)
high pitched whistling
lub-whistle-dub
pansystolic murmur

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24
Q

what valve is open in systole?

A

aortic

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25
Q

what valve is open in diastole?

A

mitral

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26
Q

when is the aortic valve shut?

A

diastole

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27
Q

when is the mitral valve shut?

A

systole

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28
Q

what are the investigations for valvular defects?

A

CXR
ECG
Transthoracic echocardiography
pos cardiac catheterisation, cardiac MRI/CT

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29
Q

basic pathophysiology of aortic stenosis

A

abnormal blood flow/trigger initiates inflammatory process similar to athersclerosis
damages valvular endocardium, leads to aortic sclerosis - leaflet fibrosis and calcium deposition
obstructs left ventricular emptying, increases pressure in left ventricle
compensatory left ventricular hypertrophy

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30
Q

what is aortic sclerosis

A

asymptomatic/pre-stenosis stage of aortic valve calcification

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31
Q

symptoms of aortic stenosis

A

syncope

angina, dyspnoea on exertion

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32
Q

causes of aortic stenosis

A

senile degeneration
congenital bicuspid valves
rheumatic fever

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33
Q

management of asmymptomatic aortic stenosis

A

observe only

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34
Q

management of symptomatic aortic stenosis

A

valve replacement

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35
Q

management of asymptomatic but less than 50% ejection fraction aortic stenosis

A

valve replacement

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36
Q

what is the option of treatment for aortic stenosis when not fit for surgery?

A

TAVI - trans-catheter aortic valve replacement

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37
Q

risk factors for aortic stenosis

A 
high LDL
elderly
smoking
hypertension
high CRP
congenital bicuspid valves
38
Q

what is the trigger for aortic stenosis in rheumatic fever patients?

A

streptococcal infection triggering autoimmune reaction

39
Q

symptoms of coarctation of aorta?

A

pale skin
irritability
sweating
difficulty breathing

40
Q

management of coarctation of aorta?

A

surgery immediately

41
Q

pathophysiology of coarctation of aorta

A

wall narrowing blocks normal blood flow
backflow to left ventricle, it works harder
LV hypertrophy
eventual heart failure

42
Q

pathophysiology of atrial septal defect

A

hole between atria
blood flows from left-right
more blood goes to lungs, so lungs and heart work harder

43
Q

symptoms of atrial septal defect

A

asymptomatic

or signs of reduced HF - SOB, murmurs, palpitations, oedema

44
Q

symptoms of ventricular septal defect

A

murmurs
breathlessness
failure to thrive
or asymptomatic

45
Q

symptoms of tetralogy of fallot

A

cyanosis
SOB
systolic murmur

46
Q

pathophysiology of tetralogy of fallot

A

VSD
pulmonary stenosis
overriding aorta - enlarged, sits over VSD so blood from both ventricles enters
right ventricular hypertrophy as a result
lack of oxygenation as blood goes from right - systemic circulation, bypassing lungs

47
Q

pathophysiology of mitral stenosis

A

acute insult leads to formation of multiple foci and infiltrates in endo/myocardium, valve walls
thickens and calcifies leading to stenosis
blood struggles to pass from left atrium - ventricle
increased left atrial pressure, enlargement
increased LA pressure leads to pulmonary hypertension, congestion and right sided dysfunction

48
Q

common cause of mitral stenosis

A

rheumatic heart disease

49
Q

symptoms of mitral stenosis

A 
palpitations
angina
orthopnoea
exertional dyspnoea
paroxysmal nocturnal dyspnoea - wakes up short of breath
50
Q

management of mild mitral stenosis

A

observation

51
Q

management of severe asymptomatic mitral stenosis

A

balloon valvotomy

52
Q

management of severe symptomatic mitral stenosis

A

beta blockers
diuretics
balloon valvotomy
valve replacement

53
Q

pathophysiology of chronic aortic regurgitation

A

valvular incompetence leads to reflux from aorta into left ventricle
increased volume and pressure in left ventricle - LV hypertrophy
eventual reduced ejection fraction and end systolic volume increases
eventual dyspnoea and ischaemia

54
Q

pathophysiology of acute aortic regurgitation

A 
inc end systolic LV volume
end diastolic pressure increases
increase in pulmonary venous pressure
dyspnoea and pulm oedema
heart failure and cardiogenic shock
55
Q

what are the main differences beyween acute and chronic aortic regurgitation

A

chronic allows for compensatory mechanisms - hypertrophy

56
Q

symptoms of acute aortic regurgitation

A 
cardiogenic shock
tachycardia
cyanosis
pulmonary oedema
austin flint murmur
57
Q

symptoms of chronic aortic regurgitation

A

wide pulse pressure

corrigan pulse/traube sign (booming pulse)

58
Q

management of acute aortic regurgitation

A

treat underlying cause
ionotropes
vasodilators
valve replacement

59
Q

management of mild chronic aortic regurgitation

A

reduction of afterload - diuretics, vasodilators

60
Q

management of severe aortic regurgitation

A

valve replacement

61
Q

pathophysiology of mitral regurgitation following infective endocarditis

A

abcess formation, vegetations, rupture of chorade tendinae and valve perforations
leads to blood leakage LV-LA

62
Q

pathophysiology of chronic mitral regurgitation

A

reflux from LV to LA
increased LA pressure, inc pulmonary pressure
congestion by fluid buildup - congestive heart failure

63
Q

common cause of mitral regurgitation

A

prolapsing mitral valve

64
Q

symptoms of mitral regurgitation

A

dyspnoea
orthopnoea
chest pain
fatigue

65
Q

management of acute mitral regurg

A

nitrates, diuretics, ionotropes,

intra-arotic balloon counterpulsation

66
Q

management of acute mitral regurg with severe regurg

A

surgery

67
Q

management of chronic mitral regurg

A

ACEi
beta blockers
spironolactone diuretic

68
Q

pathophysiology of dilated cardiomyopathy

A

ventricles stretch and thin
ventricular enlargement
ventricular systolic dysfunction
heart failure

69
Q

cause of dilated cardiomyopathy

A 
genetic 1/3
alcoholism
drug use
autoimmune
thyroid
hypertension/diabetes
70
Q

symptoms of dilated cardiomyopathy

A

heart failure - pleural effusion, dyspnoea, peripheral oedema
chest pain
fatigue
syncope

71
Q

management of dilated cardiomyopathy

A

fluid and sodium restrictions
treat underlying cause
heart failure management - diuretics, beta blockers, ACEi

72
Q

pathophysiology of hypertrophic cardiomyopathy

A

genetic AD
abnormal increase of left ventricular wall
LV outflow obstruction, heart less able to fill, diastolic dysfunction

73
Q

cause of hypertrophic cardiomyopathy

A

familial or sporadic mutations

74
Q

symptoms of hypertrophic cardiomyopathy

A 
asymptomatic
angina
syncope
SOB
ejection systolic murmur
75
Q

management of hypertrophic cardiomyopathy

A

beta blockers
calcium channel blockers
if still symptomatic - pacemaker, septal myectomy, septal ablation

76
Q

pathophysiology of restrictive cardiomyopathy

A

ventricles become rigid, restricted from stretching/filling with blood
diastolic dysfunction
reduced cardiac output

77
Q

causes of restrictive cardiomyopathy

A

idiopathic
familial
assoc. with systemic disorders

78
Q

symptoms of restrictive cardiomyopathy

A 
peripheral oedema
ascites
pulmonary hypertension
dyspnoea
fatigue 
palpitations
79
Q

management of restrictive cardiomyopathy

A

underlying cause
heart failure treatment - beta blockers, ACEi, diuretics
transplant
antiarrhythmatic therapy

80
Q

what is infective endocarditis

A

multisystem disease
infection of heart valves +/- adjacent endocardium
bacteria enters bloodstream, forms vegetations (bacteria, platelets, fibring)

81
Q

what are vegetations

A

bacteria
platelets
fibrin

82
Q

common cause of infective endocarditis

A

streptococci

83
Q

symptoms of infective endocarditis

A

fever

NEW MURMUR

84
Q

process of diagnosis of infective endocarditis

A

DUKES criteria

85
Q

dukes criteria definite infective endocarditis

A

2 major
1 major + 3 minor
5 minor

86
Q

dukes criteria of infective endocarditis possible infective endo carditis

A

1 major 1 minor

3 minor

87
Q

major dukes criteria

A

blood culture +ve for streptococci
echo with valvular vegetations
new valvular regurgitation murmur

88
Q

minor dukes criteria

A 
predisposing heart condition
iv drug use
fever over 38
embolic phenomena
immunological phenomena - glomerulonephritis etc
blood culture +ve but not usual suspects
89
Q

most commonly affected valves of IE

A

aortic then mitral then right sided

except IV drug users - tricuspid as infection enters intravenously usually

90
Q

symptoms of cardiac decompensation

A

SOB
frequent coughing
swelling of legs, abdomen
fatigue

clinically - raised JVP, lung crackles and oedema

91
Q

complications of IE

A

vascular/embolic phenomena - stroke, Janeway lesions, splinter/conjunctival haemorrhage
immunological phenomena - Oslers nodes, Roth spots

92
Q

what is cardiac decompensation

A

inability of heart to maintain adequate circulation (leading to end organ damage)

Endo, Cardio and Neuro (22 decks)

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