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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
what valve is open in diastole?
mitral
26
when is the aortic valve shut?
diastole
27
when is the mitral valve shut?
systole
28
what are the investigations for valvular defects?
CXR ECG Transthoracic echocardiography pos cardiac catheterisation, cardiac MRI/CT
29
basic pathophysiology of aortic stenosis
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
30
what is aortic sclerosis
asymptomatic/pre-stenosis stage of aortic valve calcification
31
symptoms of aortic stenosis
syncope | angina, dyspnoea on exertion
32
causes of aortic stenosis
senile degeneration congenital bicuspid valves rheumatic fever
33
management of asmymptomatic aortic stenosis
observe only
34
management of symptomatic aortic stenosis
valve replacement
35
management of asymptomatic but less than 50% ejection fraction aortic stenosis
valve replacement
36
what is the option of treatment for aortic stenosis when not fit for surgery?
TAVI - trans-catheter aortic valve replacement
37
risk factors for aortic stenosis
``` high LDL elderly smoking hypertension high CRP congenital bicuspid valves ```
38
what is the trigger for aortic stenosis in rheumatic fever patients?
streptococcal infection triggering autoimmune reaction
39
symptoms of coarctation of aorta?
pale skin irritability sweating difficulty breathing
40
management of coarctation of aorta?
surgery immediately
41
pathophysiology of coarctation of aorta
wall narrowing blocks normal blood flow backflow to left ventricle, it works harder LV hypertrophy eventual heart failure
42
pathophysiology of atrial septal defect
hole between atria blood flows from left-right more blood goes to lungs, so lungs and heart work harder
43
symptoms of atrial septal defect
asymptomatic | or signs of reduced HF - SOB, murmurs, palpitations, oedema
44
symptoms of ventricular septal defect
murmurs breathlessness failure to thrive or asymptomatic
45
symptoms of tetralogy of fallot
cyanosis SOB systolic murmur
46
pathophysiology of tetralogy of fallot
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
pathophysiology of mitral stenosis
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
common cause of mitral stenosis
rheumatic heart disease
49
symptoms of mitral stenosis
``` palpitations angina orthopnoea exertional dyspnoea paroxysmal nocturnal dyspnoea - wakes up short of breath ```
50
management of mild mitral stenosis
observation
51
management of severe asymptomatic mitral stenosis
balloon valvotomy
52
management of severe symptomatic mitral stenosis
beta blockers diuretics balloon valvotomy valve replacement
53
pathophysiology of chronic aortic regurgitation
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
pathophysiology of acute aortic regurgitation
``` inc end systolic LV volume end diastolic pressure increases increase in pulmonary venous pressure dyspnoea and pulm oedema heart failure and cardiogenic shock ```
55
what are the main differences beyween acute and chronic aortic regurgitation
chronic allows for compensatory mechanisms - hypertrophy
56
symptoms of acute aortic regurgitation
``` cardiogenic shock tachycardia cyanosis pulmonary oedema austin flint murmur ```
57
symptoms of chronic aortic regurgitation
wide pulse pressure | corrigan pulse/traube sign (booming pulse)
58
management of acute aortic regurgitation
treat underlying cause ionotropes vasodilators valve replacement
59
management of mild chronic aortic regurgitation
reduction of afterload - diuretics, vasodilators
60
management of severe aortic regurgitation
valve replacement
61
pathophysiology of mitral regurgitation following infective endocarditis
abcess formation, vegetations, rupture of chorade tendinae and valve perforations leads to blood leakage LV-LA
62
pathophysiology of chronic mitral regurgitation
reflux from LV to LA increased LA pressure, inc pulmonary pressure congestion by fluid buildup - congestive heart failure
63
common cause of mitral regurgitation
prolapsing mitral valve
64
symptoms of mitral regurgitation
dyspnoea orthopnoea chest pain fatigue
65
management of acute mitral regurg
nitrates, diuretics, ionotropes, | intra-arotic balloon counterpulsation
66
management of acute mitral regurg with severe regurg
surgery
67
management of chronic mitral regurg
ACEi beta blockers spironolactone diuretic
68
pathophysiology of dilated cardiomyopathy
ventricles stretch and thin ventricular enlargement ventricular systolic dysfunction heart failure
69
cause of dilated cardiomyopathy
``` genetic 1/3 alcoholism drug use autoimmune thyroid hypertension/diabetes ```
70
symptoms of dilated cardiomyopathy
heart failure - pleural effusion, dyspnoea, peripheral oedema chest pain fatigue syncope
71
management of dilated cardiomyopathy
fluid and sodium restrictions treat underlying cause heart failure management - diuretics, beta blockers, ACEi
72
pathophysiology of hypertrophic cardiomyopathy
genetic AD abnormal increase of left ventricular wall LV outflow obstruction, heart less able to fill, diastolic dysfunction
73
cause of hypertrophic cardiomyopathy
familial or sporadic mutations
74
symptoms of hypertrophic cardiomyopathy
``` asymptomatic angina syncope SOB ejection systolic murmur ```
75
management of hypertrophic cardiomyopathy
beta blockers calcium channel blockers if still symptomatic - pacemaker, septal myectomy, septal ablation
76
pathophysiology of restrictive cardiomyopathy
ventricles become rigid, restricted from stretching/filling with blood diastolic dysfunction reduced cardiac output
77
causes of restrictive cardiomyopathy
idiopathic familial assoc. with systemic disorders
78
symptoms of restrictive cardiomyopathy
``` peripheral oedema ascites pulmonary hypertension dyspnoea fatigue palpitations ```
79
management of restrictive cardiomyopathy
underlying cause heart failure treatment - beta blockers, ACEi, diuretics transplant antiarrhythmatic therapy
80
what is infective endocarditis
multisystem disease infection of heart valves +/- adjacent endocardium bacteria enters bloodstream, forms vegetations (bacteria, platelets, fibring)
81
what are vegetations
bacteria platelets fibrin
82
common cause of infective endocarditis
streptococci
83
symptoms of infective endocarditis
fever | NEW MURMUR
84
process of diagnosis of infective endocarditis
DUKES criteria
85
dukes criteria definite infective endocarditis
2 major 1 major + 3 minor 5 minor
86
dukes criteria of infective endocarditis possible infective endo carditis
1 major 1 minor | 3 minor
87
major dukes criteria
blood culture +ve for streptococci echo with valvular vegetations new valvular regurgitation murmur
88
minor dukes criteria
``` predisposing heart condition iv drug use fever over 38 embolic phenomena immunological phenomena - glomerulonephritis etc blood culture +ve but not usual suspects ```
89
most commonly affected valves of IE
aortic then mitral then right sided except IV drug users - tricuspid as infection enters intravenously usually
90
symptoms of cardiac decompensation
SOB frequent coughing swelling of legs, abdomen fatigue clinically - raised JVP, lung crackles and oedema
91
complications of IE
vascular/embolic phenomena - stroke, Janeway lesions, splinter/conjunctival haemorrhage immunological phenomena - Oslers nodes, Roth spots
92
what is cardiac decompensation
inability of heart to maintain adequate circulation (leading to end organ damage)

Endo, Cardio and Neuro (22 decks)

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