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BRS Y2 > structural heart disease > Flashcards

structural heart disease Flashcards

1
Q

what is coarctation of aorta

A

part of aorta is narrower than usual

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2
Q

what is it called when there is a hole between left and right atria chambers

A

patent foramen ovale (PFO)

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3
Q

fetal blood vessel fails to close after birth, leading to abnormal blood flow between the aorta and the pulmonary artery- what is this condition

A

patent ductus arteriosus (PDA)

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4
Q

what are the defects seen in Tetralogy of Fallot (TOF)

A

pulmonary stenosis,
ventricular septal defect,
overriding aorta,
right ventricular hypertrophy

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5
Q

most common to least common valve disease

A
  1. all
  2. mitral
  3. aortic

specifics:
1. mild MR
2.mild AR
3.Moderate MR
4. moderate AR

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6
Q

as Risk factor and cause

A

RF
-hypertension
-LDL levels and smoking

cause
rheumatic heart disease
-congenital heart disease
-calcium build up

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7
Q

AS pathophysiology

A
  1. valve damage from age/untreated URTI (strep)
  2. fibrosis/calcification of aortic valve
  3. disrupt blood flow
  4. LV contract harder to pump through stenotic valve
  5. concentric LV myocardial hypertrophy
  6. LV becomes stiff + harder to fill. decrease CO. Diastolic dysfunction
  7. pressure overload in LV backs up to LA causing it to dilate-> pulmonary congestion
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8
Q

sound of pulmonary congestion

A

diffused crackles

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9
Q

what are these a sign of
Exertional dyspnoea and fatigue
Chest pain, Angina
Syncope
Heart failure
Ejection systolic murmur
H/O Rheumatic fever, High lipoprotein, high LDL, CKD, age >65

A

AS

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10
Q

investigation to confirm AS

A

doppler echo

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11
Q

AS management

A

Aortic Valve replacement (AVR)
for severe aortic stenosis

-Transcatheter valve replacement
-Surgical valve prosthesis

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12
Q

AR (congenital/acquired cause) vs (aortic root dilation cause)

A

(congenital/acquired cause)
-rheumatic heart disease
-infective endocarditis

(aortic root dilation cause)
-marfan’s syndrome
-connective tissue disease/collagen vascular disease

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13
Q

AR pathophysiology

A
  1. valve leaflet close poorly due to inflammation/aortic root dilation in diastole.
  2. back flow from A->LV
  3. volume+pressure overload in LV. Increase LV pre+afterload
  4. a) acute dilatation-increase SV (frank starling law)
    4.b) chronic dilation-eccentric hypertrophy
  5. weakens myocardium. Can’t contract properly. systolic heart failure
  6. back pressure in LV to atria- > congestion
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14
Q

AR clinical finding

A

bounding/Corrigan/collapsing pulse

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15
Q

what is this a sign of :
Wide pulse pressure
Corrigan (wate hammer pulse)

A

CHRONIC AR

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16
Q

what is this a sign of: Cardiogenic shock
Tachycardia
Cyanosis
Pulmonary oedema
Diastolic murmur

A

Acute AR

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17
Q

investigation to diagnose and grade severity of AR

A

echocardiography

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18
Q

management for AR: Acute AR vs Asymptomatic patients with chronic severe AR:

A

Aortic Valve Replacement

Acute AR: medical emergency, sudden onset of pulmonary oedema and hypotension or cardiogenic shock.

Asymptomatic patients with chronic severe AR:
Vasodilator therapy improves haemodynamic and delays the need for aortic valve replacement/repair (AVR)

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19
Q

how to prevent AR

A

treat rheumatic fever and infective endocarditis

20
Q

MS cause

A

-rheumatic fever
-carcinoid syndrome
-RA
-Amyloidosis

21
Q

MS pathophysiology

A
  1. recurrent inflammation
  2. fibrous + calcification of mitral valve leaflets + chordae tendineae
    3.stiff leaflet
    4.obstruct blood flow
  3. impaired LA emptying
    6a) increase LA pressure-> back pressure in LA-> congestion
    6b) impaired filling LV. decrease SV +CO =congestive heart failure–>RV hypertrophy (right sided heart failure)
22
Q

clinical findings of MS

A

-afibrillation

-pulmonary oedema-> dyspnoea

-right sided heart failure

23
Q

what is this a sign of: H/0 of Rheumatic fever
Dyspnoea
Mid Diastolic murmur
Opening snap / loud S1 in early stages
Dysphagia
Atrial afibrillation
Haemoptysis

A

MS

24
Q

Investigations for MS

A

ECG,
Chest x-ray
transthoracic echocardiography

25
Q

MS management for: Progressive asymptomatic, Severe asymptomatic, Severe symptomatic

A

Progressive asymptomatic=No therapy required

Severe asymptomatic=no therapy generally required/ adjuvant balloon valvotomy

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

26
Q

MR- acute vs chronic cause

A

acute
Mitral valve prolapse,
rheumatic heart disease,
infective endocarditis

chronic
-rheumatic heart disease,
SLE,
Scleroderma

27
Q

MR pathophysiology

A
  1. impaired valve closure
  2. backflow LV->LA
    3.increase LA volume + pressure
  3. LV dilation-> remodelling-> decrease LV systolic function
    5a) back pressure in LA-> congestion
    5b) decrease SV +CO = congestive heart failure
28
Q

MR clinical findings

A

holosystolic murmur radiating to axilla,
-increase serum creatinine
-peripheral oedema
-frothy sputum

29
Q

what is this a sign of: Dyspnoea
Holosystolic murmur
S3 heart sound
Signs of congestive heart failure

A

MR

30
Q

investigation for MR

A

Transthoracic echocardiography,
ECG
Chestxray

31
Q

MR management -Acute severe MR vs Chronic severe MR asymptomatic vs Chronic symptomatic

A

Acute severe MR =
repair/replace the supporting valve structures. Prosthetic ring inserted to reshape the valve.

Chronic severe MR asymptomatic =
watchful waiting/surgery

Chronic symptomatic=
1st surgery plus medical treatment

32
Q

dilated cardiomyopathy cause- priamry vs secondary

A

primary: without fam fx-idiopathic

secondary
-myocardial ischemia/heart valve disease
-myocarditis
-alcohol
-thyroid disease

33
Q

Dilated Cardiomyopathy- Pathophysiology

A

1.myocyte damage
2. eccentric fibrosis /volume increase
3. enlarged LV without myocardial mass increase
4. over time-> systolic dysfunction
5. decreased CO. increased EDV/EDP
6. volume overload-> congestive heart failure

34
Q

what is this a sign of?
-dyspnoea, cold clammy extremities
- displaced apex beat
-fatigue
-angina
-pulmonary congestion
-peripheral oedema
-sudden cardiac death

A

Dilated Cardiomyopathy

35
Q

Investigation for Dilated Cardiomyopathy

A

ECG
Chest x-ray

36
Q

management for Dilated Cardiomyopathy

A

-counselling
-symptomatic treatment

-diet modification- fluid/Na restriction
-treat underlying disease
-treat symptoms of heart failure
-treat arrhythmias
-treat thrombotic events

37
Q

how to treat arrhythmias

A

amiodarone

38
Q

treatment for heart failure symptoms

A

ACEi, b-blocker
-diuretic/ARB

39
Q

hypertrophic cardiomyopathy- pathophysiology

A
  1. thickening of LV myocardium
  2. often interventricular septum thickens-> block flow
    3.disorganised myocytes disrupts signal conduction
  3. ventricular arrhythmias
  4. sudden cardiac death
40
Q

what is this a sign of:
-S4, syncope
-fatigue
-angina
-pulmonary congestion and oedema
-systolic murmur
-sudden cardiac death

A

hypertrophic cardiomyopathy

41
Q

investigation for hypertrophic cardiomyopathy

A

echocardiography

42
Q

hypertrophic cardiomyopathy management

A

HCM with Symptoms
-Beta blockers –If contraindicated
B=Verapamil

If drugs fail-> Mechanical Therapy with Pacemaker or Surgery (septal myectomy or ablation)

43
Q

Restrictive Cardiomyopathy-cause

A

-idiopathic/associated with carious systemic disorders

44
Q

Restrictive Cardiomyopathy- pathophysiology

A
  1. infiltration- deposit fibrosis-> ventricle walls stiffening. Diastolic dysfunction.
  2. Atrial enlarges (ventricle thickness normal)
  3. conduction abnormalities
  4. adverse remodelling-> systolic dysfunction
  5. reduced ventricular filling= decreased CO
45
Q

What is this a sign of?
-ascites/pitting oedema in peripheries
-hepatomegaly
-S4 heart sound
-increased jugular venous pressure
-easy bruising, weight loss

A

Restrictive Cardiomyopathy-

46
Q

investigations for Restrictive Cardiomyopathy-

A

complete blood count

47
Q

Restrictive Cardiomyopathy- management

A

Heart failure medication
-ACEi/angiotensin receptor II blockers,
diuretics and aldosterone inhibitors should be initiated in patients with reduced LV

-Antiarrhythmic Therapy
-Immunosuppression- Steroids
-Pacemaker
-Cardiac transplantation
-

BRS Y2 (60 decks)

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