structural heart disease

Question 1

what is coarctation of aorta

Answer 1

part of aorta is narrower than usual

Question 2

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

Answer 2

patent foramen ovale (PFO)

Question 3

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

Answer 3

patent ductus arteriosus (PDA)

Question 4

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

Answer 4

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

Question 5

most common to least common valve disease

Answer 5

1. all
2. mitral
3. aortic

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

Question 6

as Risk factor and cause

Answer 6

RF
-hypertension
-LDL levels and smoking

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

Question 7

AS pathophysiology

Answer 7

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

Question 8

sound of pulmonary congestion

Answer 8

diffused crackles

Question 9

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

Answer 9

AS

Question 10

investigation to confirm AS

Answer 10

doppler echo

Question 11

AS management

Answer 11

Aortic Valve replacement (AVR)
for severe aortic stenosis

-Transcatheter valve replacement
-Surgical valve prosthesis

Question 12

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

Answer 12

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

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

Question 13

AR pathophysiology

Answer 13

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

Question 14

AR clinical finding

Answer 14

bounding/Corrigan/collapsing pulse

Question 15

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

Answer 15

CHRONIC AR

Question 16

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

Answer 16

Acute AR

Question 17

investigation to diagnose and grade severity of AR

Answer 17

echocardiography

Question 18

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

Answer 18

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)

Question 19

how to prevent AR

Answer 19

treat rheumatic fever and infective endocarditis

Question 20

MS cause

Answer 20

-rheumatic fever
-carcinoid syndrome
-RA
-Amyloidosis

Question 21

MS pathophysiology

Answer 21

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)

Question 22

clinical findings of MS

Answer 22

-afibrillation

-pulmonary oedema-> dyspnoea

-right sided heart failure

Question 23

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

Answer 23

MS

Question 24

Investigations for MS

Answer 24

ECG,
Chest x-ray
transthoracic echocardiography

Question 25

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

Answer 25

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

Question 26

MR- acute vs chronic cause

Answer 26

acute Mitral valve prolapse, rheumatic heart disease, infective endocarditis chronic -rheumatic heart disease, SLE, Scleroderma

Question 27

MR pathophysiology

Answer 27

1. impaired valve closure 2. backflow LV->LA 3.increase LA volume + pressure 4. LV dilation-> remodelling-> decrease LV systolic function 5a) back pressure in LA-> congestion 5b) decrease SV +CO = congestive heart failure

Question 28

MR clinical findings

Answer 28

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

Question 29

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

Answer 29

MR

Question 30

investigation for MR

Answer 30

Transthoracic echocardiography, ECG Chestxray

Question 31

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

Answer 31

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

Question 32

dilated cardiomyopathy cause- priamry vs secondary

Answer 32

primary: without fam fx-idiopathic secondary -myocardial ischemia/heart valve disease -myocarditis -alcohol -thyroid disease

Question 33

Dilated Cardiomyopathy- Pathophysiology

Answer 33

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

Question 34

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

Answer 34

Dilated Cardiomyopathy

Question 35

Investigation for Dilated Cardiomyopathy

Answer 35

ECG Chest x-ray

Question 36

management for Dilated Cardiomyopathy

Answer 36

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

Question 37

how to treat arrhythmias

Answer 37

amiodarone

Question 38

treatment for heart failure symptoms

Answer 38

ACEi, b-blocker -diuretic/ARB

Question 39

hypertrophic cardiomyopathy- pathophysiology

Answer 39

1. thickening of LV myocardium 2. often interventricular septum thickens-> block flow 3.disorganised myocytes disrupts signal conduction 4. ventricular arrhythmias 5. sudden cardiac death

Question 40

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

Answer 40

hypertrophic cardiomyopathy

Question 41

investigation for hypertrophic cardiomyopathy

Answer 41

echocardiography

Question 42

hypertrophic cardiomyopathy management

Answer 42

HCM with Symptoms -Beta blockers –If contraindicated B=Verapamil If drugs fail-> Mechanical Therapy with Pacemaker or Surgery (septal myectomy or ablation)

Question 43

Restrictive Cardiomyopathy-cause

Answer 43

-idiopathic/associated with carious systemic disorders

Question 44

Restrictive Cardiomyopathy- pathophysiology

Answer 44

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

Question 45

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

Answer 45

Restrictive Cardiomyopathy-

Question 46

investigations for Restrictive Cardiomyopathy-

Answer 46

complete blood count

Question 47

Restrictive Cardiomyopathy- management

Answer 47

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 -