structural heart disease Flashcards
what is coarctation of aorta
part of aorta is narrower than usual
what is it called when there is a hole between left and right atria chambers
patent foramen ovale (PFO)
fetal blood vessel fails to close after birth, leading to abnormal blood flow between the aorta and the pulmonary artery- what is this condition
patent ductus arteriosus (PDA)
what are the defects seen in Tetralogy of Fallot (TOF)
pulmonary stenosis,
ventricular septal defect,
overriding aorta,
right ventricular hypertrophy
most common to least common valve disease
- all
- mitral
- aortic
specifics:
1. mild MR
2.mild AR
3.Moderate MR
4. moderate AR
as Risk factor and cause
RF
-hypertension
-LDL levels and smoking
cause
rheumatic heart disease
-congenital heart disease
-calcium build up
AS pathophysiology
- valve damage from age/untreated URTI (strep)
- fibrosis/calcification of aortic valve
- disrupt blood flow
- LV contract harder to pump through stenotic valve
- concentric LV myocardial hypertrophy
- LV becomes stiff + harder to fill. decrease CO. Diastolic dysfunction
- pressure overload in LV backs up to LA causing it to dilate-> pulmonary congestion
sound of pulmonary congestion
diffused crackles
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
AS
investigation to confirm AS
doppler echo
AS management
Aortic Valve replacement (AVR)
for severe aortic stenosis
-Transcatheter valve replacement
-Surgical valve prosthesis
AR (congenital/acquired cause) vs (aortic root dilation cause)
(congenital/acquired cause)
-rheumatic heart disease
-infective endocarditis
(aortic root dilation cause)
-marfan’s syndrome
-connective tissue disease/collagen vascular disease
AR pathophysiology
- valve leaflet close poorly due to inflammation/aortic root dilation in diastole.
- back flow from A->LV
- volume+pressure overload in LV. Increase LV pre+afterload
- a) acute dilatation-increase SV (frank starling law)
4.b) chronic dilation-eccentric hypertrophy - weakens myocardium. Can’t contract properly. systolic heart failure
- back pressure in LV to atria- > congestion
AR clinical finding
bounding/Corrigan/collapsing pulse
what is this a sign of :
Wide pulse pressure
Corrigan (wate hammer pulse)
CHRONIC AR
what is this a sign of: Cardiogenic shock
Tachycardia
Cyanosis
Pulmonary oedema
Diastolic murmur
Acute AR
investigation to diagnose and grade severity of AR
echocardiography
management for AR: Acute AR vs Asymptomatic patients with chronic severe AR:
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)
how to prevent AR
treat rheumatic fever and infective endocarditis
MS cause
-rheumatic fever
-carcinoid syndrome
-RA
-Amyloidosis
MS pathophysiology
- recurrent inflammation
- fibrous + calcification of mitral valve leaflets + chordae tendineae
3.stiff leaflet
4.obstruct blood flow - 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)
clinical findings of MS
-afibrillation
-pulmonary oedema-> dyspnoea
-right sided heart failure
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
MS
Investigations for MS
ECG,
Chest x-ray
transthoracic echocardiography
MS management for: Progressive asymptomatic, Severe asymptomatic, Severe symptomatic
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
MR- acute vs chronic cause
acute
Mitral valve prolapse,
rheumatic heart disease,
infective endocarditis
chronic
-rheumatic heart disease,
SLE,
Scleroderma
MR pathophysiology
- impaired valve closure
- backflow LV->LA
3.increase LA volume + pressure - LV dilation-> remodelling-> decrease LV systolic function
5a) back pressure in LA-> congestion
5b) decrease SV +CO = congestive heart failure
MR clinical findings
holosystolic murmur radiating to axilla,
-increase serum creatinine
-peripheral oedema
-frothy sputum
what is this a sign of: Dyspnoea
Holosystolic murmur
S3 heart sound
Signs of congestive heart failure
MR
investigation for MR
Transthoracic echocardiography,
ECG
Chestxray
MR management -Acute severe MR vs Chronic severe MR asymptomatic vs Chronic symptomatic
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
dilated cardiomyopathy cause- priamry vs secondary
primary: without fam fx-idiopathic
secondary
-myocardial ischemia/heart valve disease
-myocarditis
-alcohol
-thyroid disease
Dilated Cardiomyopathy- Pathophysiology
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
what is this a sign of?
-dyspnoea, cold clammy extremities
- displaced apex beat
-fatigue
-angina
-pulmonary congestion
-peripheral oedema
-sudden cardiac death
Dilated Cardiomyopathy
Investigation for Dilated Cardiomyopathy
ECG
Chest x-ray
management for Dilated Cardiomyopathy
-counselling
-symptomatic treatment
-diet modification- fluid/Na restriction
-treat underlying disease
-treat symptoms of heart failure
-treat arrhythmias
-treat thrombotic events
how to treat arrhythmias
amiodarone
treatment for heart failure symptoms
ACEi, b-blocker
-diuretic/ARB
hypertrophic cardiomyopathy- pathophysiology
- thickening of LV myocardium
- often interventricular septum thickens-> block flow
3.disorganised myocytes disrupts signal conduction - ventricular arrhythmias
- sudden cardiac death
what is this a sign of:
-S4, syncope
-fatigue
-angina
-pulmonary congestion and oedema
-systolic murmur
-sudden cardiac death
hypertrophic cardiomyopathy
investigation for hypertrophic cardiomyopathy
echocardiography
hypertrophic cardiomyopathy management
HCM with Symptoms
-Beta blockers –If contraindicated
B=Verapamil
If drugs fail-> Mechanical Therapy with Pacemaker or Surgery (septal myectomy or ablation)
Restrictive Cardiomyopathy-cause
-idiopathic/associated with carious systemic disorders
Restrictive Cardiomyopathy- pathophysiology
- infiltration- deposit fibrosis-> ventricle walls stiffening. Diastolic dysfunction.
- Atrial enlarges (ventricle thickness normal)
- conduction abnormalities
- adverse remodelling-> systolic dysfunction
- reduced ventricular filling= decreased CO
What is this a sign of?
-ascites/pitting oedema in peripheries
-hepatomegaly
-S4 heart sound
-increased jugular venous pressure
-easy bruising, weight loss
Restrictive Cardiomyopathy-
investigations for Restrictive Cardiomyopathy-
complete blood count
Restrictive Cardiomyopathy- management
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
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