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Year 2 Cardio > Structural Heart Disease > Flashcards

Structural Heart Disease Flashcards

1
Q

What are the determinants of cardiac stroke volume?

A

Starling’ law of the heart (length tension)
Cardiac contractility
Arterial pressure

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2
Q

What influences cardiac contractility?

A

Synthetic tone

Adrenaline

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3
Q

What is the after load?

A

Pressure in the aorta

Force per unit area

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4
Q

What is preload?

A

Stretching of the myocardium allowing the generation of forces

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5
Q

What is the law of laplace?

A

P + 2T/r

Internal pressures generated inside a chamber is directly proportional to the tensions and inversely proportional to the radius

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6
Q

Why is the law of laplace significant?

A

when radius of chamber increases pathologically

cannot generate sufficient pressure

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7
Q

What are the two classification of valvular disease?

A

Stenotics

Dilatations

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8
Q

What are two types of stenotic lesions?

A

Aortic stenosis

Mitral stenosis

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9
Q

What is aortic stenosis?

A

Aortic valve becomes significantly narrowed

Severe is area is less than 1cm^2 or if speed of blod flow is greater that 4 metres per second

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10
Q

What are the causes of aortic stenosis?

A

Bicuspid aortic valve - Congenital
Degeneration of valve with age
Rheumatic heart disease
Infective endocarditis

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11
Q

What cause mitral stenosis?

A 
Rheumatic fever
Congential
Rheumatoid arthritis
Lupus
Whipples disease
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12
Q

What is the consequence of aortic stenosis?

A

Increased afterload on the left ventricle

Causing hypertrophy

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13
Q

What is the consequence of mitral stenosis?

A

Increased pressure on the left atrium
Increased strain causes atrial dilation
Can lead to AF

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14
Q

What causes mitral regurgitation?

A

Rheumatic fever
Infective endocarditis
Mitral valve prolapse

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15
Q

What is the consequence of mitral regurgitation?

A

Less cardiac output to aorta

Reduces organ perfusion

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16
Q

What causes aortic regurgitation?

A

Biscuspid aortic valve
Marfaans syndrome
hypertension
Infective endocarditis

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17
Q

What is the consequence of aortic regurgitation?

A

Volume overload to left ventricle as blood goes back

Causing dilation

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18
Q

How does mitral regurgitation present?

A

systolic murmur

19
Q

How does aortic regurgitation present?

A

diastolic murmur

20
Q

What are the three main types of cardiomyopathy?

A

Hypertrophic
Dilated
Arrhythmogenic right ventricular

21
Q

What is the result of dilated cardiomyopathy?

A

Chambers have poor contractility

Wall tension does not generate effective pressure

22
Q

What can cause dilated cardiomyopathy?

A

Stress
Post partum
Sarcodosis
Auto-immune diseases

23
Q

What happens in arrhthmogenic right ventricular cardiomyopathy?

A

Abnormal right ventricle radius
Cannot work effectively
Also effect left ventricle

24
Q

How can you treat valve issues?

A

Valve replacement
But must treat consequences of valve failure
Aim to replace before the issues has other effects

25
Q

What are the pros and cons of different valves?

A

Metallic valves

  • last longer
  • need to be on warfarin

Prosthetic valves

-only last 20 years

26
Q

Why is the mitral valve not often replaced?

A

The arrangement of the mitral valve means that it isn’t easy to replace

increased emphasis on repairing the existing valves

This avoids open heart surgery

27
Q

Define cardiogenic shock?

A

Impairment of cardiac systolic function resulting in reduced cardiac output causing end organ dysfunction

28
Q

Why is it so important to identify cardiogenic shocl?

A

Treatment is very different to other types of shock
e.g. dangerous to give more fluid
reduces contractile function

29
Q

How is cardiogenic shock treated?

A

Early coronary angiography
PCI or CABG
Reassess haemodynamic/tissue perfusion

30
Q

What are inotropes?

A

Dopamine etc.
Increase height and leftward shift of pressure volume loop
Augmentation of end diastollic volume
Increase in stroke work and stroke volume

31
Q

What are the features of mechanical support devices?

A

Used when ionotropic drugs are ineffective

IABP
Impella recover
TandemHeart
VA-ECMO

32
Q

How do you calculate cardiac output?

A

Stroke volume x Heart rate

33
Q

How do you calculate ejection fraction?

A

Stroke volume divided by end diastolic volume

34
Q

How do you calculate mean arterial pressure?

A

MAP = Cardiac output x total peripheral resistance

MAP = Diastolic blood pressure + 1/3 Pulse Pressure

MAP = 2/3 Diastolic blood pressure + 1/3 Systolic Pressure

35
Q

What is infective endocarditis?

A

Infection of the endocardium (inner lining of the heart). Commonly caused by bacteria.

36
Q

How do you diagnose infective endocarditis?

A

Dukes criteria
Major: positive blood cultures/evidence of endocardium involvement
Minor: predisposing factors, pyrexia, vascular phenomena, immunological phenomena, microbioloigcal evidence
Blood cultures
ECG
ECHO

37
Q

Which part of the heart does infective endocarditis affect particularly?

A

Heart valves, normally left aortic and mitral valves

Right sided occurs less frequently

38
Q

What are some features of decompensation?

A

Weight loss

Difficulty breathing

Leg/Foot Swelling

Fatigue

39
Q

What is the relationship between IV drug use and infective endocarditis?

A

Higher risk of developing infective endocarditis

Can be right sided involving the tricuspid

40
Q

Define dilated cardiomyopathy

A

Ventricle stretches and thins and is no longer able to pump efficiently

41
Q

What are some common causes of dilated cardiomyopathy?

A 
Heart disease
Poorly controlled hypertension
Infection
Genetics
Peri-partum
Toxins
Auto-immune
Endocrine
Metabolic disorders
42
Q

What genes have been implicated in the diagnosis of dilated cardiomyopathy?

A

MYH7, MYBPC3, TNNT2, and TNNI3

ACBC1, ACBC 2

43
Q

How is dilated cardiomyopathy managed?

A

Medication: Diuretics, ACEi, Beta Blockers, Anti-coagulants, ARBs

Pacemaker

Surgical: LVAD (Left ventricular assist device) or Heart transplant

44
Q

What are the implications of dilated cardiomyopathy?

A

High risk of heart failure
Needs to manage BP
Lower alcohol intake, stop smoking, minimise salt and caffeine

Year 2 Cardio (10 decks)

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