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BRS Y2 > Structural Heart Disease > Flashcards

Structural Heart Disease Flashcards

1
Q

When there is heart failure, what stage of the cardiac cycle fails first?

A

Isovolumetric contraction

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2
Q

What are the 2 determinants of cardiac stroke volume?

A

Energy of contraction

Arterial pressure

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3
Q

What is Starling’s law?

A

Increased stretch of the heart increases calcium sensitivity and therefore energy of the contraction

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4
Q

Starting at the bottom left corner of a pressure volume loop, describe which valve opens and closes at each of the 4 points

A

Bottom left: mitral valve opens
Bottom right: mitral valve closes
Top right: aortic valve opens
Top left: aortic valve closes

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5
Q

What is stenosis of valves?

A

Their narrowing

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6
Q

What is the medical name for dilation of the heart valves?

A

Regurgitation lesion

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7
Q

One which side of the heart are valve problems more important?

A

Left

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8
Q

How is stenosis of heart valves assessed?

A

Transthoracic echocardiogram

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9
Q

How do transthoracic echocardiograms work? What result indicates severe stenosis?

A

They look at blood flow velocity, if blood flow is <4mm stenosis is severe

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10
Q

What are some causes of aortic stenosis?

A

Biscuspid aortic valve
Infective endocarditis
Hyper urethemia

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11
Q

What is a biscuspid aortic valve?

A

When the aortic valve has 2 flaps instead of 3

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12
Q

What are some causes of mitral stenosis?

A 
Rheumatic fever
Congenital
SLE
Whipples
Rheumatoid arthritis
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13
Q

What affect does aortic valve stenosis have on the heart?

A

It causes increased pressure/higher after load in the left ventricle leading to left ventricular hypertrophy

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14
Q

What effect does mitral valve stenosis have on the heart?

A

It causes increased pressure in the left atrium which can cause left atrial dilation and further cause atrial arrhythmia

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15
Q

Name all the heart valves, what structures they separate and include alternate names for them if they have any

A

Mitral valve: also known as the left atrio-ventricular valve and separates the left atrium and ventricle
Aortic valve: separates the left ventricle and the aorta
Bicuspid valve: also known as the right atrio-ventricular valve, separates the right atrium and ventricle
Pulmonary valve: separates the right ventricle and the pulmonary artery

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16
Q

What side of the heart is the aorta associated with?

A

Left

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17
Q

What side of the heart is the pulmonary artery associated with?

A

Right

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18
Q

When can aortic stenosis be heard?

A

When the heart is contracting

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19
Q

When can mitral stenosis be heard?

A

When the heart is relaxing, but its harder to hear than aortic stenosis

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20
Q

What type of murmur does aortic stenosis cause?

A

Systolic heart murmur

21
Q

What is regurgitation in terms of the heart?

A

Abnormal dilation

22
Q

How does aortic regurgitation cause in terms of blood flow?

A

It causes back-flow of blood from the aorta to the left ventricle which causes dilation and makes the ventricle less effective

23
Q

When must the aortic valve be replaced if theres stenosis?

A

If the patient presents with heart failure, fluid in the legs or fluid in the lungs

24
Q

How is mitral regurgitation treated?

A

Replacing the valve if it gets serious

25
Q

What complications can mitral regurgitation cause?

A

Heart failure or congestion

26
Q

What is congested heart failure?

A

Heart failure due to fluid build up around the heart

27
Q

How is mitral regurgitation treated?

A

Medication for heart failure and diuretics

28
Q

What causes hypertrophic cardiomyopathy?

A

Genetic, screen first degree relatives for risk

29
Q

What may be seen in someone with hypertrophic cardiomyopathy?

A

Abnormal ECG
Left ventricle thickening
Septum thickening
Systolic murmur

30
Q

What is dilated cardiomyopathy?

A

Chambers are dilated and have poor contractility

31
Q

What are some causes of dilated cardiomyopathy?

A

Stress induced
Infectious
Peri partum (last few months of pregnancy)
50% is genetic

32
Q

How is dilated cardiomyopathy diagnosed?

A

Via angiogram

33
Q

What is arrythmogenic right ventricular cardiomyopathy?

A

Dilation in the right ventricle that affects left ventricle function too

34
Q

What type of cardiomyopathy is deadly? Why?

A

Arrythmogenic right ventricular cardiomyopathy as it can cause ventricular arrythmia which can lead to sudden death

35
Q

When are metallic valve replacements used?

A

In children as they give longevity and durability

36
Q

What medication must be given with metallic valves?

A

Warfarin

37
Q

How many years of longevity do biological valve replacements give?

A

20 years

38
Q

The replacement of which valve is complicated?

A

Mitral

39
Q

Define cardiogenic shock?

A

Impairment of cardiac systolic function resulting in reduced cardiac output which will cause end organ dysfunction

40
Q

Why does cardiogenic shock result in end organ failure?

A

As the reduced systolic output of the heart leads to the body not receiving enough glucose, oxygen or blood

41
Q

How is cardiogenic shock different to other shocks?

A

Giving fluid will make things worse not better as the contractility of the heart is already reduced

42
Q

How is cardiogenic shock recognised and confirmed?

A

Via bedside transthoracic echocardiogram

43
Q

How is cardiogenic shock treated?

A

Percutaneous coronary intervention- stents are placed in arteries to open them up
Ionotrophs are given as the first line treatment, they alter the force of muscle contraction

44
Q

How do ionotrophs work in cardiogenic shock?

A

They alter the force of muscle contraction

45
Q

What effect will giving ionotrophs have on the pressure volume loop?

A

Increased height
Increased width
Leftward shift

46
Q

Give an example of an ionotroph drug

A

Dopamine

47
Q

What is used when ionotrophs dont work in cardiogenic shock?

A

Mechanical support devices

48
Q

What must be given alongside mechanical support devices for the heart?

A

Anticoagulants

49
Q

What will the pressure volume loop look like for someone in cardiogenic shock before treatment?

A

It will be small in terms of height and width, it will also be shifted more to the right than should be normal

BRS Y2 (85 decks)

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