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BRS YR2 > Valvular Disease and Heart Failure > Flashcards

Valvular Disease and Heart Failure Flashcards

1
Q

How do you calculate cardiac output?

A

cardiac output = heart rate x stroke volume

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2
Q

How can you calculate stroke volume?

A

stroke volume = end diastolic volume - end systolic volume

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3
Q

What is cardiac output?

A

volume of blood the heart pumps in one minute (L/min or cm3/min)

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4
Q

How do you calculate ejection fraction?

A

ejection fraction = stroke volume / end diastolic volume x 100

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5
Q

What is ejection fraction?

A

the volumetric fraction of blood ejected by the ventricles with each given contraction (%)

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6
Q

How can you calculate mean arterial pressure when under stress?

A

mean arterial pressure = (cardiac output x systemic vascular resistance) + central venous pressure

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7
Q

How can you calculate the mean arterial pressure at rest (estimated)?

A

mean arterial pressure = diastolic pressure + 1/3 (systolic pressure - diastolic pressure)

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8
Q

What is infective endocarditis?

A
  • an infection of the endocardium/vascular endothelium of the heart
  • typically affects the heart valves
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9
Q

What causes infective endocarditis?

A
  • bacteria entering the blood stream and forming a ‘vegetation’ in the endocardium
  • streptococci (20-40%)
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10
Q

What is a ‘vegetation’?

A

a bacterial infection surrounded by a layer of platelets and fibrin

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11
Q

What are the symptoms of infective endocarditis?

A
  • fever
  • malaise
  • sweats
  • unexplained weight loss
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12
Q

What may be heard on examination with infective endocarditis?

A

heart murmur (new)

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13
Q

What may blood tests show with infective endocarditis?

A
  • anaemia
  • raised infection markers
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14
Q

What may blood cultures show with infective endocarditis?

A

microorganism (strep infection)

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15
Q

What may an ECG show with infective endocarditis?

A
  • vegetation
  • abscess
  • valve perforation
  • tearing of prosthetic valve
  • regurgitation of the affected valve
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16
Q

What are the cardiac features of heart decompensation?

A
  • shortness of breath
  • frequent coughing
  • swelling of legs and abdomen
  • fatigue
  • raised JVP
  • lung crackles
  • oedema
17
Q

What are the other complications associated with heart decompensation?

A 
Vascular and embolic phenomena
- stroke
- Janeway lesions
- splinter/conjunctival haemorrhages
Immunological phenomena
- Osler's nodes
- Roth spots
18
Q

What part of the heart does infective endocarditis effect?

A

endocardium, especially the valves of the heart
- most frequently: aortic valve (mitral, right-sided valves)

19
Q

Why does infective endocarditis tend to effect the valves of the heart?

A
  • formation of vegetation is more likely if underlying damage is present
  • more common in sites of turbulent blood flow (heart valves)
20
Q

How does infective endocarditis differ for IV drug users?

A
  • increased risk due to repeated injection
  • entry of bacteria into the blood stream is the first step of development
21
Q

Which populations are at increased risk of developing infective endocarditis?

A
  • IV drug users
  • immunosuppressed
  • congenital heart defects (bicuspid aortic valve)
22
Q

What is dilated cardiomyopathy?

A

dilated and thin-walled cardiac chambers with reduced contractility

23
Q

What would an Echo of dilated cardiomyopathy show?

A
  • dilated left ventricle
  • reduced systolic function (ejection fraction)
  • global hypokinesis
24
Q

What are the common causes of dilated cardiomyopathy?

A
  • idiopathic
  • genetic
  • toxins (alcohol, cardiotoxic chemo)
  • pregnancy (peripartum cardiomyopathy)
  • viral infections (myocarditis)
  • tachycardia-related cardiomyopathy
  • thyroid disease
  • muscular dystrophies
25
Q

How is dilated cardiomyopathy managed?

A 
Medical heart failure therapy
- ACE inhibitors 
- Beta blockers
- mineralcorticoid receptor antagonists
Diuretics (fluid overload)
Anticoagulation (A fib)
Cardiac devices
- cardiac resynchronisation therapy
- implantable cardioverter defibrillator
Transplant
26
Q

What are the complications associated with dilated cardiomyopathy?

A
  • heart failure hospitalisation
  • cardiac arrhythmias
  • sudden cardiac death (ventricular arrhythmia)
  • reduced survival
27
Q

What is part of the major Modified Duke’s criteria to diagnose infective endocarditis?

A
  • positive blood cultures for infective endocarditis (typical micro-organism)
  • echocardiographic evidence of valvular regurgitation
28
Q

What is part of the minor Modified Duke’s criteria to diagnose infective endocarditis?

A
  • predisposing heart condition
  • IV drug use
  • fever
  • vascular phenomena
  • microbiological evidence
  • immunologic evidence
29
Q

According to the Modified Duke’s criteria what is required for definite infective endocarditis?

A
  • 2 major
  • 1 major + 3 minor
30
Q

According to the Modified Duke’s criteria what is required for possible infective endocarditis?

A
  • 1 major + 1 minor
  • 3 minor
31
Q

What is heart decompensation?

A

Inability of the heart to maintain adequate circulation

32
Q

What is heart failure with preserved ejection fraction?

A
  • EF >50%
  • diastolic or right heart dysfunction
  • diastolic dysfunction causes increased blood reservoir in pulmonary veins
  • causes increased pulmonary hypertension and oedema
33
Q

What is heart failure with reduced ejection fraction?

A
  • EF <50%
  • impaired left ventricular systolic function and poor blood flow via the aorta
  • causes pulmonary oedema due to back flow of blood to pulmonary veins and lungs
34
Q

What are the clinical signs of right heart failure?

A

Peripheral oedema (leg swelling, raised jugular venous pressure)

35
Q

What are the signs of left heart failure?

A

Pulmonary oedema

36
Q

What medications are used to treat heart failure with preserved EF?

A

Diuretics and SGLT2 inhibitors

37
Q

What medications are used to treat heart failure with reduced EF?

A
  • ACE inhibitiors
  • angiotensin II receptor blockers
  • beta blockers
  • mineralcorticoid receptor antagonists
  • SGLT2 inhibitors
  • diuretics
38
Q

How is heart failure monitored?

A
  • clinical signs of fluid overload
  • low O2 saturation
  • NT-proBNP biomarker
  • ECG
39
Q

What are the clinical signs of fluid overload?

A
  • shortness of breath
  • leg swelling
  • orthopnoea
  • reduced exercise tolerance due to shortness of breath

BRS YR2 (67 decks)

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