Valvular Disease and Heart Failure Flashcards

1
Q

how to calculate cardiac output?

A

stroke volume x heart rate

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2
Q

how to calculate stroke volume?

A

end diastolic volume - end systolic volume

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3
Q

how to calculate ejection fraction?

A

(stroke volume/end diastolic volume) x 100

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4
Q

how to calculate mean arterial blood pressure?

A

1/3(SBP-DBP)+DBP
OR
Cardiac Output (CO) x Systemic Vascular Resistance (SVR) + central venous pressure (CVP)

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5
Q

define infective endocarditis

A

an infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel

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6
Q

common symptoms of infective endocarditis

A
fever 
malaise
sweats
unexplained weight loss
may be new heart murmur
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7
Q

blood tests may show what in a patient with infective endocarditis?

A

anaemia

raised markers of infection

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8
Q

what imaging can be used to help diagnose infective endocarditis?

A

echocardiogram

transoesophageal echo

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9
Q

an echocardiogram can show what in a patient with infective endocarditis?

A

vegetation
abscess
valve perforation and/or new dehiscence of prosthetic valve. often regurgitation of affected valve

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10
Q

why is a transoesophageal echo better than a transthoracic echo in diagnosing infective endocarditis?

A

it has a higher sensitivity

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11
Q

what is Duke’s criteria for infective endocarditis?

A

A set of criteria to determine the likelihood of an individual having infective endocarditis

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12
Q

list major criteria for infective endocarditis

A

Persistently +ve blood culture for typical organisms
ECHO: vegetation, dehiscence of prosthetic valve, abscess
New valvular regurgitation murmur
Coxiella burnetti infection

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13
Q

list minor criteria for infective endocarditis

A

Predisposing heart condition /IV drug use
Fever >38 C
Vasc: emboli to organs, brain
Immuno: glomerulonephritis, Oslers nodes, Roth spots
+ve blood cultures that do not meet specific criteria

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14
Q

what is the most common causative bacteria for endocarditis?

A

streptococcus
enterococci
staph aureus
gram -ve bacteria

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15
Q

what cardiac features of decompensation would you look for?

A

symptoms: SOB, freq coughing, leg/abdo swelling, fatigue

clincal signs: ^JVP, lung crackles, oedema

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16
Q

what other features of decompensation would you look for?

A

Vascular and embolic phenomena
(stroke, Janeway lesions, splinter/ conjunctival haemorrhages)
Immunological phenomena
(Osler’s nodes, Roth spots)

17
Q

define decompensation

A

inability of the heart to maintain inadequate circulation

18
Q

what part of the heart does infective endocarditis affect?

A

Infective endocarditis affects the endocardium, especially the valves of the heart

19
Q

what heart valve is affected most frequently in infective endocarditis?

A

Aortic valve is affected most frequently (aortic > mitral > right-sided valves)

20
Q

why does infective endocarditis affect the valves more commonly?

A

formation of a vegetation at valves > change to their thickness or a failure in their ability open + close appropriates > bacteria to attach to the endocardium if underlying damage is present, occurs more frequently at sites of turbulent blood flow

21
Q

why are IV drug users at an increased risk of infective endocarditis?

A

due to repeated injection – potentially exposing their bloodstream to bacteria on the surface of the skin or use of non-sterile needles

22
Q

increased risk of infective endocarditis is in what populations?

A

IV drug users
complication of routine surgeries
immunosuppressed individuals
individuals w/ congenital heart defects

23
Q

treatment of infective endocarditis

A

meds: antibiotics for infection
surgery: may have to remove/replace damaged valves
prophylaxis for those with congenital heart defects

24
Q

define dilated cardiomyopathy

A

characterised by dilated and thin-walled cardiac chambers with reduced contractility

25
what does a echocardiogram show in a patient with dilated cardiomyopathy?
dilated left ventricle with reduced systolic function (ejection fraction) and typically global hypokinesis
26
what are common causes of dilated cardiomyopathy?
idiopathic, genetic, toxins (alcohol, cardiotoxic chemotherapy), pregnancy (peripartum cardiomyopathy), viral infections (myocarditis), tachycardia-related cardiomyopathy, thyroid disease, muscular dystrophies
27
what genes have been implicated in the diagnosis of dilated cardiomyopathy?
mutations in genes encoding cardiac cytoskeletal proteins e.g. Titin, Lamin, Phospholamban, cardiac myosin binding protein C, myosin heavy chain
28
how is dilated cardiomyopathy managed?
Medical HF therapy - ACEi, beta-blockers, mineralocorticoid receptor antagonists fluid overload > diuretics AF > Anticoagulation Cardiac devices – cardiac resynchronisation therapy and/or implantable cardioverter defibrillator Transplant
29
list complications of dilated cardiomyopathy
ventricular or atrial arrhythmias, sudden death, impaired systolic and/or diastolic dysfunction, heart failure