Valvular Disorders & Heart Failure

Question 1

How is cardiac output calculated?

Answer 1

Stoke volume x heart rate

Question 2

What is cardiac output

Answer 2

The volume of blood the heart pumps in a minute

Question 3

What units is cardiac output usually given in?

Answer 3

L/min

Question 4

How is ejection fraction calculated?

Answer 4

(stroke volume/ end diastolic volume) x100

Question 5

What is ejection fraction?

Answer 5

The volumetric fraction of blood ejected by the ventricle

Question 6

What units is ejection fraction given in?

Answer 6

%

Question 7

What are the 2 ways mean arterial pressure calculated?

Answer 7

Cardiac output x systemic vascular resistance + central venous pressure
OR
diastolic pressure + 1/3( systolic pressure- diastolic pressure)

Question 8

What is mean arterial pressure?

Answer 8

Average arterial pressure through a single cardiac cycle

Question 9

What are the units of mean arterial pressure?

Answer 9

mm Hg

Question 10

What should mean arterial pressure be for there to be adequate perfusion?

Answer 10

65 mm Hg or above

Question 11

What is characteristic of infective endocarditis?

Answer 11

Fever and new heart murmur

Question 12

What is infective endocarditis?

Answer 12

Infection of the endocardium

Question 13

What is the endocardium?

Answer 13

The innermost lining of the heart

Question 14

How many layers are there in the lining of the heart? What are they called?

Answer 14

There are 3, from innermost to outermost they are:
Endocardium
Myocardium
Pericardium

Question 15

What is the most common cause of infective endocarditis?

Answer 15

Streptococcus

Question 16

How will patients with infective endocarditis present?

Answer 16

Fever, malaise, breathlessness, chest pain, fatigue, coughing

Question 17

What set of criteria are used to diagnose infective endocarditis?

Answer 17

Duke’s criteria

Question 18

What part of the heart does infective endocarditis most effect?

Answer 18

The left side and its valves as this is where most blood flows and where theres turbulent blood flow
aortic valve > mitral > right sided valves

Question 19

How are IV drug users a concern in infective endocarditis?

Answer 19

They are at higher risk due to frequent intravenous injections- they may also present irregularly with more right sided problems as when injected, this is the first place bacteria in the blood will flow to

Question 20

What is dilated cardiomyopathy?

Answer 20

Dilation in the heart walls with impaired contractibility

Question 21

What are some complications of dilated cardiomyopathy?

Answer 21

Ventricular/atrial arrhythmias, sudden death, heart failure, impaired systolic and diastolic function

Question 22

What mutated genes are associated with dilated cardiomyopathy?

Answer 22

Mutations in genes encoding cardiac cytoskeletal proteins eg titin, lamin, phospholamban etc

Question 23

How is cardiac myopathy managed?

Answer 23

ACE inhibitors, beta blockers, diuretics for fluid overload, anticoagluation meds for atrial fibrillation, cardiac devices eg internal defribillator

Question 24

What are signs of decompensation in infective endocarditis?

Answer 24

SOB, coughing, fatigue, swelling of legs and abdo

Clinical signs: JVP, lung crackles and oedema

Other complications:
Vascular and embolic phenomena (stroke, Janeway lesions, splinter/ conjunctival haemorrhage)
Immunological phenomena (Osler's nodes, Roth spots)

Question 25

What does echocardiography for dilated cardiomyopathy show?

Answer 25

Dilated left ventricle with reduced systolic function and global hypokinesis

Question 26

What are the commonest causes of dilated cardiomyopathy?

Answer 26

Pregnancy
Idiopathic
Genetic
Toxins (alcohol, chemo)
viral infections (myocarditis)
thyroid disease
muscular dystrophy
tachycardia related cardiomyopathy

Question 27

Who is at increased risk of infective endocarditis?

Answer 27

IV drug users
Complication of routine surgery e.g. dental surgery
Immunosuppressed individuals
Individuals with congenital heart defect

Question 28

How do you diagnose infective endocarditis?

Answer 28

Fever, malaise, swear and unexplained weight loss
Might be new heart murmur
Bloods show anaemia and raised infection markers
Blood cultures might isolate microorganism
Echo might show vegetation, abscess, valve perforation or dehiscence of prosthetic valve
Transesophageal echo has higher sensitivity than transthoracic echo