Valvular, Genetic, Inflammation Flashcards
Causes of mitral stenosis
Rheumatic fever (majority of the time) Congenital causes
Definition of mitral stenosis (size)
Orifice less than 2 square cm
What does severity of mitral stenosis depend on?
Trans-valvular pressure gradient
Trans-valvular flow rate
Treatment of mitral stenosis
Diuretics and restrict sodium intake
Anticoagulation
Is acute mitral regurgitation an emergency?
Yes
Most common valvular disease
Aortic stenosis
Treatment of aortic stenosis
Surgical
Aortic regurgitation causes
Aorta disease
Valve leaflet pathology
Is acute aortic regurgitation an emergency?
Yes
Treatment for aortic regurgitation
Surgical
Vasodilator therapy delays requirement of surgery
Conditions patients must meet before CABG
Adequate lung function Adequate mental function Adequate hepatic function Ascending aorta OK Distal coronary targets OK LVEF >20%
What vessels are used for a graft in CABG?
Reversed saphenous vein
Internal mammary vein
Radial arteries
What 2 valves are more commonly operated on in adults?
Aortic and mitral
What are the 3 most common valve conditions requiring surgery?
Senile tricuspid AS
Bicuspid AS
Degenerative MR
What sort of infection is rheumatic fever related to?
Streptococcal infections
What is the hallmark of pathology in rheumatic fever?
Pancarditis
Treatment of rheumatic fever
Aspirin and bed rest
Presentation of chronic rheumatic heart disease
Gradually progressive mitral valve disease and/or aortic valve disease
Commonest cause of endocarditis
Strep viridans
What sort of endocarditis does strep viridans lead to?
Subacute bacterial endocarditis
Second commonest cause of endocarditis
Staph aureus
What sort of endocarditis does staph aureus lead to?
Acute bacterial endocarditis
Is cure more likely with strep viridans or staph aureus endocarditis?
Strep viridans
What’s more likely to be cured with antibiotics alone, native valve or prosthetic valve enocarditis?
NVE. 90% chance vs 50%
How long are antibiotics given after op for endocarditis?
6 weeks IV antibiotics
Audibility of aortic stenosis
Murmur usually easily heard
Audibility of aortic regurgitation
Murmur usually difficult to hear. Louder the murmur, the more severe it is
Audibility of mitral stenosis
Murmur usually difficult to hear. Louder the murmur, the more severe it is
Audibility of mitral regurgitation
Murmur usually easy to hear. If murmur loud then MR usually severe
Type of surgical procedure indicated if severe valve disease
Valve replacement
What size indicates surgery for mitral stenosis?
Orifice <1.5cm squared
Where is blood drained from and returned to in cardiopulmonary bypass?
Drained from RA, returned to ascending aorta
Max time limit for patient to be on cardiopulmonary bypass
12 hours
Type of embolism that can be involved as complication of open thoracic surgery?
Air embolism
Pros and cons of biological and mechanical prosthetic valves
Biological: no warfarin, wears out after 15 years
Mechanical: warfarin required, lasts >40 years
2 commonest signs/symptoms of infective endocarditis
Fever
Heart murmur
What criteria is used for diagnosis of infective endocarditis?
Modified Duke criteria
Indications for surgery in IE
Heart failure with valvular dysfunction or cardiac complications
Uncontrolled infection
Prevention of embolism
Effect of rheumatic heart disease on valve leaflets
Leaflet thickening, calcification, restricted movement
Pretest scoring system for DVT
Wells scoring system
Pretest scoring system for PE
Wells scoring system
Treatment for DVT and PE
Anticoagulation is main treatment
Vascular surgery for massive DVT
Thrombolysis for massive PE
How long is anticoagulation given for provoked vs unprovoked DVT and PE?
Provoked: 3 months
Unprovoked: usually lifelong
3 aims of treatment of DVT and PE
Prevent clot extension
Prevent clot embolisation
Prevent clot recurrence
3 causes of congenital heart disease
Copy number variation
Single nucleotide variation
Teratogens
How does genetics of down syndrome present?
3 ways
95% maternal non-disjunction
3% translocation
2% mosaic
Common cardiac problem associated with down sydrome
Atrio-ventricular septal defects (in 12%)
Percentage of Turner syndrome that are mosaic
30%
Common cardiac problem associated with turner sydrome
Coarctation of aorta
Mnemonic for 22q11 deletion syndrome
Cardiac malformation Abnormal face Thymic hypoplasia Cleft palate Hypoparathyroidism 22q11 deletion
Percentage of 22q11 deletion patients that have schizophrenia
22%
What 2 syndromes does 22q11 deletion encompass?
DiGeorge and Shprintzen
Common cardiac problem associated with Williams sydrome
Aortic stenosis
What deficiency is ventricular septal defects associated with?
Folate deficiency
Is marfans dominant or recessive?
Autosomal dominant
Gene and chromosome mutated in marfans
Fibrillin 1 gene on chromosome 15
Management of marfans
At least annual review
ECHO
When is surgery offered for marfans?
Sinus of valsalva exceeds 5.5cm or 5% growth per year
2 conditions that come under long QT syndrome
Romano-ward syndrome
Jervell Lange-Neilsen
Effects of brugada syndrome
Sudden cardiac death, ventricular fibrillation/tachycardia
Enlarged LV/poor LV function
Management of brugada syndrome
Avoid fever, excess alcohol, overeating
ICD
Affect of hypertrophic cardiomyopathy on heart rhythm
Arrhythmia
Screening system for genetic diseases
NICCS
Most common cause of myocarditis
Viral infection
Most common causes of pericardial disease
Viral or idiopathic
Most important causes of pericardial disease to pick up
Bacterial, post-MI, perforation, neoplasia
