Cardiovascular diseases Flashcards
What is aortic stenosis?
When valve area is smaller than a quater of normal (3-4 cm^2 is normal),`
What are the 3 types of aortic stenosis?
Supravalvular, sibvalvular and valvular
What is the Etiology of aortic stenosis?
Congenital eg it was not formed correctly in the first place usually preenst in 30-50s, acquired degenerative calcification(comes in 80s), rheumatic heard disease fusions of commisures and cusps, Rare causes like paget disease prostradiation and infections
What is a congenital aortic stenosis?
bicuspid aortic valve where two of the leaflets are fused which happens in 0.5% to 2% of people.
What happens as aortic stenosis progresses?
The LV can initial compensate due to hypertrophy, later it cannot and LV function declines
What is the physiological evidence of aortic stenosis in terms of pressures?
The left ventricular pressure ends up highr than aortic pressure
What are the presentations of aortic senosis?
Dysponea on exertion due to heart failure, angina, syncope on exertion and sudden death
What are the pysical signs of aortic stenosis?
Slow rising carotid pulse(pulsus tardius) and decreased pulse amplitude (pulsus parvus), heart sounds are soft or absent second heart, S4 gallop due to left ventricular hypertrophy, ejection systolic murmur crecendo-decrescendo,
Can onset of symptoms help prognosis?
No as it is very variable
What is the prognosis in Aortic stenosis without treatment?
Depends on symptoms, angins 50% survice 5 years syncope 50% for 5 years with heart failure less than 2 years if no intervention is made
What is best treatment for aortic stenosis?
Valve replacement for severe classified stenosis
What investigations are needed in aortic stenosis?
Echocardiography, left ventricuar size and function, doppler derived gradient and valve area
How are aortic stenosis graded?
Mild moderate and seere based on area and velocity
What is ejection fraction?
the amount of blood ejected from the ventricle during systole usually between 50 and 70%`
What is mitral regurgitaion?
Backflow of blood from the left ventricle to the left atrium during stroke80% have mild which causes no problem
What can cause mitral regurgitation?
Myxomatous degeneration (nodules and thickening of valves), Ischemic MR, rheumatic heart disease and infective endocarditis
Which are the main forms of valvular diseases?
Mitral regurgitation and aortic stenosis
What should you be careful of with valvular dysfunction?
Be careful in dental processes as dont want to get infective endocarditis
What is TAVI?
transcatheter aortic valve implantation
What is the pathopysiology of mitral regurgitation?
The volume overload on the left ventricle as the regurgitation loses blod in the ventricle
What is the presentation of Mitral regurgitation?
A systolic murmur which is pansystolic murmur S3 from overload, intensity of murmer correlates with severity and displaces the apex beat to reflect hypertrophy, exertion dyspnoea, heart failure with increased haemodynamic burden pregnancy infection or atrial fibrilation
How long is compensatory phase for mitral regurgitation?
10-15 years
What investigations hould be done in mitral regurgiation?
ECG CXR ECHO to look at left atrium and ventricle size and function valve structure assessment trasnsoesophageal echocardiagram usefull for these
How can management of mitral regurgitation?
Medication for blood pressure, control of heartrate, anticoagulation in AF and fluid overload
serial echocardigraphy to monitor, IE prophylaxis, replacement with symptoms with severe regurgitation
What is aortic regurgitation?
Leakage of blood from aorta in diastole into the left ventricle due to ineffective coactation of the cusps
What is likely to lead to aortic regurgitation?
Bicuspid aortic valve, rheumatic, infective endocarditis
What is the pathophysiology of Aortic regurgitation?
Pressure and volume overload on the ventiricles, leads to dilaion of ventricle and hypertrophy
What are the physical findings of aortic regurgitaion?
Wide pulse pressure most sensitive, hyperdynamic and displasced apical imulse, hear disastolic blowing murmurs at the left sternal border decrecendo, austin flint murmur apex regurgitant jet impinfes on mitral valve causing it to vibrate also systolc ejection murmur due t increased flow across aortic valve
When does aortic regurgitation become symptomatic?
4th 5th decade often is progressive with palpitation, and dyspnoea
What can you do to investigate aortit regurgiation?
CXR enlarged cardiac silhouette and aortic rout enlargement, echocardiagram to assess the level of regurgitation
What are the management options for aortic rgurgitation?
IE prophylaxis, replacements of the valve when has symptoms or echocardiagram shows dilation of chambers
What is mitral stenosis?
quite rare, rheumatic heart disease problems, obstruction of LV inflow that prevents proper filling of diastole
what causes mitral stenosis?
Rheumatic heart disease almost all and infective endocarditis and mitral annular calcification
What are pathophysiological symptomes of mitral stenosis?
LA dilatiion and pulmonary congestion and breathlessnes, LA hypertropy and atrial fibulation and Rich heart failyre syymptoms and can get blood in lugs
What causes the problem with mitral stenosis?
lung problems embolysism
What are physical signsof mitral stenosis?
peripheral oedema, right heart fialur signs, low pitched diastolic rumble heart best lying on left side, A1 snap heard when ape are still mobile,
What investigations are needed for mitral stenosis
ECG shows LA enlarge and AF CXR LA enlargment and pulmonary congestion sometiems calcification of valve, Echo gold standard for looking at pressure and area of valve aperture
What is management of mitral stenosis?
serial endocardiography, medications dont do much just symptoms, need anticoagulation. replace the valve IE prophylaxis
What is the most indicative risk factor for atherosclerosis?
Age, tobacco smoking, high serum cholesterol, obesity, diabetes, hypertension, family history(strongest predictor)
Where is atherosclerosis usually?
Disrupted flow, peripheral and coronary arteries, focal distribution like bifurcations
What are the constituents of an atherosclerotic plaque?
Lipid, necrotic, connective tissue and a fibrous cap
What is the problem with astherosclerosis?
it can rupture the blood and cause a thrombus to form
What is the underlying cause of atheroclerosis?
Inflamation, low density lipoprotein can pass through the wall and can be oxidation and glycation and endothelial dysfunction
What allows leukocytes to get into the artery wall?
the endothelium becomes sticky and attracts white blood cells and allows entrance of the cells
What is c reactive protein?
cells produce it during inflammation of MI
What happens in intermediat lesions?
They have lots of macrophages with lipids accumulation foam cells and vascular smooth muscle cells, get adhesion of platelets
What forms a fatty streak?
The macrophages entering the walls
What is the final stage of atherosclerosis?
Fibrous plaques or advanced lesions that impede blood flow covered by dense fibrous cap
What causes plaque ruptures?
the fibrous cap is dissolved away, usually caused by infection or other inflamatory events
What is plaque erosion?
second most cause of coronary thrombosis, tend to be early lesions collagen triggers thrombosis rather thantissue factor
What is intervention for coronary artery disease?
PCI percutaneous coronary intervention usually stenting
Which drug is usually used on stents?
Siroluus, anti inflamatory and stops prolieration
What drugs are used in PCI?
Asprin and clopidogrel or ticagrelor and statins
What is angina?
A sympotom of restricted oronary blood flow usually secondary to atherosclerosis mismatch between supply and demand of oxygen
When do you get symptoms of angina?
When diameter has fallen 75%
Why might coronary heart disease not cause problems at rest but will when eerted?
The increased resistance in arteries at rest can be compensated by reduced resistance in microvasculature but cannot be done enuough for exercise
What are other anginas not coronary artery disease reated?
Prinzmetal’s angina form coronary spasm, microvascullar angina syndrome X and crecendo angina and unstable angina
What is presentation for angina?
Chest pain or discomfort, very subjectiv, heavy central tight rdiating to arms jaw and neck, precipitated by exertion and relieved by rest ot GTN spray
What are differential diagnosis for patients with angina presentation?
Pericarditis/myocarditis, pulmonary embolism pleurisy, chest infection, dissection of aorta, GORD. MSK psychological
What are the basic investigations for Angina?
12-lead ecg no abnormalites expected but look for IHD, Echo no markers but could be previous infarcts
What is SCAD?
Sever coronary artery disease
What does Pretest probablilty help wiht?
Deciding to investigate other causes in heart disease
What is the treadmill test for?
Induce ischaemia whille walking up hill look for ST depression, often cant be done by patients,not on guidlines anymore
What are the test statistics for CT angiogram and who is is useful for?
High negative predict good for ruling out, low positive predict good for excluding CAD in younger low risk candidates
What is a stess echo used for?
good all round functional test depends on local expetse looing at the heart for abnormal behaviour
What is SPECT/myoview?
Radiolabelled tracer to kok at perfusio of heart
What is the management of SCAD?
primary prevention reducing the risk of CAD complications, secondary prevention symptomatic and prognostic therapy
what are aspects of primary prevention of CAD?
correct hypertension, lower cholesterol, improv diabetic control, smoking cessation, exercise
What 1st line medications can be used for angina?
beta blockers, Beta 1 specific to reduces heart rate and contractility to reduce the workload of the heart,
nitrates to venodilate
calcium channel antagonists to dilate arteries
What are contraindications for betablockers?
severe bronchospasm in asthma, prinzmetals angina, sever heart block and bradycardia
What are 2nd line antianginals?
Nicorandil dilates vessels and Ivabridine, funy sodium channes to slow pacemaker currents
What clotting mesaures can be used in CAD?
aspririn, Gastric ulceration issues, or clopidogrel ticagrelor
When are revascularisation interventions done?
When medication fails and new risks identified
What is cardiogenic shock?
severe heart failure
What are are natural hypertorphies?
Pregnant females and athletes
Which diseases are related to atherosclerosis?
Ischaemic heart disease, myocardial infarction, stroke, peripheral vascular disease
What are complications of plaque rupture?
Ischemia, occlusion, chronic narrowing, dissection, aneurisms
What is chronic congestive heart failure?
Dilated failing heart reflects ischeamic heart disease
What are the patterns of infarction in the tissue?
Subendocardial, patchy infarction and transmural
What happens to ischaemic heart tissues?
replacement and revascularisation, deposition of fibrosis all take place over time
What is the problem with ischaemic reprofusion?
Reprofusion can sometimes cause dammage due to too much inflammation reprofusion disease
What can happen with complications of ischaemia
arrrhythmias, left ventricua failure extension of infarction and rupture of myocardium
What is an aneurysm?
Diation of part of the mycocardial wall associated with fibrosis and atrohy of myocytes
What is acute rheumatic fever?
Grou A betahaemolytic streptocoocus, upper respiratory tract but usually effect young, the antibodies for the bacteria cause autoimmune attack of the heart
What are clinical features of rheumatic fever complications?
dammage of valve architecture, leading to stenosis or regurgittation, can cause succeptibiligt to infective endocarditis,
What disorders can effect heart valves?
SLE rheumatoid arthritis, ankylosing spondylitis and connective tissue disorders
Who is likely to get infcctive endocarditis?
rheumatic fever, mitral valve prolapse, intravenous drug use, prosthetic valves diabetes and old
What is non-bacterial thrombotic endocarditis?
Sterile thrombotic matter deposition on valves
What is myocarditis?
inflammation of the myocardium usually associated with necrosis and degeneration
What can often cause myocarditis?
Viral infections coxacki adenvirusses, bacteria fungi uaully done by lymphocytic variants
What is cardiomyopathy?
death of the myocardium
What are the types of cardiomyopathy?
DCM dilated, HCM hypertrophic ARVC arrythmogenic right ventricular there are a lot more rare forms, end secondary
What are dilated cardiomyopathies caused by?
Often from chronic ischaemia or myocardial infraction, calcular disease previous myocarditis, often genetic links
What are the causes of hypertrophic cardiomyopathies/
Generally from genetic mutations from certain muscular proteins very large hearts very thick hearts can be very young,
What causes the arrhythmogenic right ventricular cardiomyopathy?
Mainly genetic linked causes thinning and fatty infiltration
What is restrictive cardiomyopathy?
Sarcoid disease can cause granulomatous inflammation inflammation also caused by buildup of amyloid
What characteristics of heart tumours?
Usually seccondary, can be cardia myxoma commenest rimary, left atrium myxoma, can be non specific.
What is sero-sanguinous effusion?
When you get blood in the pericardial fluid
What is haemopericardium?
Direct bleeding from casculature wall to the sac
What is cardiac tampnade?
Compression of the heart leading to acute cardiac failure from bleeding
What happens to the heart in hypertension/
Cardiac enlargement due to hypertrophy and the absence of other cause, also arteriosclerosis and causes hyalin cartilage formed that can calcify
What is vasculitis?
Inflammation of the vessels, can involve arteries veins caillaries can be caused by immune disies or viral infection and causes lumina narrowing