Alterations to the heart wall Flashcards
(77 cards)
1
Q
What is the pericardium?
A
The outer layer of the heart that contains approximately 10–30 mL of pericardial fluid for lubrication and protection.
2
Q
What is pericarditis?
A
Inflammation of the pericardium, usually a response to other cardiac conditions.
3
Q
What is the most common symptom of pericarditis?
A
Pain.
4
Q
What are some causes of pericardial disease?
A
- Infection (bacterial, viral, fungal, parasitic) * Trauma or surgery * Neoplasm * Metabolic disorders * Immunological disorders * Vascular disorders
5
Q
What percentage of acute pericarditis cases are caused by viruses or are idiopathic?
A
Approximately 90%.
6
Q
List some causes of acute pericarditis.
A
- Acute myocardial infarction * Uraemia * Cardiac surgery * Some medications * Autoimmune disorders
7
Q
What are the symptoms of acute pericarditis?
A
- Sudden onset of severe retrosternal chest pain * Pain worsens with respiratory movements and lying down * Pain may radiate to the back * Dysphagia * Restlessness * Irritability * Anxiety * Weakness * Malaise
8
Q
What physical examination findings are associated with acute pericarditis?
A
- Low-grade fever * Sinus tachycardia * Friction rub at the cardiac apex and left sternal border
9
Q
What does the friction rub in pericarditis indicate?
A
Roughened pericardial membranes rubbing against each other.
10
Q
What is cardiac tamponade?
A
A condition where pericardial fluid impairs heart function.
11
Q
What are the ECG changes associated with acute pericarditis?
A
- PR segment depression * Diffuse ST segment elevation without Q waves
12
Q
What is the treatment for uncomplicated acute pericarditis?
A
Relief of symptoms with anti-inflammatory agents and exploration of the underlying cause.
13
Q
What is pericardial effusion?
A
The accumulation of fluid in the pericardial cavity.
14
Q
What types of fluid can be present in pericardial effusion?
A
- Transudate (low protein) * Exudate (high protein)
15
Q
What can cause transudate fluid in pericardial effusion?
A
- Left heart failure * Overhydration * Hypoproteinaemia
16
Q
What can cause exudate fluid in pericardial effusion?
A
- Acute pericarditis * Heart surgery * Chemotherapeutic agents * Infection * Autoimmune disorders
17
Q
What is the danger of rapid fluid accumulation in pericardial effusion?
A
It can lead to cardiac compression and potentially cardiac tamponade.
18
Q
What is pulsus paradoxus?
A
A substantial decrease in systolic blood pressure during inspiration.
19
Q
What are some clinical manifestations of pericardial effusion?
A
- Distant or muffled heart sounds * Poorly palpable apical pulse * Dyspnoea on exertion * Dull chest pain
20
Q
What imaging technique can detect a small pericardial effusion?
A
Doppler echocardiogram.
21
Q
What is the treatment for pericardial effusion or tamponade?
A
Pericardiocentesis and treatment of the underlying condition.
22
Q
What are cardiomyopathies?
A
A diverse group of diseases primarily affecting the myocardium.
23
Q
What are the three types of cardiomyopathy?
A
- Dilated * Hypertrophic * Restrictive
24
Q
What are common causes of cardiomyopathies?
A
- Myocardial and neurohumoral responses to ischaemic events and hypertension * Infectious disease * Exposure to toxins * Nutritional deficiencies
25
What are the major symptoms of dilated cardiomyopathy?
* Fatigue * Weakness * Palpitations
26
What physiological changes occur in hypertrophic cardiomyopathy?
* Compliance decreased, particularly in left ventricle * Contractility increased or vigorous
27
What is valvular dysfunction?
Damage to heart valves that can be congenital or acquired.
28
What is valvular stenosis?
A condition where the valve orifice is constricted and narrowed.
29
What are common causes of acquired valvular dysfunction?
* Degeneration * Inflammation due to rheumatic heart disease * Infectious alterations
30
What is valvular regurgitation?
Failure of valve leaflets to shut completely, allowing backflow of blood.
31
What are the common cardiovascular outcomes of untreated aortic stenosis?
Left ventricular hypertrophy followed by left heart failure.
32
What are clinical manifestations of aortic stenosis?
* Decreased stroke volume * Reduced systolic blood pressure * Narrowed pulse pressure
33
What are the three common causes of aortic stenosis?
* Congenital bicuspid valve abnormalities * Inflammatory damage from rheumatic heart disease * Degeneration with ageing
34
What leads to myocardial hypertrophy in valvular dysfunction?
Increased workload due to chamber dilation and compensatory mechanisms.
35
What is aortic stenosis?
Narrowing of the orifice of the aortic semilunar valve, causing diminished blood flow from the left ventricle into the aorta.
36
What are the clinical manifestations of aortic stenosis?
Decreased stroke volume, reduced systolic blood pressure, narrowed pulse pressure, slow heart rate, faint pulses, left ventricular hypertrophy.
37
What can untreated aortic stenosis lead to?
Arrhythmias, myocardial infarction, heart failure.
38
What is the primary management for aortic stenosis?
Valve repair or replacement with a prosthetic valve, followed by long-term anticoagulation and prophylaxis for endocarditis.
39
What is mitral stenosis?
Impairment of blood flow from the left atrium to the left ventricle, commonly caused by rheumatic heart disease.
40
What are the consequences of mitral stenosis?
Increased left atrial pressure, atrial dilation, hypertrophy, risk of atrial arrhythmias, pulmonary hypertension, pulmonary edema, right ventricular failure.
41
What is a common cause of aortic regurgitation?
Inability of the aortic valve leaflets to close properly during diastole due to abnormalities.
42
What are the hemodynamic effects of aortic regurgitation?
Volume overload in the left ventricle, compensatory dilation, increased stroke volume, ventricular hypertrophy.
43
What clinical manifestations are associated with aortic regurgitation?
Widened pulse pressure, heart failure symptoms, arrhythmias, endocarditis.
44
What is mitral regurgitation?
Backflow of blood from the left ventricle into the left atrium during ventricular systole.
45
What are the potential complications of mitral regurgitation?
Left ventricular dilation, hypertrophy, atrial fibrillation, pulmonary hypertension, right ventricular failure.
46
What is tricuspid regurgitation commonly associated with?
Failure and dilation of the right ventricle secondary to pulmonary hypertension.
47
What is rheumatic heart disease?
Cardiac damage resulting from untreated rheumatic fever, characterized by scarring and deformity of cardiac structures.
48
What is the primary cause of rheumatic fever?
Delayed immune response to infection by group A β-haemolytic streptococcus.
49
What are the major clinical manifestations of acute rheumatic fever?
Carditis, acute migratory polyarthritis, chorea, erythema marginatum.
50
What laboratory analyses are used to diagnose acute rheumatic fever?
Throat culture for streptococci, elevated white blood cell count, erythrocyte sedimentation rate, and C-reactive protein.
51
What is the treatment for acute rheumatic fever?
Eradication of streptococcal infection with penicillin or erythromycin, NSAIDs for inflammation, possible cardiac glycosides, corticosteroids, diuretics.
52
What is infective endocarditis?
Infection and inflammation of the endocardium, especially the cardiac valves.
53
What are common causes of infective endocarditis?
Streptococcus viridans, Staphylococcus aureus, Staphylococcus epidermidis, group A β-haemolytic streptococci.
54
What are the critical elements required for the pathogenesis of infective endocarditis?
1. Endocardial damage, 2. Microorganism adherence, 3. Microorganism proliferation.
55
How do microorganisms enter the bloodstream leading to infective endocarditis?
Through intravenous drug use, trauma, minor procedures, or from respiratory or skin infections.
56
What role do vegetations play in infective endocarditis?
They form on the endocardial surface and protect bacterial colonies from host defenses.
57
What forms when the endocardial surface is colonised?
Infected vegetations form
## Footnote
These vegetations can lead to serious complications in infective endocarditis.
58
How do bacteria contribute to the formation of vegetations in infective endocarditis?
Bacteria may accelerate fibrin formation by activating the coagulation cascade.
59
What protects bacterial colonies in infective endocarditis from host defenses?
Bacterial colonies are embedded in protective fibrin clots.
60
Where do lesions typically occur in infective endocarditis?
On the endocardial surfaces of heart valves and surrounding structures.
61
Which pathogen is most commonly found following dental or oral procedures in infective endocarditis?
S. viridans (α-haemolytic streptococci).
62
What is the most common bacterium found following genitourinary and gastrointestinal tract surgery in infective endocarditis?
Enterococcus faecalis (enterococci).
63
What factors increase the risk of bacterial endocarditis in children?
Children with congenital heart disease are at higher risk.
64
What are the classic findings of infective endocarditis?
Fever and petechial lesions of the skin, conjunctiva, and oral mucosa.
65
What are the typical clinical manifestations of infective endocarditis?
Weight loss, back pain, night sweats, and heart failure.
66
What criteria are used for the diagnosis of infective endocarditis?
Persistent bacteraemia, new heart murmurs, vascular complications, and appropriate echocardiographic findings.
67
How long is antimicrobial therapy generally given for infective endocarditis?
4–6 weeks.
68
What role does surgery play in the treatment of infective endocarditis?
Surgery to remove infected tissue can improve outcomes, especially in severe cases.
69
What are the three critical elements required for the pathogenesis of infective endocarditis?
1. Endocardial surface injury
2. Bacterial colonization
3. A source of bacteria.
70
True or False: Infective endocarditis involves only the heart.
False
71
What is the primary function of the sinoatrial (SA) node in cardiac conduction?
To generate normal heart rhythm.
72
What is the term used to refer to a disturbance of heart rhythm?
Dysrhythmia.
73
What is the difference between dysrhythmia and arrhythmia?
Dysrhythmia refers to a disturbance of rhythm; arrhythmia means without rhythm.
74
What can cause arrhythmias?
1. Abnormal rate of impulse generation
2. Abnormal conduction of impulses.
75
Fill in the blank: Arrhythmias can range from occasional 'missed' beats to _______.
serious disturbances that impair heart pumping ability.
76
What may result from severe arrhythmias?
Heart failure and death.
77
What is one non-pathological cause of arrhythmias?
Missed beat in an athlete due to bradycardia.
