Cardio - Structural Heart Diseases Flashcards

Question

How do you treat DCM if the underlying cause is sarcoidosis or myocarditis?

Answer 1

immunosuppressants

Answer 2

phlebotomy

Answer 3

→ ACE inhibitors → beta blockers → addition of angiotensin II receptor antagonists

Answer 4

if patient develops: → a cough → hypotension → and/or renal dysfunction

Answer 5

→ LVAD | → orthotropic heart transplantation

Answer 6

→ LVAD | → optimise medical management

Answer 7

→ amiodarone → dofetilide → ICD or CRT

Answer 8

anticoagulants e.g. warfarin after assessing previous TE, severe systolic dysfunction or ventricular dilation

Answer 9

→ defined by increase in LV wall thickness | → not solely explained by abnormal loading conditions

Answer 10

→ genetic cardiovascular disease | → familial HCM = autosomal dominant Mendelian-inherited disease in approx 50 % of cases

Answer 11

sudden cardiac death (in preadolescent + adolescent children)

Answer 12

→ most patients are asymptomatic | → first clinical manifestation can range from atrial fibrillation, tachycardia or sudden cardiac death

Answer 13

myocardial hypertrophy that is inappropriate, often asymmetrical, occurs in absence of obvious hypertrophy stimulus

Answer 14

→ can be anywhere | → frequently involves inter ventricular septum

Answer 15

obstruction of flow through the LF outflow tract

Answer 16

→ abnormal diastolic function = impaired ventricular filling + increased filling pressure despite small or normal ventricular cavity → abnormal calcium kinetics → sub-endocardial ischemia → related to profound hypertrophy + myopathic process

Answer 17

``` → double carotid artery impulse → S3 gallop → syncope → presyncope → ejection systolic murmur → congestive heart failure → dizziness → palpitations → angina → sudden cardiac death ```

Answer 18

``` → haemoglobin level → brain natriuretic peptide (BNP) → troponin T levels → ECG → CXR → cardiac MRI ```

Answer 19

anaemia exacerbates chest pain + dyspnea

Answer 20

high levels of both are associated with higher risk of CVD events, heart failure + death

Answer 21

``` → beta blockers → verapamil → disopyramide → mechanical therapy → PM with short AV delay → septal myectomy or ablation ```

Answer 22

→ after side effects from beta blockers | → instead of beta blockers if there is non-cardiac contraindication to beta blockers

Answer 23

if there is: → LVOT gradient → and persistent symptoms → and absence of contraindication to disopyramide

Answer 24

when the patient presents with refractory symptoms

Answer 25

when patient has a existing PM or contraindication to more invasive management

Answer 26

when refractory symptoms present to a PM with AV delay AND there's no contraindication to more invasive management

Answer 27

→ increased stiffness of the myocardium → diastolic dysfunction with restrictive ventricular physiology → atrial enlargement due to impaired ventricular filling during diastole → systole function, volume + wall thickness of ventricles is usually normal

Answer 28

diagnosis is based on establishing the presence of a restrictive ventricular filling pattern

Answer 29

→ idiopathic → familial (related to troponin I or design mutations to do with skeletal myopathy) → various systemic disorders

Answer 30

``` → haemochromatosis → amyloidosis → sarcoidosis → Fabry's disease → carcinoid syndrome → scleroderma → anthracycline toxicity → previous radiation ```

Answer 31

→ Infiltrative CMs are characterized by deposition of abnormal substances (ie, amyloid proteins, non-caseating granulomas, iron) within the heart tissue. → Infiltration causes the ventricular walls to stiffen, leading to diastolic dysfunction → Restrictive physiology predominates in the early stages, causing conduction abnormalities and diastolic heart failure → Adverse remodelling may lead to systolic dysfunction and ventricular arrhythmias in advanced cases.

Answer 32

→ Increased stiffness of the myocardium causes ventricular pressures to rise precipitously with small increases in volume → accentuated filling occurs in early diastole + terminates abruptly at the end of the rapid filling phase → reduced compliance due to increased diastolic stiffness = LV doesn't fill adequately in normal filling pressures → reduced LV filling = reduced cardiac output

Answer 33

→ more comfy in sitting position because fo fluid in abdomen or lungs → frequent ascites + pitting edema of the lower extremities → liver enlarged + full of fluid = very painful → weight loss + cardiac cachexia common → Increased jugular venous pressure → pulse volume is decreased, consistent with decreased stroke volume and cardiac output

Answer 34

→ Easy bruising → periorbital purpura → macroglossia → other systemic findings e.g. carpal tunnel syndrome

Answer 35

``` → CBC (complete blood count) → serology → amyloidosis check → CXR → ECG → catheterisation → MRI / biopsy ```

Answer 36

``` → heart failure medication → anti arrhythmic therapy → immunosuppression - steroids → pacemaker → cardiac transplantation ```

Answer 37

``` should be initiated in patients with reduced LV: → ACE inhibitors → angiotensin receptor II blockers → diuretics → aldosterone inhibitors ```

Answer 38

cardiac output = heart rate x stroke volume

Answer 39

stroke volume = end diastolic volume - end systolic volume

Answer 40

ejection fraction = (stroke volume / end diastolic volume) / 100

Answer 41

MAP = DP + 1/3(SP-DP)

Answer 42

infection of the endocardium or vascular endothelium of the heart → result of bacteria entering the blood stream and forming a "vegetation" in the endocardium → vegetation = bacterial infection surrounded by layer o platelets + fibrin

Answer 43

heart valves

Answer 44

→ STREPTOCOCCI (20 - 40%) → strep viridans → staph aureus → gram negative bacteria

Answer 45

``` → fever → malaise → sweats → unexplained weight loss → cardiac decompensation → anaemia → raised markers of infection ```

Answer 46

→ vegetation → abscess → valve perforation and/or new dehiscence of prosthetic valve → regurgitation of the affected valve

Answer 47

``` → ECG → CXR → blood tests → blood cultures → transoesophageal echocardiogram ```

Answer 48

higher sensitivity in the first one

Answer 49

→ persistently positive blood culture for typical organisms → ECHO : vegetation, dehiscence of prosthetic valve, abscess → new valvular regurgitation murmur → coxiella brunetti infection

Answer 50

→ predisposing heart condition or IV drug use → fever greater than 38 degrees celsius → vascular emboli to organs ro brain → immunological signs e.g. glomerulonephritis, Osler snores, Roth spots → positive blood cultures that don't meet the major criteria

Answer 51

→ 2 major clinical criteria OR → 1 major and 3 minor clinical criteria OR → 5 minor clinical criteria OR → positive gram stain or culture from surgery or autopsy

Answer 52

→ 1 major and more than 1 minor clinical criteria OR | → 3 minor criteria

Answer 53

→ resolution after less than 4 days of antibiotic treatment → no evidence of infection after surgery → definite or possible criteria not met

Answer 54

→ first-line medical management = IV antibiotic course | → surgical management to repair or replace a damaged heart valve or drain away any abscesses

Answer 55

``` → shortness of breath → frequent coughing → swelling of legs + abdomen → fatigue → raised JVP (jugular venous pressure) → lung crackles → oedema ```

Answer 56

→ aortic → then mitral → then right-sided valves

Answer 57

→ easier for vegetation to occur on valves that are already damaged → damage occurs most to the valves of the heart that experience turbulent blood flow

Answer 58

→ IV drug users → those who undergo dental surgeries → immuno-suppressed → congenital heart defects that lead to damaged endocardium

Answer 59

``` mutations in genes encoding cardiac cytoskeletal proteins: → Titin → Lamin → Phospholamban → Cardiac myosin binding protein C → myosin heavy chain ```

Cardio - Structural Heart Diseases Flashcards

(84 cards)