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Flashcards in Cardiovascular Diseases 2 Deck (68):
1

Sterling's hypothesis

Volume of blood in the chamber is proportional to the contractile ability of the heart in that chamber

2

What are the 3 causes of increased cardiac workload?

Hypertension, vascular disease or MI

3

What is the result of increased cardiac work?

Increased stress- hypertrophy and/or dilation= cardiac dysfunction

4

What are the 2 main results of left sided heart failure that have effects throughout the body?

Low output
congestion

5

What are the effects of low output resulting from left ventricular heart failure

pre-renal azotremia (high N2content in blood)
Salt and fluid retention (renin-angiotensin activation/natriuretic peptides)
Brain-irritability, decreased attention, stupor>coma

6

What are the effects of congestion, resulting from left ventricular heart failure?

Lungs: pulmonary congestion and oedema. Dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, blood tinged sputum, cyanosis, increased pulmonary wedge pressure

7

Causes of right sided heart failure

Left heart failure
Cor pulmonale

8

What is cor pulmonale

Abnormal enlargement of the right side of the heart as a result of lung disease or pulmonary blood vessels

9

Organs/areas affected by right sided heart failure

Liver and spleen
Kidneys
Pleura/pericardium
Peripheral tissues

10

What are the effects of right sided heart failure on the liver and spleen

Passive congestion (nutmeg liver)
Congestive splenomegaly
Ascites

11

Autopsy findings of cardiac heart failure

Cardiomegaly, chamber dilation, hypertrophy of myocardial fibres, BOXCAR nuclei, pulmonary/peripheral oedema

12

What are BOXCAR nuclei?

Rectangular nuclei in hypertrophied myocytes

13

Valvular opening problems

Stenosis

14

Valvular closing problems

Regurgitation

15

70% valvular heard disease is made up of what 2?

Aortic and mitral stenosis

16

Causes of aortic stenosis

Senile-old age
Rheumatic heart disease

17

Causes of mitral stenosis

Rheumatic heart disease

18

Rheumatic heart disease follows what infection?

Group A strep

19

Effects of rheumatic heart disease

Pancarditis:
1)endocarditis
2)myocarditis
3)pericarditis

20

5 acute effects of rheumatic heart disease

Inflammation
Asschoff bodies (nodules)
Anitschlcow cells (enlarged macrophages with asschoff bodies)
Pancarditis
Vegetations on chordae tendinae

21

3 chronic effects of rheumatic heart disease

Thickened valves
Commisural fusion
Thick, short chordae tendinae

22

Left ventricular hypertrophy but no hypertension

Aortic stenosis

23

Calcification of the mitral skeleton, usually a result of regurgitation, but sometimes stenosis

Mitral annular calcification

24

What mitral valve dysfunction is more common in females than males?

Mitral annular calcification
mitral valve prolapse

25

Causes of aortic regurgitation

Syphilis
Rheumatoid arthritis
Marfan's syndrome

26

Causes of mitral regurgitation

Mitral valve prolapse
Infectious
Fen Phen (anti obesity drug)
Weakness in papillary muscles/chordae tendinae
Mitral annular calcification

27

Myxomatous (pathological weakening of tissue) degeneration of mitral valve. Associated with connective tissue disorders.

Mitral valve prolapse

28

Usually asymptomatic, mid-systolic 'click', holocystolic murmur if regurg present, occasional chest pain, dyspnoea

Mitral valve prolapse

29

Effects of mitral valve prolapse

97% no significant effects
3% infective endocarditis, mitral insufficiency, arrythmias, sudden death

30

Which congential heart defects may not be evident until adult life?

Coarctation of the aorta and ASD

31

Give 4 examples of left to right shunt congenital heart defects

VSD
ASD
Atrioventricular septal defect
Patent ductus arteriosus

32

Give 5 examples of right to left shunt congenital heart defects

Tetralogy of fallot
Transposition of the great arteries
Truncus arteriosus
Total anomalous pulmonary venous connection
Tricuspid atresia

33

Gene abnormalities account for what percentage of CHDs

10%

34

What are the most common genetic defects in CHDs

Trisomies
Mutations of single genes (TBX5 for ASD and VSD, NKX2.5 for ASD)
Deletion of a specific region of chromosome 22

35

Environmental factors that can result in CHDs

Rubella
Teratogens

36

Name of the gap between the 2 parts of the septum primum

ostium secundum

37

The septum secundum grows on what side of the septum primum?

The right side

38

The border of the septum secundum delineates what foramen?

Foramen ovale

39

In the development of the aorticopulmonary system of the heart, the septum divides what 2 parts of the heart into the spiralling aorta and pulmonary artery?

bulbis cordis
Truncus

40

Does ASDs include a patent forament ovale?

NO

41

What are the 3 types of ASD

Secundum (90%)
Primum (5%)
Sinus venosus (5%)

42

A type of ASD with a defective fossa ovalis

Secundum

43

A type of ASD next to AV valves,mitral cleft

Primum

44

A type of ASD next to superior vena cava, anomalous pulmonary veins draining to SVC on right atrium

Sinus venosus

45

Most common CHD

VSD

46

The majority of VSD involve with septum

Membranous

47

If msucular septum is involved in VSD, what appearance can this have?

Multiple holes 'swiss cheese septum'

48

What can be the result of a large VSD?

Pulomary hypertension

49

What happens both initially and evenutally in patent ductus arteriosus?

Left to right shunt, possibly reverse shunt as pulmonary hypertension approaches systemic pressure.

50

What treatment is given to keep the ductus arteriosus patent?

Protstaglandin E1

51

Continuous harsh, machinery like murmur

Patent ductus arteriosus

52

More than 30% patients with Atrioventricular septal defect have what other medical condition?

Down's syndrome

53

Atrioventricular septal defect is associated with what part of the heart?

AV valves

54

What does complete atrioventricular septal defect mean?

All 4 chambers freely communicate

55

What are the 4 characteristics of tetralogy of fallot?

Pulomonary stenosis
VSD
Right ventricular hypertrophy
Over-riding aorta

56

Abnormal formation of truncal and aortopulmonary septa, needs a shunt for survival

Transposition of great artereis

57

What classes as an unstable shunt for transposition of the great arteries- the majority

PDA or PFO

58

What calsses as stable shunt for transposition of the great arteries- the minority

VSD

59

In transposition of the great arteries, which ventricular wall is thicker?

Right

60

What is the prognosis for transposition of the great arteries?

Fatal in the first few months unless surgically repaired

61

Developmental failure of separation of truncus arteriosus and associated VSD

Truncus arteriosus

62

Produces systemic cyanosis as well as increased pulmonary blood flow

Truncus arteriosus

63

pulmonary veins do not go into LA but into L.innominate vein or coronary sinus

total anomalous pulmonary venous connection

64

Name 3 obstrucive congenital heard diseases

Coarctation of the aorta
Pulmonary stenosis/atresia
Aortic stenosis/atresia

65

Is coarcation of the aorta more common in males or females?

Males, common in turner's syndrome

66

Which is more serious, preductal coarctation of the aorta or post ductal ?

Preductal

67

What other heart defects present with pulmonary stenosis/atresia

If 100% stenosed, hypoplastic RV with ASD.

68

What are the 3 types of aortic stenosis/atresia

Valvular
Subvalvular
Supra-valvular