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Y1 Cardiovascular > Conditions - Congenital Heart Disease > Flashcards

Conditions - Congenital Heart Disease Flashcards

1
Q

What is infective endocarditis

A

Infection in endothelial lining of heart valves

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2
Q

Risk factors for IE

A 
Age over 60 
Male
IV drug user
Prosthetic heart valve 
Poor dental hygiene
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3
Q

How does damaged heart valves cause infective endocarditis

A

1) damaged valves causes turbulent flow over the endothelial lining
2) this causes platelet and fibrin deposits
3) Bacteria lodges onto the deposits and colonizes
4) Infected vegetation can dislodge and lodge in capillaries

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4
Q

How does IE cause mitral / aortic regurgitation

A

Infective vegetation can grow over the mitral/aortic valve, preventing it from closing properly

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5
Q

Pathogens causing IE

A

Staphylococcus aureus
Staphylococcus epidermis
Streptococcus viridans
Streptococcus bovis

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6
Q

Which pathogen is the most common cause of IE

A

Staphylococcus aureus

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7
Q

Types of IE

A

Native valve
Prosthetic valve
IV drug abuse

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8
Q

Which pathogen is the most common pathogen for IE due to IV drug abuse

A

Staphylococcus aureus

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9
Q

Co morbid conditions that increase risk of IE

A

Valvular disease
Congenital heart disease
History of IE

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10
Q

Which valve does IE due to drug abuse usually affect

A

tricuspid valve

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11
Q

Which pathogen is the most common cause of IE in patients with prosthetic valves

A

Staphylococcus epidermis

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12
Q

Which pathogen is the most common cause of IE in patients with prosthetic valves after 2 months

A

Staphylococcus aureus

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13
Q

Which IE pathogen is common in patients with IBD / colorectal cancer

A

Streptococus bovis

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14
Q

Which IE pathogen is coagulase negative

A

Staphylococcus epidermis

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15
Q

Symptoms of IE

A 
New murmur 
Fever 
Malaise
Dyspnea
Chest pain

Suspect IE if new murmur + fever

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16
Q

Clinical signs of IE

A

Roth spots = exudative haemorrhagic lesions of retina with pale center
Janeway lesions = macules on sole and palm
Osler nodes = subcutaneous nodules on finger pads and toes
Splinter haemorrhages
Splenic / renal / pulmonary abscesses

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17
Q

What is a sign of aortic root abscess due to IE

A

Prolonged PR interval or complete AV block

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18
Q

Complications of IE

A

Acute valvular insufficiency -> heart failure
Abscesses
Infarction of kidneys / spleen / lung due to embolism

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19
Q

Diagnosis of IE

A

3 sets of blood cultures
ECG
FBC / CRP levels
Echocardiogram

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20
Q

What would echocardiogram for IE show

A

Presence of vegetation / abscess / valvular perforation

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21
Q

Types of echocardiogram

A

Transoesophageal and transthoracic

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22
Q

Which type of echocardiogram is non invasive and used first before the other in IE

A

Transoesophageal echocardiogram

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23
Q

Treatment of IE (prior to results)

A

Long term IV antibiotics
for native valve: amoxicillin + gentamicin
for prosthetic valve: vancomycin + gentamicin + rifampicin

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24
Q

Antibiotics against staphylococcus aureus

A

Flucloxacillin

+ gentamicin and vancomycin if MRSA

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25
Q

Antibiotic against staphylococcus epidermis

A

Vancomycin + gentamicin + rifampicin

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26
Q

Antibiotics against strepococcus viridans

A

Benzylpenicillin + gentamicin

Vancomycin if penicillin allergic

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27
Q

Symptoms of pericarditis

A

Chest pain - worse when lying down, relieved when leaning forward
Dyspnea
Non-productive cough

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28
Q

Causes of pericarditis

A 
TB
Viral infections 
Post MI
Trauma
Hypothyroidism
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29
Q

What is pericarditis post MI called

A

Dressler’s syndrome

30
Q

What antibiotics are given to patients with native valve IE prior to their blood culture results

A

Amoxicillin + gentamicin

Vancomycin if penicillin allergic

31
Q

What antibiotics are given to patients with prosthetic valve prior to their blood culture result

A

Vancomycin + gentamicin + rifampicin

32
Q

Example of enterococcus that causes IE

A

Enterococcus faecalis

33
Q

Antibiotics against enterococcus

A

Amoxicillin + gentamicin

Vancomycin if penicillin allergic

34
Q

What are the cyanotic congenital heart diseases

A

Transposition of the great arteries
Tetralogy of Fallot
Tricuspid atresia

35
Q

What are the non-cyanotic congenital heart diseases

A

Coarctation of the aorta
Atrial septal defect
Ventricular septal defect
patent ductus arteriosus

36
Q

What are the 4 features of tetralogy of fallot

A

Right ventricle hypertrophy
pulmonary stenosis
ventricular septal defect
misplaced aorta

37
Q

When does tetralogy of fallot usually occur

A

1-2 months after birth but may not be picked up till 6 months old

38
Q

Signs of ToF

A

Cyanosis
Ejection systolic murmur
boot shaped heart on CXR
Right ventricular hypertrophy on ECG

39
Q

What causes ejection systolic murmur in ToF

A

pulmonary stenosis

40
Q

What is the most common congenital heart disease at birth

A

Transposition of the great arteries

41
Q

What is transposition of great arterise

A

Aorta and pulmonary artery switched around

42
Q

What increases the risk of the child having transposition of great arteries

A

Diabetic mother

43
Q

Signs of transposition of great arteries

A

Cyanosis
Egg on side on CXR
loud S2

44
Q

What is pulmonary atresia

A

The pulmonary valve does not form properly so blood cannot be pumped into the lungs

45
Q

When does pulmonary atresia occur

A

First 8 weeks during foetal development

46
Q

What are the changes that occur after birth

A 
Ductus arteriosus closes
Foramen ovale closes
Umbilical vessels closes
First few breaths forces fluid out of lungs
Haemoglobin F changed to haemoglobin A
47
Q

What may occur as a result of change in haemoglobin and why

A

Physiological jaundice may occur due to F having lower oxygen affinity

48
Q

What is the foramen ovale and what is its function

A

A small opening between the left and right atrium

allows blood to pass from the right atrium to the left atrium, bypassing the nonfunctional fetal lungs while the fetus obtains its oxygen from the placenta

49
Q

What is the ductus arteriosus

A

Blood vessel that connects between the aorta and pulmonary artery

50
Q

What is ductus venosus

A

The blood vessel that allows oxygenated blood from the umbilical vein to bypass the liver during foetal development

51
Q

Describe the flow of blood during foetal development

A

1) oxygenated blood from the placenta travels through the umbilical vein to the liver
2) most blood bypasses the liver by ductus venosus and enters the IVC
3) blood goes to the right atrium. Most blood enters the left atrium through foramen ovale
4) Blood is pumped into the ascending aorta, supplying the coronary arteries and upper body
5) Deoxygenated blood enters the right atrium via SVC and mixes with the oxygenated blood from placenta
6) the mixed blood is pumped out of the right ventricle to pulmonary artery
7) most goes through the ductus arteriosus to the aorta and travels down the descending aorta to supply the lower body and umbilical arteries

52
Q

Why does foramen ovale close after birthD

A

Due to increase in pressure in left atrium, forcing the flaps closed

53
Q

What causes ductus arteriosus to close

A

O2 , O2 is a vasoconstrictor for ductus arteriosus

54
Q

What is needed to keep the ductus arteriosus open

A

Prostalglandin E2

During foetal development, placenta produces PGE2

55
Q

What is atrial septal defect

A

There is a hole in atrial septum, causing blood from left atrium to flow into right atrium, causing a mixture of oxygenated and deoxygenated blood.

56
Q

What can occur as a result of atrial septal defect

A

Increase in blood flow to lungs increases pressure in lungs, can cause pulmonary oedema and congestion
Right ventricular hypertrophy

57
Q

What is hypoplastic heart

A

When the left side of the heart, including aorta and mitral valves are underdeveloped

58
Q

Treatment of hypoplastic heart

A

Keep foramen ovale open by using PGE2

59
Q

Inheritance pattern of hypertrophic cardiomyopathy

A

Autosomal dominant

60
Q

What causes hypertrophic cardiomyopathy

A

Abnormal gene coding for beta myosin or myosin binding protein C which are needed for muscle contraction

61
Q

What is the most common cause of sudden death in young people

A

Hypertrophic cardiomyopathy

62
Q

Complications of hypertrophic cardiomyopathy

A

Arrhythmias (esp. AF and VT)
Diastolic HF
Mitral regurgitation
Left ventricular outflow obstruction

63
Q

Symptoms of hypertrophic cardiomyopathy

A 
Often asymptomatic
Exertional dyspnea
Exertional syncope 
Sudden death
Signs of HF
64
Q

What causes exertional syncope in hypertrophic cardiomyopathy

A

Due to subaortic interventricular septum hypertrophy leading to functional aortic stenosis

65
Q

Which chambers are dilated in dilated cardiomyopathy

A

All 4 but mainly left ventricle (dilated more than the right)

66
Q

Signs of hypertrophic cardiomyopathy

A 
ECG showing AF / VT / VT 
Echo showing diastolic HF 
Ejection systolic murmur 
Mitral regurgitation
Double apex beat 
Systolic anterior motion of mitral valve
67
Q

What is considered as hypertrophic cardiomyopathy in cardiac MRI

A

Increase in thickness >15mm

68
Q

What is a common cause of systolic HF

A

Dilated cardiomyopathy

69
Q

Inheritance pattern of dilated cardiomyopathy

A

mostly autosomal dominant

70
Q

What are the causes of dilated cardiomyopathy

A 
Idiopathic 
Inherited
Infections 
Drug therapy 
Alcohol / cocaine
71
Q

What infections may lead to dilated cardiomyopathy

A

Coxsackie B, HIV

72
Q

Signs of dilated cardiomyopathy

A 
S3 
Systolic murmur 
Signs of HF 
arrhythmias 
Balloon shaped heart

Y1 Cardiovascular (6 decks)

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