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Flashcards in Heart Disease Deck (72):
1

Name valves (inc no of leaflets) and chambers as blood passes through heart from the body

- right atrium
- tricuspid valve (3) - atrioventricular valve
- right ventricle
- pulmonary value (3) - semilumar valve
- left atrium
- mitral valve (2) - atrioventricular valve
- left ventricle
- aortic valve (3) - semilunar valve

2

What is systole and diastole?

Systole = contraction
Diastole = relaxation (think dying!)

3

What is cardiac vascular disease?

Functional deficiency of cardiac valves
- stenosis
- incompetence / regurgitation

4

What is narrowing of valves called?

valvular stenosis

5

What is regurgitation at valves called?

valvular incompetence

6

What are main 2 consequences of valvular heart disease?

1. Reduced cardiac output
- exercise intolerance
- left ventricular hypertrophy
- left ventricular failure (sudden death)

2. Infection
- infective endocarditis

7

What are the 4 types of left heart valvular disease?

- mitral stenosis
- mitral regurgitation
- aortic stenosis
- aortic regurgitation

8

What is mitral stenosis?

Narrowing of mitral valve
- calcification
- thickens the leaflets

9

What are causes of mitral stenosis?

- degenerative mitral stenosis (age related calcification)
- rheumatic heart disease

10

What are complications of mitral stenosis?

- heart failure (oedema- feet/ankles, breathlessness, cyanosis)
- atrial fibrilation
- infective endocarditis

11

What are the causes of mitral regurgitation?

- rheumatic heart disease
- bacterial endocarditis
- mitral valve prolapse (floppy valves)
- Ischemic heart disease (ruptures papillary muscles / chordae tendinae)
- cardiomyopathy

12

What % of people in UK have mitral valve prolapse?

2-5%

13

What is cardiomyopathy?

enlargement of heart

14

What type of heart disease can you hear a heart murmur?

mitral regurgitation

15

What are complications of mitral valve regurgitation?

- heart failure
- atrial fibrillation
- infective endocarditis

16

What is aortic stenosis?

- narrowing of aortic valve
- reduced flow to body

17

What can cause aortic stenosis?

- rheumatic heart disease
- degenerative calcification (age related)
- congenital bicuspid valve

18

What is congenital bicuspid valve?

When 2 leaflets of aortic valve fuse together in development, so value only has 2 leaflets / cusps

19

What is senile aortic stenosis?

age related calcification of aortic value = stenosis

20

What is aortic regurgitation?

valve dysfunction / incompetence

21

What causes aortic regurgitation?

- rheumatic heart disease
- infective endocarditis
- hypertension
- Marfan's syndrome
- Syphilis (bacterial infection)
- Ehler's Danlos syndrome
- Osteogenesis imperfecta
- idiopathic aortic root dilation

22

Where is the aortic root?

Just above the aortic valve

23

What is syphilis?

bacterial infection

24

What is Ehler's Danlos syndrome?

- connective tissue disorder
- inherited disorder
- issues with collagen

25

What gene is linked to Marfan's syndrome?

Fibrillin 1 gene

26

What are symptoms of Marfan's disease?

Head
- elongated forehead (dolichocephaly)
- cerebral bosselation (pertuberances)
Eye
- subluxation/misalignment of lens
- retinal detachment
- cateract
Heart:
- aortic aneurysm
- floppy valves (prolapse)
Vertebrae deformity
Long fingers (arachnodactyly)

27

What is dolichocephaly?

Longer than normal head
- eg elongated forehead in Marfan's syndrome

28

What is arachnodactyly?

Long, spider-like fingers
- eg Marfan's disease

29

What do people with Marfan's syndrome usually look like?

Tall
Elongated forehead
Wide skull
Long fingers
eg man from Ghost

30

What valvular diseases are associated with the right side of the heart?

- tricuspid stenosis
- tricuspid regurgitation

31

What causes tricuspid stenosis?

- rheumatic heart disease (most common)

32

What causes tricuspid regurgitation?

Right ventricular enlargement, due to:
- rheumatic heart disease
- infective endocarditis (due to IV drug abuse)
- congenital heart disease

33

Which valve is effected by IV drug abuse?

Tricuspid valve
- bacteria in blood get to tricuspid valve first on right side of heart

34

Where in the world is rheumatic heart disease most common and why?

Developing world
- poor nutrition
- overcrowding

35

What causes rheumatic heart disease?

acute rheumatic fever
- caused by streptococcus A infection (sore throat)

36

How long after what type of infection, does acute rheumatic fever present?

2-3 weeks after streptococcus A infection

37

What age group is most prone to acute rheumatic fever?

5-15yrs

38

What environ conditions are associated with acute rheumatic fever?

- poor nutrition
- overcrowding
Therefore more common in dev world

39

What are complications of rheumatic heart disease?

Antibody cross reactivity with:
1. Heart: pericarditis, myocarditis, endocarditis
2. Joints: polyarthritis
3. Skin: subcutaneous nodules, skin rashes (erythema marginatum)
4. Arteries: arteritis!

40

What is erythema marginatum?

Skin rash
- associated with antibody cross reactivity of rheumatic heart disease

41

What is arteritis?

inflam of arteries

42

What are cardiac complications of rheumatic heart disease?

Deposition of cross-reactive antibody:
1. Vegetations - eg attach to mitral valves
2. Aschoff body - histological hallmark of RHD (swollen eosinophilic collagen, macrophages, lymphocytes)
3. Fibrinous pericarditis

43

What is antibody cross reactivity?

When antibodies bind to other proteins, other than protein intended for.
eg rheumatic heart disease

44

What is an Aschoff body?

- swollen eosinophilic collagen
- macrophages
- lymphocytes
- above visible in a group in histology
- hallmark of rheumatic heart disease
- seen in postmortum

45

What is hallmark sign of rheumatic heart disease?

Aschoff body
- swollen eosinophilic collagen
- macrophages
- lymphocytes
- above visible in a group in histology

46

What % recover from acute rheumatic fever?

>95%

47

What % get chronic scarring on mitral valve cusps and over what period does this happen?

10-15% over 40-50 years

48

What happens in chronic scarring of mitral valve cusps in rheumatic heart disease?

- scarring thickens cusps and fuses them = stenosis

49

What is infective endocarditis?

Acute or chronic infection of endocardium
- valve is usually involved
- could also be inner lining of heart chambers (mural endocardium)
Could be due to congenital defect
- ductus arteriousus
- coarctation of aorta

50

Is infective endocarditis acute or chronic?

both
- also subacute

51

What is mural endocardium?

inner lining of heart chambers - atrium/ventricles
- can be infected in infective endocarditis

52

What bacteria causes acute infective endocarditis?

Staphlococcus aureus
- v viralent organism

53

What is value condition usually like prior to acute infective endocarditis?

normal heart valves

54

What is valve condition like prior to subacute infective endocarditis?

diseased / abnormal valve(s)

55

What bacteria causes subacute infective endocarditis?

Streptococcus viridans
- low viralence

56

Where are 4 main sources of organisms to cause infective endocarditis and give examples?

Oropharynx: streptococci (eg Strep viridans)
Respiratory Tract
GI and Urinary Tracts: Streptococcus faecalis (in large intestine - can cause UTI)
- enter blood via cystoscopy or prostatectomy
Skin: Staphlococci (eg S. aureus), yeasts (Candida)
- enter blood via cannulae or venepuncture

57

What is a cystoscopy?

to see inside the bladder

58

What bacteria causes 60% cases of infective endocarditis?

Streptococcus viridans

59

What % of infective endocarditis cases is caused by streptococcus viridans?

60%

60

What are lesions of infective endocarditis called and what do they consist of?

Vegetations (grape like nodular masses)
- platelets, fibrin, (thrombotic debris), bacteria
- they adhere to cusps

61

What side of the heart is infective endocarditis most common and what valves are affected?
What % of cases occurs on that side?

The left side (95% cases)
- mitral valve (bicuspid)
- aortic valve
Mainly in previously damaged valves

62

How does infective endocarditis vegetations form?

NB endothelial lining is usually resistant to infection
- endocardial damage
- platelets and fibin adhere
- then infected by bacteria in blood (from focal infection or transient bacteraemia from skin/mucosa)

63

What happens if infective endocarditis vegetations detach / break off?

embolism

64

What are the potential complications of infective endocarditis?

Mycotic aneurysm
Stroke
Roth spots in eye
Embolism
Skin - Rod nodules, Purpura
Splinter haemorphages
Kidney - infection, hemuria
Spleen - infection, abcess

65

What is mycotic aneurysm?

Aneurysm from bacterial infection in any artery wall in body

66

What are roth spots?

Dark spots with a white/pale centre due to retinal hemorrhage, visible in the back of the eye

67

What is purpura?

a rash of purple spots on the skin caused by internal bleeding from small blood vessels.
- a potential complication of infective endocarditis
- aka Janeway lesion
- ie micro-abcesses from vegetation embolism

68

What are splinter haemorphages?

brown marks on finger nails
- sign of infective endocarditis

69

What heart medications have oral impacts?

Anticoagulants
- bleeding risk

Calcium channel blockers
- gingival hyperplasia

Beta blockers, ACE inhibitors, diuretics
- oral drug reactions
- eg lichenoid reactions

70

When might gingival hyperplasia be caused by drugs?

if no plaque present

71

What % get bacteraemia following:
- tooth brushing
- RSD (perio)
- XLA?

Tooth brushing - 0-26%
RSD - 36-88%
XLA - 51-85%

72

What is aortic coarctation?

aorta narrows in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts