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Year 3 Cardio > Structural Heart Disease > Flashcards

Structural Heart Disease Flashcards

(65 cards)

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1
Q

What are the determinants of cardiac stroke volume?

A

Starling’ law of the heart (length tension)
Cardiac contractility
Arterial pressure

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2
Q

What influences cardiac contractility?

A

Synthetic tone

Adrenaline

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3
Q

What is the after load?

A

Pressure in the aorta

Force per unit area

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4
Q

What is preload?

A

Stretching of the myocardium allowing the generation of forces

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5
Q

What is the law of laplace?

A

P + 2T/r

Internal pressures generated inside a chamber is directly proportional to the tensions and inversely proportional to the radius

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6
Q

Why is the law of laplace significant?

A

when radius of chamber increases pathologically

cannot generate sufficient pressure

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7
Q

What are the two classification of valvular disease?

A

Stenotics

Dilatations

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8
Q

What are two types of stenotic lesions?

A

Aortic stenosis

Mitral stenosis

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9
Q

What is aortic stenosis?

A

Aortic valve becomes significantly narrowed

Severe is area is less than 1cm^2 or if speed of blod flow is greater that 4 metres per second

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10
Q

What are the causes of aortic stenosis?

A

Bicuspid aortic valve - Congenital
Degeneration of valve with age
Rheumatic heart disease
Infective endocarditis

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11
Q

What cause mitral stenosis?

A 
Rheumatic fever
Congential
Rheumatic arthritis
Lupus
Whipples disease
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12
Q

What is the consequence of atrial stenosis?

A

Increased afterload on the left ventricle

Causing hypertrophy

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13
Q

What is the consequence of mitral stenosis?

A

Increased pressure on the left atrium
Increased strain causes atrial dilation
Can lead to AF

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14
Q

What causes mitral regurgitation?

A

Rheumatic fever
Infective endocarditis
Mitral valve prolapse

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15
Q

What is the consequence of mitral regurgitation?

A

Less cardiac output to aorta

Reduces organ perfusion

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16
Q

What causes aortic regurgitation?

A

Biscuspid aortic valve
Marfaans syndrome
hypertension
Infective endocarditis

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17
Q

What is the consequence of aortic regurgitation?

A

Volume overload to left ventricle as blood goes back

Causing dilation

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18
Q

How does mitral regurgitation present?

A

systolic murmur

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19
Q

How does aortic regurgitation present?

A

Diastolic murmur
Collapsing pulse
Quincke’s sign - nailbed pulsations
Previous history of rheumatic heart disease

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20
Q

What are the three main types of cardiomyopathy?

A

Hypertrophic
Dilated
Arrhythmogenic right ventricular

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21
Q

What is the result of dilated cardiomyopathy?

A

Chambers have poor contractility

Wall tension does not generate effective pressure

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22
Q

What can cause dilated cardiomyopathy?

A

Stress
Post partum
Sarcodosis
Auto-immune diseases

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23
Q

What happens in arrhthmogenic right ventricular cardiomyopathy?

A

Abnormal right ventricle radius
Cannot work effectively
Also effect left ventricle

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24
Q

How can you treat valve issues?

A

Valve replacement
But must treat consequences of valve failure
Aim to replace before the issues has other effects

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25
What are the pros and cons of different valves?
Metallic valves - last longer - need to be on warfarin Prosthetic valves -only last 20 years
26
Why is the mitral valve not often replaced?
The arrangement of the mitral valve means that it isn't easy to replace increased emphasis on repairing the existing valves This avoids open heart surgery
27
Define cardiogenic shock?
Impairment of cardiac systolic function resulting in reduced cardiac output causing end organ dysfunction
28
Why is it so important to identify cardiogenic shocl?
Treatment is very different to other types of shock e.g. dangerous to give more fluid reduces contractile function
29
How is cardiogenic shock treated?
Early coronary angiography PCI or CABG Reassess haemodynamic/tissue perfusion
30
What are inotropes?
Dopamine etc. Increase height and leftward shift of pressure volume loop Augmentation of end diastollic volume Increase in stroke work and stroke volume
31
What are the features of mechanical support devices?
Used when ionotropic drugs are ineffective IABP Impella recover TandemHeart VA-ECMO
32
How do you calculate cardiac output?
Stroke volume x Heart rate
33
How do you calculate ejection fraction?
Stroke volume divided by end diastolic volume
34
How do you calculate mean arterial pressure?
MAP = Cardiac output x total peripheral resistance MAP = Diastolic blood pressure + 1/3 Pulse Pressure MAP = 2/3 Diastolic blood pressure + 1/3 Systolic Pressure
35
What is infective endocarditis?
Infection of the endocardium (inner lining of the heart). Commonly caused by bacteria.
36
How do you diagnose infective endocarditis?
Dukes criteria Major: positive blood cultures/evidence of endocardium involvement Minor: predisposing factors, pyrexia, vascular phenomena, immunological phenomena, microbioloigcal evidence Blood cultures ECG ECHO
37
Which part of the heart does infective endocarditis affect particularly?
Heart valves, normally left aortic and mitral valves | Right sided occurs less frequently
38
What are some features of decompensation?
Weight loss Difficulty breathing Leg/Foot Swelling Fatigue
39
What is the relationship between IV drug use and infective endocarditis?
Higher risk of developing infective endocarditis | Can be right sided involving the tricuspid
40
Define dilated cardiomyopathy
Ventricle stretches and thins and is no longer able to pump efficiently
41
What are some common causes of dilated cardiomyopathy?
``` Heart disease Poorly controlled hypertension Infection Genetics Peri-partum Toxins Auto-immune Endocrine Metabolic disorders ```
42
What genes have been implicated in the diagnosis of dilated cardiomyopathy?
MYH7, MYBPC3, TNNT2, and TNNI3 | ACBC1, ACBC 2
43
How is dilated cardiomyopathy managed?
Medication: Diuretics, ACEi, Beta Blockers, Anti-coagulants, ARBs Pacemaker Surgical: LVAD (Left ventricular assist device) or Heart transplant
44
What are the implications of dilated cardiomyopathy?
High risk of heart failure Needs to manage BP Lower alcohol intake, stop smoking, minimise salt and caffeine
45
What are causes of aortic regurgitation?
Valvular: Rheumatic fever Infective endocarditis Connective tissue disease e.g. RA/SLE Bicuspid aortic valve ``` Other: Aortic dissection Spondylarthropathies HTN Syphilis Marfan's, Ehler-Danlos syndrome ```
46
What are RFs for infective endocarditis?
``` Previous episode Prosthetic valves Congenital heart defects IVDUs Recent piercings ```
47
What is the most common causative organism for infective endocarditis?
Staph A
48
What is management of infective endocarditis dependent on?
Causative organism | Prosthetic or Native valve
49
What initial blind therapy is used in infective endocarditis?
``` Native = Amoxicillin Prosthetic = Vancomycin + Rifampicin + low dose gentamicin ```
50
What is the management for IE caused by staphylococi?
Flucloxacilin | Vanc + Rif if pen allergy
51
What are indication for surgery in infective endocarditis?
severe valvular incompetence aortic abscess (often indicated by a lengthening PR interval) resistant infections cardiac failure refractory to standard medical treatment recurrent emboli after antibiotic therapy
52
What are signs of tricuspid regurgitation?
``` pan-systolic murmur louder on inspiration prominent/giant V waves in JVP pulsatile hepatomegaly left parasternal heave ```
53
What are causes of tricuspid regurgitation?
``` right ventricular infarction pulmonary hypertension e.g. COPD rheumatic heart disease infective endocarditis (especially intravenous drug carcinoid syndrome ```
54
What causes mitral regurgitation?
CAD or MI Mitral valve prolapse Infective endocarditis Rheumatic fever
55
What are symptoms of mitral regurgitation?
Asymptomatic Can present as fatigue, SOB and oedema Caused by LV failure, arrhythmias or pulmonary HTN
56
What are signs of mitral regurgitation?
Pan-systolic murmur Apex and radiates to axilla S1 might be quiet because of incomplete valve closure
57
What is the management for mitral regurgitation?
``` Increase CO: Nitrates Diuretics Inotropes Intra-aortic ballon pump ``` If HF: ACEi, Betablockers and spironolactone If acute, severe: surgical repair or replacement
58
What is mitral stenosis?
obstruction of blood flow across the mitral valve from the left atrium to the left ventricle increases in pressure within the left atrium, pulmonary vasculature and right side of the heart
59
What are the presenting features of mitral stenosis?
``` mid-late diastolic murmur (best heard in expiration) loud S1, opening snap low volume pulse malar flush atrial fibrillation L. atrial enlargement maybe on CXR ```
60
What is the management for mitral stenosis?
With AF: Warfarin Asypmto: Monitor with reg echos Sympto: Percutaneous mitral balloon valvotomy Mitral valve surgery (repair or replacement)
61
What are the presenting features of aortic stenosis?
chest pain dyspnoea syncope / presyncope (e.g. exertional dizziness) murmur an ejection systolic murmur, radiates to carotids
62
What are some causes of aortic stenosis?
degenerative calcification (most common cause in older patients > 65 years) bicuspid aortic valve (most common cause in younger patients < 65 years) post-rheumatic disease HOCM
63
What is the management of aortic stenosis?
Asympto: Observe Sympto: Valve replacement
64
What are the surgical options?
Aortic Valve replacement 1. Surgical - young low/medium risk operative pts - CVD may coexist - angiogram done prior to surgery 2. Transcatheter - high operative risk Balloon valvuloplasty - in children - or adults not fit for replacement
65
What is a cause of sudden death in HOCM?
Young, fit athletes | Ventricular arrhythmia

Year 3 Cardio (12 decks)

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