Structural Heart Disease

Question 1

Cardiac cycle

Answer 1

Image

Question 2

Tetralogy of Fallot

Answer 2

Widen aorta (overriding)
Narrow pulmonary artery (stenosis)
Thicken right ventricular wall (hypertrophy)
Septal defect

Question 3

AS causes

Answer 3

Rheumatic heart disease
Calcium build up

Hypertension
LDL

Question 4

AS pathophysiology

Answer 4

Endocardial injury
Inflammation
Calcification
Stenosis

Question 5

AS investigations

Answer 5

Transthoracic echocardiogram

Chest X ray

Question 6

AS management

Answer 6

Aortic valve replacement - symptomatic, asymptomatic with LVEF <50%

Question 7

AR causes

Answer 7

Rheumatic heart disease
Infective endocarditis
Valve stenosis

Question 8

AR pathophysiology

Answer 8

Trauma, IE lead to rupture of leaflets in acute cases

RF, bicuspid aortic valves lead to retraction of leaflets and leak

Question 9

AR investigation

Answer 9

Transthoracic echocardiogram

Chest X-ray

Question 10

AR management

Answer 10

Acute - ionotropes/vasodilator and valve replacement

Chronic asymptomatic- if LV function is normal can be managed with drugs

Chronic symptomatic- valve replacement with vasodilator

Prevention is key

Question 11

MS causes

Answer 11

Rheumatic fever
SLE
Rheumatoid arthritis
Carcinoid syndrome

Question 12

MS pathophysiology

Answer 12

Insult to endometrium lead to formation of infiltrates, calcification and stenosis

Question 13

MS investigation

Answer 13

ECG

Transthoracic echocardiogram

Question 14

MS management

Answer 14

Asymptomatic- none
Severe asymptomatic- none, adjuvant balloon valvotomy
Severe symptomatic- diuretic, balloon valvotomy, valve replacement and adjunct b blocker

Question 15

MR cause

Answer 15

Acute

• mitral valve prolapse
• rheumatic heart disease
• infective endocarditis

Chronic

• rheumatic heart disease
• SLE
• scleroderma

Question 16

MR pathophysiology

Answer 16

Disruption of any part of mitral leaflets, perforations etc lead to abnormal reversal of blood

Question 17

MR investigation

Answer 17

ECG

Transthoracic echocardiogram

Question 18

MR management

Answer 18

Acute - emergency surgery with diuretics and intraaortic balloon counterpulsation

Chronic asymptomatic - ACE inhibitor, beta blocker. If LVEF less than 60% - surgery

Chronic symptomatic - surgery plus medicine. If LVEF less than 30% then intraaortic balloon counterpulsation

Question 19

Dilated cardiomyopathy cause

Answer 19

Heart valve disease
Myocarditis
Autoimmune
Primary with and without family history

Question 20

DC pathophysiology

Answer 20

Ventricular chamber enlargement with normal LV wall function

Question 21

DC presentation

Answer 21

Dyspnoea
Systolic murmur
Angina
Low CO

Question 22

DC investigations

Answer 22

Genetic testing
Viral serology
ECG

Question 23

DC management

Answer 23

Diet
Underlying immune - immunosuppressant 
ACEi and BB
Heart transplant or medicine 
Warfarin

Question 24

HC cause

Answer 24

Genetic
Increase in LV wall thickness not explained by abnormal loading conditions
Sudden death

Question 25

HC pathophysiology

Answer 25

Myocardial hypertrophy that is inappropriate and occurs in absence of hypertrophy stimulus

Question 26

HC presentation

Answer 26

``` Sudden cardiac death Dizziness Palpitations Ejection systolic murmur Angina ```

Question 27

HC investigations

Answer 27

Haemoglobin level - anemia exacerbate chest pain and dyspnoea BNP elevated

Question 28

HC management

Answer 28

Beta blocker or verapamil Add disopyramide Pacemaker or septal myectony or ablation

Question 29

RC cause

Answer 29

Diastolic dysfunction with restrictive ventricular physiology, but systolic function, volume and wall thickness normal

Question 30

RC pathophysiology

Answer 30

Increases stiffness cause ventricular pressure to rise with small increase in volume Reduced compliance and cannot fill adequately Reduced CO

Question 31

RC presentation

Answer 31

Comfortable in sitting position because of fluid in abdo Enlarged liver Weight loss and cardiac cachexia Easy bruising Increases jugular venous pressure Pulse volume decreased and decreased stroke volume and CO

Question 32

RC investigations

Answer 32

CBC Serology ECG

Question 33

RC management

Answer 33

``` ACEi or angiotensin receptor ii blocker, diuretics and aldosterone inhibitor in patients with reduced LV for heart failure Antiarrhythmic therapy Immunosuppression - steroids Pacemaker Transplant ```

Question 34

Ejection systolic murmur

Answer 34

AS

Question 35

Early diastolic murmur

Answer 35

AR

Question 36

Mid diastolic murmur

Answer 36

MS

Question 37

Pansystolic murmur

Answer 37

MR

Question 38

AS feature

Answer 38

Pressure overload LV hypertrophy If stenosis worsen - systolic function decline leading to systolic heart failure

Question 39

AR feature

Answer 39

LV end diastolic pressure increase Increase in LV venous pressure Pulmonary congestion and cardiogenic shock in acute AR

Question 40

MS feature

Answer 40

Increase in left atrial pressure pulmonary hypertension Right heart failure

Question 41

MR feature

Answer 41

Chronic MR - enlargement of LA - LV enlargement and eccentric hypertrophy - compensation fails - heart failure

Question 42

DC feature

Answer 42

LV enlargement Increased heart rate and PVR Eventually compensation fail and heart fail

Question 43

HC feature

Answer 43

Abnormal diastolic Impair ventricular filling Increase filling pressure despite normal or small ventricular cavity

Question 44

RC feature

Answer 44

Reduced compliance LV cannot fill adequately Reduced LV volume - reduced CO

Question 45

Atrial fibrillation

Answer 45

MR

Question 46

Neck vein distention

Answer 46

MS

Question 47

Austin Flint murmur

Answer 47

Acute AR

Question 48

Traube sign

Answer 48

Chronic AR

Question 49

Wate hammer sign

Answer 49

Chronic AR