Structural Heart Disease

Question 1

What are the 4 congenital heart diseases?

Answer 1

Coarctation of aorta
Tetralogy of fallot
Atrial septal defect
Ventricular septal defect

Question 2

How do ventricular and atrial septal defect work?

Answer 2

There is a hole in the septum causing oxygenated blood to become mixed with deoxygenated blood

Question 3

What does coarctation of the aorta do to stroke volume and cardiac output?

Answer 3

Decreases it

Question 4

What are the abnormalities of tetralogy of fallot?

Answer 4

Pulmonary stenosis
RVH- due to PS
Ventricular septal defect
Overriding aorta

Question 5

What precedes aortic stenosis and what causes it?

Answer 5

Aortic sclerosis
Valve narrowing due to leaflet fibrosis and calcium deposits on valve

Question 6

What are the causes of aortic stenosis
What is its pathophysiology with and without rheumatic disease?

Answer 6

Rheumatic fever
Congenital heart disease- bicuspid aortic valve
Calcium build up

Inflammation and damage leads to fibrosis and calcification of valve = stenosis

Autoimmune inflammatory reaction to streptococcus infection targeting valvular endothelium (endocardium) = calcification

Question 7

How does aortic stenosis present?

Answer 7

Dyspnoea- difficulty breathing
Angina
Fatigue
Syncope- fainting
Ejection systolic murmur
Systolic heart failure
High lipoprotein and high LDL

Question 8

Why can aortic stenosis cause systolic heart failure

Answer 8

Systolic heart failure = heart failure specific to left ventricle
The prolonged high pressure in the LV = LVH, this leads to dilation after some time due to the increased pressure and = systolic heart failure

Question 9

What are the management techniques for aortic stenosis?

Answer 9

AVR
Statins
Balloon aortic valvuloplasty

Question 10

What is aortic regurgitation?
What are its causes?

Answer 10

Diastolic leakage from aorta to ventricle
Rheumatic fever
Congenital
Infective endocarditis
Marfans syndrome
Ankylosing spondylitis

Question 11

What is the pathophysiology of aortic regurgitation via infective endocarditis and other?

Answer 11

Bacterial vegetation on valve causing rupture or perforation of leaflets or dilation of valve due to aortic root dilation
Can also be fibrosis and calcification

Question 12

How does aortic regurgitation cause cardiogenic shock?

Answer 12

Can’t blood properly due to the increased blood volume in LV (and LVH) causing heart failure and ultimately cardiogenic shock

Question 13

Why does aortic regurgitation affect ejection fraction?

Answer 13

At first its normal but due to LVH ejection fraction decreases

Question 14

How does aortic regurgitation present?

Answer 14

Cardiogenic shock
Early-diastolic murmur: austin flint murmur
Dyspnoea
Tachycardia

Question 15

What is the management of aortic regurgitation?

Answer 15

AVR
Vasodilatory therapy
Treat rheumatic fever or infective endocarditis

Question 16

What are the causes of mitral stenosis?

Answer 16

Rheumatic fever
SLE
Drugs

Question 17

How can mitral stenosis cause hemoptysis?

Answer 17

Increased LA pressure leads to pulmonary hypertension due to backflow into pulmonary veins = fluid in lungs transudates into interstitium from pressure gradient = bronchial vein ruptures = hemoptysis (coughing up blood)

Question 18

How does mitral stenosis cause decreased cardiac output?

Answer 18

Decreased LV filling causes the decreased cardiac output

Question 19

How does mitral stenosis cause right sided heart failure?

Answer 19

Blood cannot drain into the left side of the heart due to the valve, meaning it stays in the pulmonary system. This means that eventually there is RVH and causes the heart failure (note this happens secondary to left sided heart failure)

Question 20

What are the presentations of mitral stenosis?

Answer 20

Hemoptysis
Mid-diastolic murmur
Dyspnoea
History of rheumatic fever
Right sided heart failure

Question 21

How do you manage mitral stenosis?

Answer 21

AVR
Balloon valvotomy
BB

Question 22

What are the causes of mitral regurgitation?

Answer 22

Rheumatic heart disease
Infective endocarditis
Hypertrophic cardiomyopathy

Question 23

How does mitral regurgitation end in decrease end-systolic volume?
How does it affect preload and afterload?

Answer 23

Less blood flow into LV causing LVH, causing an increase in preload but decreasing afterload as the blood now has two directions it can go in, increasing end diastolic volume and decreasing end systolic volume

Question 24

How does mitral regurgitation present?

Answer 24

Holodiastolic murmur
Dyspnoea
Chest pain
Fatigue
Decreased end systolic volume but increases systolic end volume
Increased preload and decreased afterload

Question 25

How do you manage mitral regurgitation?

Answer 25

MVR ACE inhibitors BB

Question 26

What is dilated cardiomyopathy? What are the causes?

Answer 26

Ventricular chamber enlargement with normal left ventricular wall thickness Heart valve disease Thyroid disease Myocarditis Alcoholism

Question 27

How does dilated cardiomyopathy cause contractile dysfunction?

Answer 27

Increased LV size causes heart to have to pump with more force to get blood out, this becomes overwhelming and eventually fails as muscles aren’t strong enough

Question 28

How does dilated cardiomyopathy present?

Answer 28

Dyspnoea Heart murmur Fatigue Angina Low cardiac output

Question 29

How do you treat dilated cardiomyopathy?

Answer 29

Diet- decrease Na+ and fluid Treat underlying conditions Bb, ace inhib

Question 30

What is hypertrophic cardiomyopathy? Why does it cause sudden death?

Answer 30

Autosomal dominant genetic disease increasing LV wall thickness or septal thickness= obstructed blood flow Often asymptomatic - first symptom is ventricular fibrillation

Question 31

How do you manage hypertrophic cardiomyopathy?

Answer 31

BB Septal myectomy

Question 32

What is restrictive cardiomyopathy?

Answer 32

Atrial enlargement due to impaired ventricle filling due to stiff muscles but ventricle size was normal

Question 33

What are the causes of restrictive cardiomyopathy?

Answer 33

Troponin mutations Haemochromocytosis Amyloids Sarcoidosis

Question 34

What is the pathophysiology of restrictive cardiomyopathy?

Answer 34

Deposition of abnormal substances on heart tisse causing stiffening of the ventricular walls and myocardium

Question 35

How does restrictive cardiomyopathy present?

Answer 35

Hepatomegaly Comfort in sitting Weight loss Reduced cardiac output Increasing jugular venous pressure

Question 36

How is restrictive cardiomyopathy managed?

Answer 36

BB Ace inhib Immunosuppressants- troponin Heart transplant