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Cardio Conditions > Structural Heart Disease > Flashcards

Structural Heart Disease Flashcards

1
Q

Atrial septal defect?

A

Hole between atria - causes mixing of oxygenated and deoxygenated blood

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2
Q

Ventricular septal defect?

A

Hole between ventricles - causes mixing of oxygenated and deoxygenated blood

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3
Q

Coarctation of aorta

A

Narrow aorta

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4
Q

Patent Foramen ovale

A

Hole between LA and RA doesn’t close

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5
Q

Patent ductus arteriosus

A

Opening between aorta and pulmonary artery

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6
Q

Tetralogy of Fallot

A

Overriding aorta
Ventricular septal defect
Narrowing of pulmonary artery (stenosis)
Right ventricular hypertrophy

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7
Q

Aortic stenosis definition?

A

Stiffening of aortic valve causing narrowing of aortic orifice

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8
Q

Aortic stenosis risk factors and causes?

A

Risk factors:
-hypertension
-LDL
-smoking, old age
-CRP
-congenital bicuspid
-CKD
-radiotherapy

Causes - rheumatic heart disease, congenital, calcium build up, group A streptococcus

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9
Q

Aortic stenosis pathophysiology?

A
  1. Abnormal blood flow through valve -> damage -> inflammatory process -> leaflet fibrosis and calcium deposition
  2. This causes disrupted blood flow through valve so LV has to contract harder - increased pressure in LV
  3. Continuous forceful contraction of LV -> concentric LV myocardial hypertrophy
  4. Hypertrophic LV becomes stiff -> decreased cardiac output and diastolic dysfunction
  5. Pressure overload in LV backs up to LA = dilated LA -> increased pressure in lungs -> pulmonary congestion
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10
Q

Aortic stenosis clinical findings

A

Ejection systolic murmur
Syncope on exertion
Angina on exertion
Diffuse crackles on auscultation and dyspnoea

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11
Q

Aortic stenosis history and presentation

A

Exertional dyspnoea and fatigue
Chest pain, angina
Syncope
Heart failure
Ejection systolic murmur

H/O rheumatic fever, high lipoprotein, high LDL, CKD, age >65

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12
Q

Aortic stenosis investigations

A

Doppler echocardiogram (for pressure gradient)

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13
Q

Aortic stenosis management?

A

Transcatheter valve replacement
Surgical valve prosthesis

mechanical vs biprosthetic valve

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14
Q

Aortic sclerosis?

A

Stiffening of aortic valve without flow limitation
Precedes aortic stenosis
Ejection systolic murmur - if it radiates to the carotids, is aortic stenosis

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15
Q

Aortic regurgitation definition

A

Incompetence of aortic valve causing leakage of blood from aorta -> LV during diastole

Systolic heart failure

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16
Q

Aortic regurgitation causes

A

Congenital + acquired - rheumatic heart disease, infective endocarditis, aortic stenosis, congenital (bicuspid or heart defects)

Aortic root dilation - Marfan’s Syndrome, ankylosing spondylitis, connective tissue disorders, trauma

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17
Q

Aortic regurgitation pathophysiology

A
  1. Aortic root dilation/inflammation of endocardium (-> abnormal valve leaflets) -> poor valve leaflet closing when aortic pressure is higher than LV (diastole)
  2. Back flow from aorta -> LV causes volume and pressure overload in LV -> increased LV preload and afterload
    (3)Acute dilatation = increased stroke volume due to Frank Starling Law
  3. Chronically dilates LV -> eccentric hypertrophy to accommodate increased volume
  4. Excessive stretching weakens myocardium -> systolic heart failure -> back pressure in LV -> atria -> lung vasculature -> pulmonary congestion
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18
Q

Aortic regurgitation clinical findings

A

Diastolic murmur, S3
Angina on exertion, fatigue
Diffuse crackles on auscultation, dyspnoea, Orthopnea
Bounding/Corrigan/Collapsing pulse

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19
Q

Aortic regurgitation history and presentation?

A

Acute - Cardiogenic shock, tachycardia, cyanosis, pulmonary oedema, diastolic murmur

Chronic - wide pulse pressure, Corrigan (water hammer pulse)

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20
Q

Aortic regurgitation investigations

A

Echocardiography

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21
Q

Aortic regurgitation management

A

Aortic valve replacement
Acute - medical emergency
Chronic severe - vasodilators therapy

treat rheumatic fever and infective endocarditis

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22
Q

Mitral stenosis definition

A

Stiffening of mitral valve causing insufficient blood flow into LV during diastole

eventually leads to pulmonary hypertension and right sided heart failure

23
Q

Mitral stenosis causes

A

RHEUMATIC FEVER
Carcinoid syndrome, mitral annular calcification due to aging, congenital deformity
Shipley disease, SLE, Rheumatoid arthritis, amyloidosis

24
Q

Mitral stenosis pathophysiology

A
  1. Recurrent inflammation of mitral valve -> fibrous deposition and calcification on mitral valve leaflets and chordate tendineae -> thickening and shortening
  2. Thick and stiff leaflets and fusion of junction -> decreased area of orifice -> obstructed blood flow through MV -> impaired emptying of LA
    3. increased LA pressure -> back pressure + congestion
  3. Impaired filling of LV -> decreased stroke volume and cardiac output -> congestive heart failure
  4. Increased RV pressure -> RV hypertrophy -> right sided heart failure
25
Q

Mitral stenosis clinical findings

A

Mid diastolic murmur, opening snap
Afibrillation (stretch of conduction fibres due to LA enlargement)
Dysphasia and hoarseness
Right sided heart failure
Dyspnoea

26
Q

Mitral stenosis history and presentation

A

H/O rheumatic fever
Dyspnoea
Mid diastolic murmur
Opening snap (S1 in early stages)
Dysphasia
Atrial afibrillation
Haemoptasis

27
Q

Mitral stenosis investigations

A

ECG
CXR
Transthoracic echocardiography

28
Q

Mitral stenosis management

A

Progressive asymptomatic - no therapy
Severe asymptomatic - no therapy generally, adjuvant ballon valvotomy
Severe symptomatic - diuretic, balloon valvotomy, valve replacement and repair adjunct b-blockers

29
Q

Mitral regurgitation definition

A

Abnormal reversal of blood flow from LV -> LA due to incompetence of mitral valve
most common valvular heart disease

30
Q

Mitral regurgitation causes

A

Acute - mitral valve prolapse, rheumatic heart disease, infective endocarditis, valvular surgery, prosthetic mitral valve dysfunction
Chronic - rheumatic, SLE, scleroderma, drug related

31
Q

Mitral regurgitation pathophysiology

A
  1. Backflow from LV -> LA due to impaired closure of mitral valve -> increased volume and pressure in LA -> increased volume pushed back into LV in next diastole
  2. LV dilation - remodelling -> decreased systolic function
  3. Decreased stroke volume and cardiac output (congestive heart failure) + back pressure from LA -> congestion
32
Q

Mitral regurgitation clinical findings

A

Holosystolic (pansystolic) murmur radiating to axilla
S3
Increased serum creatinine (decreased organ perfusion - parenchyma damage)
Cardiogenic shock
Peripheral oedema
Decreased O2 saturation, tachypnea
Wheeze, crackles, frothy sputum

33
Q

Mitral regurgitation history and presentation

A

Dyspnoea
Holosystolic murmur
S3
Signs of congestive heart failure

34
Q

Mitral regurgitation investigations

A

Transthoracic echocardiography
ECG
CXR
Cardiac MRI/CT

35
Q

Mitral regurgitation management

A

Acute severe - repairing or supporting valve structures. Prosthetic ring.
Chronic severe asymptomatic - watchful waiting or surgery
Chronic severe symptomatic - surgery plus medical treatment

36
Q

Dilated cardiomyopathy definition

A

Progressive, irreversible dilation of LV (usually more than 4cm)
Causes systolic dysfunction

37
Q

Dilated cardiomyopathy causes

A

Familial (25%)
Secondary - MI/valve disease, thyroid disease, myocarditis, alcoholism, autoimmune, drugs, inherited

38
Q

Dilated cardiomyopathy pathophysiology

A
  1. (Inflammatory damage/toxic damage) -> death of myocytes -> eccentric fibrosis -> enlargement of LV chamber without increase in mass
  2. Initially Frank starling law, but gradually becomes distension and systolic dysfunction
  3. Decreased cardiac output and increased EDV/EDP -> volume overload - congestive heart failure
39
Q

Dilated cardiomyopathy history and presentation

A

Dyspnoea, cold clammy extremities
Displaced apex beat
Fatigue
Angina
Pulmonary congestion (diffuse crackles)
Peripheral oedema
Sudden cardiac death

40
Q

Dilated cardiomyopathy investigations

A

ECG, CXR, cardiac MRI/CT
EEG, genetic testing, cardiac catheterisation, viral serology

41
Q

Dilated cardiomyopathy management?

A

Lifestyle - sodium and fluid restriction
Medical - ACEi, B-blockers, diuretics, ARBs, amiodarone, anticoagulants
Surgical - LV assisted device

42
Q

Hypertrophic cardiomyopathy definition

A

Genetic (autosomal dominant in 50% of cases)
Increased LV thickness, not explained by abnormal loading conditions

43
Q

Hypertrophic cardiomyopathy causes

A

Genetic, storage diseases, neuromuscular, mitochondrial disorders, malformation syndromes

44
Q

Hypertrophic cardiomyopathy pathophysiology

A
  1. Thickening and disarray of LV myocardium (often involves septum = obstruction of flow through LV outflow tract)
  2. Disorganised myocytes disrupt signal conduction -> ventricular arrhythmias -> sudden cardiac death
45
Q

Hypertrophic cardiomyopathy history and presentation

A

Systolic murmur
S4
Syncope
Fatigue
Angina
Pulmonary congestion and oedema (diffuse crackles)
Sudden cardiac death

46
Q

Hypertrophic cardiomyopathy investigations

A

Echocardiography
CXR
Cardiac MRI

47
Q

Hypertrophic cardiomyopathy management

A

Symptomatic - beta blockers (if contraindicated verapamil)
Refractory and drugs fail - mechanical therapy with pacemaker or surgery (septal myectomy or ablation)

48
Q

Restrictive cardiomyopathy definition

A

Restrictive ventricular filling pattern

49
Q

Restrictive cardiomyopathy causes?

A

Idiopathic
Familial (related to troponin I or desmin mutations)
Haemochromatosis, AMYLOIDOSIS, sarcoidosis, Fabry’s disease, carcinoid syndrome, scleroderma

50
Q

Restrictive cardiomyopathy pathophysiology

A
  1. Deposition of abnormal substances -> infiltration -> endomyocardial fibrosis -> ventricular wall stiffening -> diastolic dysfunction
  2. Atrial enlargement due to impaired diastolic filling. Restrictive physiology -> conduction abnormalities + diastolic heart failure
  3. Adverse remodelling -> systolic dysfunction + ventricular arrhythmias
  4. Reduced ventricular filling -> decreased cardiac output
51
Q

Restrictive cardiomyopathy history and presentation

A

Ascites and pitting oedema
Hepatomegaly
S4
Increased jugular venous pressure
Easy bruising, weight loss

52
Q

Restrictive cardiomyopathy investigations

A

CBC, serology, amyloidosis check
CXR, ECG, EEG. catheterisation, MRI/biopsy

53
Q

Restrictive cardiomyopathy management

A

Heart failure medication
Antiarrhythmic therapy
Immunosuppressants
Pacemaker
Cardiac transplantation

Cardio Conditions (1 decks)

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