CVS Revision Quiz

Aortic valve stenosis (AS) due to inflammation is uncommon. It is typically seen in young patients and caused by bicuspid aortic valve (BAV), which is a congenital condition resulting in a valve with two cusps instead of the typical three. BAV is often associated with heart failure, and patients may need surgery to replace the valve.

Aortic valve stenosis (AS) in elderly patients is usually caused by degeneration and calcification of the valve. This process occurs due to aging and the hardening of arteries (atherosclerosis).

Aortic valve stenosis (AS) is a condition where the aortic valve doesn't fully open, resulting in a narrowing of the opening. This narrowing creates a higher pressure gradient between the left ventricle (LV) and the aorta, hindering blood flow.

Aortic valve stenosis (AS) is often diagnosed by recognizing a specific set of criteria. These include a mean transvalvular pressure gradient (MTPG) of greater than 40 mmHg, a peak flow velocity across the valve exceeding 4 m/s, and a valve surface area of less than 1 cm2. Remember, normal valve surface area is 3-4 cm2.

The heart compensates for the reduced blood flow caused by aortic stenosis (AS) by thickening the left ventricle muscle (concentric LV hypertrophy). This adaptation helps maintain cardiac output, but it can also lead to heart failure if the AS worsens.

Aortic stenosis (AS) can lead to various symptoms such as angina, syncope (fainting), and dyspnea (shortness of breath). The prognosis for untreated AS worsens over time, with a 5-year survival rate after the onset of angina, a 3-year survival rate after syncope, and a 2-year survival rate after dyspnea.

A heart murmur in which the sound is low-pitched, heard best in the mid-diastolic phase, and is characterized by an opening snap (OS) that follows a short gap after the second heart sound (S2).

A condition characterized by increased pulmonary artery pressure, leading to right ventricular hypertrophy and eventual right ventricular failure. Often associated with a mitral stenosis murmur.

An abnormal heart rhythm characterized by irregular and rapid atrial contractions. In mitral stenosis, the murmur may be absent or less prominent due to the lack of a regular atrial contraction.

A process where the mitral valve leaflets become thickened and less pliable, leading to a narrowed valve opening and obstruction of blood flow from the left atrium to the left ventricle.

A condition where the mitral valve does not close properly, leading to a backflow of blood from the left ventricle into the left atrium during systole. It can be caused by various factors like rheumatic heart disease or mitral valve prolapse.

A condition where the mitral valve leaflets bulge into the left atrium during ventricular systole. Can lead to mitral regurgitation (MR). Often found in developed countries.

A heart condition caused by damage to the heart valves, often following a strep throat infection. Can lead to both mitral stenosis (MS) and mitral regurgitation (MR).

A condition where the mitral valve leaflets experience a rupture, often due to inferior wall myocardial infarction (heart attack) involving the right coronary artery. This leads to a sudden and severe mitral regurgitation (MR).

Diastolic heart failure is characterized by difficulty breathing due to increased pressure within the left ventricle and pulmonary circulation.

Right-sided heart failure presents with symptoms like swelling in the legs and abdomen, a swollen neck vein, and an enlarged liver.

A truncated variant titin mutation is the most common genetic cause for dilated cardiomyopathy, affecting the protein responsible for heart muscle elasticity.

Peripartum cardiomyopathy, often affecting women during or after pregnancy, usually has a good prognosis.

Anti-angiogenic factors, like SFLT1, can contribute to peripartum cardiomyopathy by disrupting blood vessel formation.

Alcohol-induced cardiomyopathy has a good prognosis if the patient abstains from alcohol consumption; however, drug-induced cardiomyopathy caused by anthracyclines has a poorer prognosis.

Dilated cardiomyopathy can be triggered by autoimmune disorders like sarcoidosis.

Dilated cardiomyopathy can result from an acute post-inflammatory process, often linked to viral infections like HHV6 or Chagas disease.

LVOT obstruction is frequently asymptomatic, but when it does occur, it can manifest as angina (chest pain), syncope (fainting), and dyspnea (shortness of breath). These symptoms are due to the increased workload on the heart caused by the narrowed LV outflow tract.

LVOT obstruction is increased by factors that augment preload or afterload. For example, an increased preload can be caused by a high volume of blood returning to the heart, such as after a large meal.

LVOT obstruction is increased by factors that increase afterload. These can include factors like hypertension (high blood pressure) or conditions that make the heart muscle contract more forcefully.

LVOT obstruction is decreased by factors that reduce preload and afterload. These can include maneuvers such as standing up (shifting blood to the lower extremities) or the Valsalva maneuver (holding breath and bearing down).

The Brockenbrough sign is a physical exam finding in HCM that indicates LVOT obstruction. This sign is characterized by a decrease in pulse volume after a premature ventricular contraction (PVC).

The Brockenbrough sign is a physical exam finding in HCM. This sign is characterized by a decrease in pulse volume after a premature ventricular contraction (PVC). This occurs because the ventricle is left with a reduced amount of blood to pump following a PVC.

Beta-blockers, such as propranolol, are the first-line treatment for LVOT obstruction because they slow the heart rate, reduce contractility, and increase preload. This reduces LVOT obstruction.

When beta-blockers are contraindicated (not appropriate), the alternative medications used to treat LVOT obstruction include verapamil or diltiazem. These drugs also belong to the calcium channel blocker family.

Abnormal automaticity occurs when heart cells spontaneously fire faster than normal. It can be caused by factors like focal areas of the heart, certain medications, or conditions like ischemia.

Triggered activity involves heart cells being stimulated by abnormal electrical impulses. This is often seen in conditions like Long QT syndrome or when the heart is exposed to high levels of stress hormones.

Re-entry occurs when an electrical impulse travels in a circle within the heart. This can lead to rapid and sustained heartbeats. Common examples include AVNRT, atrial fibrillation, and scar-related ventricular tachycardia.

Narrow QRS complex tachycardia refers to a fast heart beat where the electrical signal in the heart is originating from the upper chambers (atria) or the junction of the atria and ventricles.

Slightly wide QRS complex tachycardia signals suggest the issue originates in the part of the heart that connects the upper and lower chambers (bundle of His).

Wide QRS complex tachycardia indicates the abnormal electrical signals are originating from the lower chambers (ventricles) of the heart.

Narrow QRS tachycardia with a regular rhythm is often due to a consistent repetition of a single abnormal electrical loop in the heart (AVNRT). It can also be caused by rapid heartbeats in the upper chambers (atrial fibrillation).

Narrow QRS tachycardia with an irregular rhythm is most likely due to the upper chambers (atria) beating chaotically (atrial fibrillation) or with multiple independent triggers (multifocal atrial tachycardia).

A type of atrial tachycardia characterized by a long RP interval (time between the P wave and the R wave) and a short PR interval (time between the P wave and the Q wave). The P wave is abnormal.

Adenosine is the first-line treatment for AVNRT (atrioventricular nodal reentrant tachycardia). Verapamil and metoprolol are used if adenosine fails. Synchronized DC cardioversion is the last resort.

Rate-lowering agents are used to manage atrial tachycardia. Verapamil and beta-blockers are commonly used.

Multifocal atrial tachycardia (MAT) is often associated with COPD and patients may be on theophylline. Verapamil and beta-blockers are the treatment options.

Unsynchronized cardioversion is used in life-threatening arrhythmias like pulseless VT, ventricular fibrillation, and polymorphic VT.

Atrial fibrillation is an irregular heart rhythm characterized by no identifiable P-wave, an irregular R-R interval, and a potential for spontaneous reversion or the need for medication or permanent management.

Atrial fibrillation can be categorized as Paroxysmal (lasting less than 7 days and resolving spontaneously or with drugs), Persistent (lasting longer than 7 days), or Permanent (not reversible).

The main complications of atrial fibrillation are thromboembolism and stroke. Risk factors include age, hypertension, structural heart/lung diseases, obstructive sleep apnea, thyroid disorders, psoriasis, mitral stenosis, and prosthetic valves.