Podcast
Questions and Answers
What is a key characteristic of a normal ventricle's diastolic filling?
What is a key characteristic of a normal ventricle's diastolic filling?
- Atria must undergo significant hypertrophy
- Filling occurs at low atrial pressures (correct)
- Most filling occurs during late diastole
- Filling requires high atrial pressures
Which condition commonly leads to impaired oxygen supply in heart failure?
Which condition commonly leads to impaired oxygen supply in heart failure?
- Mitral valve regurgitation
- Myocardial infarction (correct)
- Hypertrophic cardiomyopathy
- Aortic stenosis
What consequence arises from prolonged increased afterload on the ventricles?
What consequence arises from prolonged increased afterload on the ventricles?
- Dilation of chamber size (correct)
- Increased contractility
- Decreased wall thickness
- Improved compliance
What pathophysiological adaptation occurs in heart failure related to reduced compliance?
What pathophysiological adaptation occurs in heart failure related to reduced compliance?
How does hypertensive heart disease contribute to heart failure?
How does hypertensive heart disease contribute to heart failure?
What defines HFpEF in the context of heart failure?
What defines HFpEF in the context of heart failure?
Which medication mechanism is commonly associated with treating heart failure?
Which medication mechanism is commonly associated with treating heart failure?
Which statement correctly reflects the features of congestive heart failure?
Which statement correctly reflects the features of congestive heart failure?
What is a common consequence of long-term mitral valve prolapse (MVP)?
What is a common consequence of long-term mitral valve prolapse (MVP)?
Which of the following conditions is NOT typically associated with mitral regurgitation?
Which of the following conditions is NOT typically associated with mitral regurgitation?
What type of damage can cause acute mitral regurgitation?
What type of damage can cause acute mitral regurgitation?
What is the primary immune response responsible for rheumatic heart disease?
What is the primary immune response responsible for rheumatic heart disease?
How does mitral regurgitation impact left atrial pressures?
How does mitral regurgitation impact left atrial pressures?
Which characteristic of rheumatic fever indicates a genetic susceptibility?
Which characteristic of rheumatic fever indicates a genetic susceptibility?
What is a potential consequence of papillary muscle rupture?
What is a potential consequence of papillary muscle rupture?
Which layer of the heart is primarily affected in endocarditis related to rheumatic heart disease?
Which layer of the heart is primarily affected in endocarditis related to rheumatic heart disease?
What is the most common lesion associated with mitral valve in chronic rheumatic heart disease?
What is the most common lesion associated with mitral valve in chronic rheumatic heart disease?
Which of the following symptoms is NOT typically associated with aortic stenosis?
Which of the following symptoms is NOT typically associated with aortic stenosis?
What is the primary clinical feature associated with rheumatic fever that causes morbidity and death?
What is the primary clinical feature associated with rheumatic fever that causes morbidity and death?
Which complications are associated with aortic stenosis that can lead to poor prognosis?
Which complications are associated with aortic stenosis that can lead to poor prognosis?
In what order do the valves typically become involved with rheumatic fever?
In what order do the valves typically become involved with rheumatic fever?
What is the typical murmur associated with aortic regurgitation?
What is the typical murmur associated with aortic regurgitation?
What is a common consequence of untreated chronic rheumatic heart disease?
What is a common consequence of untreated chronic rheumatic heart disease?
Which valve disorder in rheumatic heart disease is often characterized by fused aortic commissures?
Which valve disorder in rheumatic heart disease is often characterized by fused aortic commissures?
Which condition is associated with a mid- or late-systolic 'click' and is typically asymptomatic?
Which condition is associated with a mid- or late-systolic 'click' and is typically asymptomatic?
What type of murmur is typically heard in severe mitral regurgitation?
What type of murmur is typically heard in severe mitral regurgitation?
What is indicated when a patient with mitral valve regurgitation develops left ventricular hypertrophy (LVH)?
What is indicated when a patient with mitral valve regurgitation develops left ventricular hypertrophy (LVH)?
What symptom becomes apparent in mitral stenosis as it progresses and worsens with activity?
What symptom becomes apparent in mitral stenosis as it progresses and worsens with activity?
Which sign would you expect to find on examination of a patient with mitral stenosis?
Which sign would you expect to find on examination of a patient with mitral stenosis?
What is the prognosis for most patients with mitral valve prolapse?
What is the prognosis for most patients with mitral valve prolapse?
Which of the following best describes the complications associated with mitral regurgitation?
Which of the following best describes the complications associated with mitral regurgitation?
During auscultation of a patient with possible mitral valve issues, which finding is characteristic of mitral regurgitation?
During auscultation of a patient with possible mitral valve issues, which finding is characteristic of mitral regurgitation?
What signifies a diagnosis of HFrEF in terms of ejection fraction?
What signifies a diagnosis of HFrEF in terms of ejection fraction?
Which condition is most commonly associated with chronic heart failure?
Which condition is most commonly associated with chronic heart failure?
What is true about BNP in relation to heart failure diagnostics?
What is true about BNP in relation to heart failure diagnostics?
What best describes the role of beta-blockers in the management of heart failure?
What best describes the role of beta-blockers in the management of heart failure?
Which mechanism of action best describes digoxin?
Which mechanism of action best describes digoxin?
What is the characteristic feature of concentric left ventricular hypertrophy due to chronic hypertension?
What is the characteristic feature of concentric left ventricular hypertrophy due to chronic hypertension?
Which class of medications directly addresses fluid overload in CHF?
Which class of medications directly addresses fluid overload in CHF?
What is a major complication of aortic stenosis?
What is a major complication of aortic stenosis?
What causes aortic regurgitation when compared to normal valve function?
What causes aortic regurgitation when compared to normal valve function?
What is the primary effect of statins in managing dyslipidemia?
What is the primary effect of statins in managing dyslipidemia?
Ezetimibe primarily functions by which mechanism in lipid management?
Ezetimibe primarily functions by which mechanism in lipid management?
What does mitral valve prolapse lead to in terms of blood flow?
What does mitral valve prolapse lead to in terms of blood flow?
Which condition results from a 'wear and tear' process on heart valves?
Which condition results from a 'wear and tear' process on heart valves?
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Study Notes
Heart Failure
- Normal ventricle is compliant, able to relax quickly and fill with low pressure, and strong, able to generate enough force at rest.
- Common causes of heart failure: Ventricular overload, impaired oxygen supply from chronic ischemia, reduced compliance, cardiomyopathies.
- Heart failure can be diagnosed with echocardiography and BNP.
- Chronic IHD is the most common cause of heart failure.
- Chronic hypertension is the second most common cause of heart failure.
- Medications for heart failure and/or angina: beta-blockers, cardiac glycosides, diuretics, ACE inhibitors.
- Digoxin inhibits sodium-potassium pump, increasing contractility and decreasing heart rate.
- Medications for angina: calcium channel blockers, nitrates.
- Dyslipidemia medications: statins, PCSK9 inhibitors, ezetimibe, niacin.
Valvular Pathology
- Valves are lined by endocardium with underlying connective tissue, connected to fibrous rings.
- Valvular pathologies can be caused by congenital disorders, wear and tear, inflammation, acute impairment, idiopathic causes.
- Stenosis: Narrowed orifice or difficult opening, leading to strain on the proximal heart wall and hypertrophy.
- Regurgitation: Backflow of blood, leading to increased preload and chamber enlargement.
- Incompetence: Valve does not close completely.
- Prolapse: Excessive valve movement into the proximal chamber.
Selected Valvular Pathologies
- Mitral valve prolapse (MVP) - most cases are idiopathic.
- Mitral regurgitation (MR) – usually due to MVP, ischemia, infective endocarditis, rheumatic heart disease, left ventricular/atrial enlargement.
- RHD is an autoimmune reaction caused by Group A Streptococcus.
- RHD primarily affects children and teens, but can recur.
- RHD affects the entire heart wall (valves, myocardium, pericardium).
- RHD is common in less-industrialized countries, and is responsible for significant morbidity and mortality.
- Common RHD valvular lesions: mitral stenosis and aortic stenosis.
- Aortic stenosis (AS) - common cause of CHF.
- Aortic regurgitation (AR) - very dangerous if acute and severe.
Aortic Stenosis & Regurgitation
| Valvular Defect | Symptoms | Signs - Murmur | Prognosis |
|---|---|---|---|
| Aortic Stenosis | Chest pain, syncope, asymptomatic if not severe | Systolic crescendo-decrescendo murmur, loudest @ 2nd Rt IC space, radiates to neck and downwards. Heard between S1 and S2. | Common cause of CHF. If it causes LVH, a risk factor for IHD. Valve replacement helpful if done prior to LVH. LVH common. |
| Aortic Regurgitation | Dangerous if acute and severe. Flash pulmonary edema. | Diastolic decrescendo murmur. Can be Lt or Rt IC space, radiates parasternally. | If significant, replacement is necessary. Volume-overload LVH. |
Cardiogenic Shock
- Asymptomatic unless severe
- Causes bounding, water-hammer pulse (large pulse pressure)
- Heard after S2 - starts strong/loud then becomes less
- This is found in eccentric hypertrophy and CHF over time in significant defects
Mitral Valve Prolapse
- Many patients are asymptomatic
- Most have a good prognosis, surgery not usually needed urgently
- Many have non-specific findings – pre-syncope, palpitations, poorly-characterized chest pain
- If regurgitation develops + LVH then surgery is more urgently needed
Mitral Valve Regurgitation
- Asymptomatic if regurgitation is minor
- If LVH or symptomatic (CHF symptoms) then surgery more urgently needed
- Volume overload, CHF symptoms if severe
- Holosystolic murmur, hard to hear S1, usually best heard at apex but sometimes can radiate to heart base
Mitral Valve Stenosis
- Often asymptomatic, when symptoms do appear it's due to elevated atrial pressures
- Cough, dyspnea (worsens with exercise)
- Opening snap then rumbling, diastolic murmur that is best heard at the apex
- Symptomatic patients and those with severely reduced MV orifice usually need surgery
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