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Cardiovascular Week 6 2016/17 > 1: Valvular heart disease > Flashcards

1: Valvular heart disease Flashcards

1
Q

What are some characteristic symptoms of valvular heart disease?

A

Chest pain

Breathlessness

Collapse / dizziness

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2
Q

Patients will often describe their cardiac chest pain using characteristic ___.

A

gestures

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3
Q

What are some traits of cardiac chest pain?

A

Heavy, squeezing, crushing, gripping

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4
Q

Cardiac breathlessness is usually related to ___.

A

activity / exertion

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5
Q

What other cardiac symptom may you see alongside breathlessness?

A

Ankle oedema

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6
Q

What is orthopnea?

A

Breathlessness when lying flat - usually due to pulmonary oedema

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7
Q

What is paroxysmal nocturnal dyspnoea?

A

Gasping / having to sit up during the night due to pulmonary oedema

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8
Q

What key questions should you ask a patient who you suspect is suffering pulmonary oedema?

A

Do you lie flat at night?

Do you need 2+ pillows to sleep?

Do you feel better if you get up and do something?

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9
Q

What is the NYHA?

A

New York Heart Association Functional Classification

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10
Q

NYHA grades are used to classify cardiac ___.

A

breathlessness

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11
Q

What should you be thinking about when you feel a patient’s pulse?

A

RRCV

Rate, rhythm, character, volume

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12
Q

An elevated JVP is an indicator of __-sided heart failure.

A

right

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13
Q

What are some signs of right sided heart failure?

A

Raised JVP

Pitting oedema

Hepatic congestion

(all related to build-up of fluid due to failure of heart as a pump)

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14
Q

Where can pitting oedema be found?

A

Ankles

Sacrum

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15
Q

What is pitting oedema?

A

Swelling in an area of the body - if you press on it, dents will remain for a period of time

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16
Q

What is a tapping apex indicative of?

A

Mitral stenosis

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17
Q

Volume ___ causes __ ventricular dilatation and displaces the __ beat.

A

overload , left , apex

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18
Q

What causes a right parasternal heave?

A

Right ventricular overload

(cor pulmonale / pulmonary hypertension)

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19
Q

What is a cardiac murmur?

A

Audible turbulence of blood flow

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20
Q

Murmurs are either ___ or ___.

A

systolic , diastolic

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21
Q

The first heart sound is made by the ___ and ___ closing and signs the start of ___.

A

mitral , tricuspid

systole

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22
Q

The second heart sound is made by the ___ and ___ valves closing and signals the start of ___.

A

aortic , pulmonary

diastole

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23
Q

What is a pansystolic murmur?

A

A murmur which doesn’t increase/decrease in volume during cardiac cycle

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24
Q

What is an ejection systolic murmur?

A

A murmur where the heart sound peaks at some point (e.g aortic stenosis)

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25
Where does aortic stenosis radiate?
**Carotid arteries**
26
Where does mitral regurgitation radiate?
Towards the **axilla**
27
Which type of murmurs are louder with **inspiration**? Why?
Right-sided murmurs Venous return is greater
28
When are **innocent murmurs** heard?
**Early systole** (remember that diastolic murmurs are always pathological)
29
What are some characteristics of an **innocent murmur**?
**Early systolic** **Soft** **Position dependent** More common in young, thin people
30
What is valve stenosis?
**Valves which don't open properly**
31
What is **valve regurgitation**?
**Valves which do not close properly**
32
Apart from stenosis and regurgitation, what other valvular disease can you get?
**Mixed valve disease** (i.e both at once)
33
What should be asked about during a history-taking of someone with suspected valvular disease?
Restriction to activities and function capacity
34
What is a **non-invasive method** of investigating valvular disease?
Echocardiogram
35
What is an invasive method of investigating valvular disease?
**Cardiac catheterisation**
36
The most common valvular disease you will see is ___ \_\_\_.
**aortic stenosis**
37
Why may **aortic stenosis** occur?
**Degeneration** due to **age** (e.g calcification) **Congenital** (e.g bicuspid valve instead of tricuspid aortic valve) **Rheumatic** **aortic stenosis**
38
What are some common **symptoms** of aortic stenosis?
**Exertional breathlessness** (insufficient cardiac output) **Chest pain** (insufficient perfusion of coronary arteries, overlap with CHD but not neccessarily) **Dizziness/syncope**
39
What are some common **signs** of **aortic stenosis**?
**Low volume pulse** **Forceful displaced apex** (due to **_left ventricular hypertrophy_** - pressure overload) **Ejection systolic murmur which radiates to the carotids**
40
Valvular diseases cause either __ overloads or __ overloads.
**volume** **pressure**
41
What may you see in the ECG of a patient with aortic stenosis?
**Indications of left ventricular hypertrophy** i.e **_elevated QRS complexes in lateral chest leads_**
42
How is **aortic stenosis** treated?
**Valve replacement**
43
Which sort of valve replacement would be done in **younger patients**?
**Mechanical**
44
Which sort of valve replacement would be done in **older patients** or those with a poorer prognosis?
**Prosthetic** (e.g pig tissue)
45
Which treatment needs to be started in those with **mechanical valve replacements**?
**Warfarin** (/rivaroxaban)
46
Which treatment involves fitting a stent-like device to open the aortic valve?
**Transcatheter aortic valve implantation (TAVI)**
47
Currently, (**AVR / TAVI**) is the preferred treatment in patients with aortic stenosis.
**Aortic valve replacement**
48
People with **aortic stenosis** who are **asymptomatic (are / aren't)** operated on immediately.
**aren't**
49
Generally, people with aortic stenosis are monitored carefully without intervention until they become \_\_\_.
**symptomatic**
50
Many patients with **mitral regurgitation** have it as a ___ complication of their ___ \_\_\_.
**functional , heart failure**
51
Degeneration of leaflets, chordae and papillary muscles causes ___ \_\_\_.
**mitral regurgitation**
52
Which inflammatory disease can damage the mitral valve leaflets and cause **mitral regurgitation**?
**Endocarditis**
53
What are some **symptoms** of **mitral regurgitation**?
**Exertional breathlessness** **Peripheral oedema** **Fatigue** (all symptoms of right-sided heart failure as the regurgitation causes **back pressure** into the right side of the heart)
54
What are some **signs** of **mitral regurgitation**?
**Displaced apex** **Pansystolic murmur radiating to the axilla**
55
The two most common valvular diseases you will encounter are...
**aortic stenosis** **mitral regurgitation**
56
On a CXR of a patient with **mitral regurgitation** you may see \_\_\_.
**cardiomegaly**
57
Mitral regurgitation causes a ___ overload, ___ of the left ventricle and ___ back pressure which leads to right-sided heart failure.
**volume , dilation , increased**
58
Which medication would you give to someone with **mitral regurgitation**?
**Diuretics** **ACE Inhibitors** (same as heart failure)
59
In terms of surgery, **prolapsed** mitral valves are ___ and **degenerating** mitral valves are \_\_\_.
**repaired , replaced**
60
What is the main cause of **mitral stenosis**?
**Rheumatic fever**
61
**Severe mitral stenosis** commonly results in ___ \_\_\_ due to hypertrophy, remodelling and eventual failure of the atria.
**atrial fibrillation**
62
What are some **signs** of **mitral stenosis**?
**MALAR FLUSH** **Tapping apex peat** **Mid-diastolic rumbling localised in the apex, brought out by turning the patient to their left**
63
What are some **symptoms** of **mitral stenosis**?
Breathlessness Fatigue **Palpitations (AF)**
64
On a CXR of someone with **mitral stenosis**, you may see a straight __ \_\_ \_\_. Why?
**straight left heart border** **Pulmonary hypertension**
65
What causes **aortic regurgitation**?
Leaflet problems - they don't meet properly and blood flows back into the left atrium ## Footnote **Endocarditis, connective tissue diseases, rheumatic causes** **Also: _Marfan's Syndrome, Aortic dissection_**
66
Aortic regurgitation causes ___ overload.
**volume**
67
Volume overload causes ___ of heart chambers.
**dilatation**
68
What is the main **symptom** of aortic regurgitation?
**Breathlessness**
69
What are some **signs** of aortic regurgitation?
**Collapsing pulse** (backflow of blood back into the atrium) **Displaced apex** (due to dilatation) **Early diastolic murmur heard at the left sternal edge** (tricuspid area?), **brought out best when patient sits forward**
70
On a CXR of someone with **aortic regurgitation**, you may see ____ (chamber dilatation).
**cardiomegaly**
71
\_\_\_ ___ are shown to be useful in reducing dilatation of the left ventricle in **aortic regurgitation**.
ACE inhibitors

Cardiovascular Week 6 2016/17 (6 decks)

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