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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
Q

Where does aortic stenosis radiate?

A

Carotid arteries

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26
Q

Where does mitral regurgitation radiate?

A

Towards the axilla

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27
Q

Which type of murmurs are louder with inspiration?

Why?

A

Right-sided murmurs

Venous return is greater

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28
Q

When are innocent murmurs heard?

A

Early systole (remember that diastolic murmurs are always pathological)

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29
Q

What are some characteristics of an innocent murmur?

A

Early systolic

Soft

Position dependent

More common in young, thin people

30
Q

What is valve stenosis?

A

Valves which don’t open properly

31
Q

What is valve regurgitation?

A

Valves which do not close properly

32
Q

Apart from stenosis and regurgitation, what other valvular disease can you get?

A

Mixed valve disease (i.e both at once)

33
Q

What should be asked about during a history-taking of someone with suspected valvular disease?

A

Restriction to activities and function capacity

34
Q

What is a non-invasive method of investigating valvular disease?

A

Echocardiogram

35
Q

What is an invasive method of investigating valvular disease?

A

Cardiac catheterisation

36
Q

The most common valvular disease you will see is ___ ___.

A

aortic stenosis

37
Q

Why may aortic stenosis occur?

A

Degeneration due to age (e.g calcification)

Congenital (e.g bicuspid valve instead of tricuspid aortic valve)

Rheumatic aortic stenosis

38
Q

What are some common symptoms of aortic stenosis?

A

Exertional breathlessness (insufficient cardiac output)

Chest pain (insufficient perfusion of coronary arteries, overlap with CHD but not neccessarily)

Dizziness/syncope

39
Q

What are some common signs of aortic stenosis?

A

Low volume pulse

Forceful displaced apex (due to left ventricular hypertrophy - pressure overload)

Ejection systolic murmur which radiates to the carotids

40
Q

Valvular diseases cause either __ overloads or __ overloads.

A

volume

pressure

41
Q

What may you see in the ECG of a patient with aortic stenosis?

A

Indications of left ventricular hypertrophy

i.e elevated QRS complexes in lateral chest leads

42
Q

How is aortic stenosis treated?

A

Valve replacement

43
Q

Which sort of valve replacement would be done in younger patients?

A

Mechanical

44
Q

Which sort of valve replacement would be done in older patients or those with a poorer prognosis?

A

Prosthetic (e.g pig tissue)

45
Q

Which treatment needs to be started in those with mechanical valve replacements?

A

Warfarin (/rivaroxaban)

46
Q

Which treatment involves fitting a stent-like device to open the aortic valve?

A

Transcatheter aortic valve implantation (TAVI)

47
Q

Currently, (AVR / TAVI) is the preferred treatment in patients with aortic stenosis.

A

Aortic valve replacement

48
Q

People with aortic stenosis who are asymptomatic (are / aren’t) operated on immediately.

A

aren’t

49
Q

Generally, people with aortic stenosis are monitored carefully without intervention until they become ___.

A

symptomatic

50
Q

Many patients with mitral regurgitation have it as a ___ complication of their ___ ___.

A

functional , heart failure

51
Q

Degeneration of leaflets, chordae and papillary muscles causes ___ ___.

A

mitral regurgitation

52
Q

Which inflammatory disease can damage the mitral valve leaflets and cause mitral regurgitation?

A

Endocarditis

53
Q

What are some symptoms of mitral regurgitation?

A

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
Q

What are some signs of mitral regurgitation?

A

Displaced apex

Pansystolic murmur radiating to the axilla

55
Q

The two most common valvular diseases you will encounter are…

A

aortic stenosis

mitral regurgitation

56
Q

On a CXR of a patient with mitral regurgitation you may see ___.

A

cardiomegaly

57
Q

Mitral regurgitation causes a ___ overload, ___ of the left ventricle and ___ back pressure which leads to right-sided heart failure.

A

volume , dilation , increased

58
Q

Which medication would you give to someone with mitral regurgitation?

A

Diuretics

ACE Inhibitors (same as heart failure)

59
Q

In terms of surgery, prolapsed mitral valves are ___ and degenerating mitral valves are ___.

A

repaired , replaced

60
Q

What is the main cause of mitral stenosis?

A

Rheumatic fever

61
Q

Severe mitral stenosis commonly results in ___ ___ due to hypertrophy, remodelling and eventual failure of the atria.

A

atrial fibrillation

62
Q

What are some signs of mitral stenosis?

A

MALAR FLUSH

Tapping apex peat

Mid-diastolic rumbling localised in the apex, brought out by turning the patient to their left

63
Q

What are some symptoms of mitral stenosis?

A

Breathlessness

Fatigue

Palpitations (AF)

64
Q

On a CXR of someone with mitral stenosis, you may see a straight __ __ __. Why?

A

straight left heart border

Pulmonary hypertension

65
Q

What causes aortic regurgitation?

A

Leaflet problems - they don’t meet properly and blood flows back into the left atrium

Endocarditis, connective tissue diseases, rheumatic causes

Also: Marfan’s Syndrome, Aortic dissection

66
Q

Aortic regurgitation causes ___ overload.

A

volume

67
Q

Volume overload causes ___ of heart chambers.

A

dilatation

68
Q

What is the main symptom of aortic regurgitation?

A

Breathlessness

69
Q

What are some signs of aortic regurgitation?

A

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
Q

On a CXR of someone with aortic regurgitation, you may see ____ (chamber dilatation).

A

cardiomegaly

71
Q

___ ___ are shown to be useful in reducing dilatation of the left ventricle in aortic regurgitation.

A

ACE inhibitors

Cardiovascular Week 6 2016/17 (6 decks)

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