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Cardio Block > 4- valvular heart disease > Flashcards

4- valvular heart disease Flashcards

1
Q

what is cardiac breathlessness types?

A
  • usually breathlessness = related to activity
  • orthopnea (breathlessness when lying down) and is associated with heart failure
  • paroxysmal nocturnal dyspnoea

*often associated with ankle swelling

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2
Q

what is new york association functional classification?

A

classification for breathlessness

Class I - No limitation

Class II - Slight limitation of ordinary activity

Class III - Marked limitation of less than ordinary activity

Class IV - Severe limitation of minimal activity or at rest

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3
Q

what is involved in clinical examination? (general cardiac one)

A
  • general appearance
  • arterial pulse (radial, carotid)
  • venous pulse (JVP) - sign of HF
  • palpitation - apex beat or parasternal heave
  • auscultation = heart sounds & murmurs
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4
Q

what are signs of right heart failure?

A
  • raised JVP
  • pitting oedema at ankles & sacrum
  • hepatic congestion
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5
Q

what is JVP test?

A

measured when patient at 45 degrees, measure height from JVP at sternal notch

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6
Q

what does tapping apex beat mean?

A

mitral stenosis

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7
Q

what does displace and diffusing apex beat mean?

A

means volume overload in left ventricular dilation

(displaced= unusual place & diffused = heard in large area?)

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8
Q

what does displaced and heaving apex beat mean?

A

pressure overload in LV hypertrophy

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9
Q

what does parasternal heave suggest? and how do you determine?

A

determine by hand left of sternum
- suggests RV overload or pulmonary hypertension

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10
Q

what is cardiac murmur?

A

audible noise caused by turbulence of blood flow (can be innocent or pathological)

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11
Q

what are ways to describe murmurs?

A
  • Systole or diastole?
  • What type of murmur?
  • Where is it loudest?
  • Where does it radiate to?
  • What grade of murmur?
  • (Influenced by respiration?)
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12
Q

what determines whether murmur is in systole or diastole?

A

depends if 1st or 2nd heart sound

  • 1st sound = mitral & tricuspid valve closing = start of systole
  • 2nd sound = aortic & pulmonary valves closing = start of diastole
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13
Q

what are types of systolic murmur?

A
  • pansystolic
  • ejection systolic
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14
Q

what are types of diastolic murmur?

A
  • early diastolic
  • mid diastolic
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15
Q

where do murmurs radiate to?

A

carotids = aortic stenosis
axilla = mitral regurgitation

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16
Q

what is the grading of murmurs?

A

I. Very quiet
II. Quiet - easy to hear
III. Loud
IV. Loud with a thrill
V. Very loud with a thrill
VI. Loud - audible without a stethoscope

(remember extremes - very quiet and loud audible without stethescope)

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17
Q

what is an innocent murmur characteristics?

A
  • soft
  • position dependant
  • often early systolic (diastolic murmurs always pathological)
18
Q

what is valvular stenosis?

A

valves which don’t open properly

19
Q

what is valvular regurgitation?

A

valves which do not close properly

20
Q

what is mixed valve disease?

A

valves can’t open or close properly

21
Q

what murmurs are louder with inspiration?

A

right sided murmurs (as decreased intrathoracic pressure so increased venous return so increased filling of right chambers)

22
Q

what are common murmurs?

A
  • 2nd sound splitting
  • 3rd sound
  • 4th sound
  • systolic clicks
  • innocent murmur
  • mitral regurgitation
  • aortic stenosis
  • aortic regurgitation
  • mitral stenosis
  • continuous murmur
  • tricuspid regurgitation
  • pericardial rub(scratching/grating sound)
23
Q

what is aortic stenosis causes?

A
  • most common = age related changes of aortic valve (calcium & cholesterol deposits in valve)
  • also congenital - bicuspid valve
  • occasionally rheumatic process affects
24
Q

what are symptoms of aortic stenosis?

A
  • breathlessness
  • occasionally chest pain
  • syncope & dizziness (late sign due to reduced cardiac output)
25
Q

what are signs of aortic stenosis?

A
  • low volume pulse
  • forceful displaced apex
  • ejection systolic murmur that can radiate to carotids (so can also hear same murmur in neck) - usually heard in aortic area
26
Q

what is treatment for aortic stenosis?

A
  • conventional valve replacement
  • trans catheter aortic valve replacement (TAVI) - nonsurgical so better for old people
  • balloon aortic valvotomy
27
Q

what are pros & cons for mechanical valve?

A
  • last long time
  • but needs to be on warfarin
  • usually good for younger patients
28
Q

what are pros & cons for bio-prosthetic mechanical valve?

A
  • no warfarin needed
  • lasts not as long (usually 10 years)
  • usually good for older patients
29
Q

AVR vs TAVI?

A

AVR (aortic valve replacement) still preferred, long-term outcomes, no contra-indications, can do angiogram to check if CABG done as well

TAVI = comorbidity, previous sternotomy

30
Q

what are symptoms of mitral regurgitation?

A
  • breathlessness
  • peripheral oedema
  • fatigue
31
Q

what are signs of mitral regurgitation?

A
  • displaced apex
  • pansystolic murmur
    • heard at apex in mitral area and radiates to axilla
32
Q

what are causes of mitral regurgitation?

A

leaflets prolapse:
= one of leaflets doesn’t close properly during systole
- rheumatic fever = a consequence of rheumatic fever is that the valve leaflets become scarred & distorted
- degenerative myxomatous = leaflets become floppy & thickened
- endocarditis = inflammation of endocardium directly affects leaflet function

chordae rupture
= chordae tendinae are fibrous cords that connect valve leaflets to papillary muscles, rupture can lead to mitral regurgitation
- degenerative (prolapse/flail leaflet) - chordae can rupture in cases of severe mitral valve prolapse or when there’s a flail leaflet

papillary muscles - rupture leading to inadequate valve closure
- caused by ischaemic

annulus dilation
- - secondary or functional mitral regurgitation (most common)
- annulas getting bigger due to heart failure
- functional

33
Q

what is treatment for mitral regurgitation?

A
  • medication (for secondary - you try treat cause)
    • diuretics & heart failure (ACEi)
  • surgical (more favoured for primary valve problems)
    • repair - prolapse, aim is to preserve mitral valve
    • replacement - degenerative
  • percutaneous
    • new technique microclips - encouraging results (less invasive for elderly)
34
Q

what is cause of mitral stenosis?

A
  • essentially rheumatic main cause
  • congenital rare
35
Q

what are symptoms of mitral stenosis?

A
  • breathlessness
  • fatigue
  • palpitations
36
Q

what are signs of mitral stenosis?

A
  • malar flush (plum red discolouration of high cheeks)
  • tapping apex beat
  • mid diastolic rumbling (after 2nd heart sound), low rumbling localised to apex
    - best heard with patient lying on left hand side at apex
37
Q

what is treatment of mitral stenosis?

A
  • medications
    • diuretics and treat AF
  • surgery
    • gold standard = valve replacement
  • balloon valvuloplasty - placing a balloon across valve (cracks calcium deposits and opens it up), not great longevity
38
Q

what causes aortic regurgitation?

A

primary problem (most common)= affecting leaflets, caused by:
- endocarditis
- connective tissue diseases
- rheumatic

secondary problem affecting annulus, caused by:
- marfans
aortic dissection

39
Q

what is symptom of aortic regurgitation?

A

breathlessness

40
Q

what are signs of aortic regurgitation?

A
  • collapsing pulse
  • displaced apex
  • early diastolic murmur left sternal edge
    • loudest sound heard as soon as valve shuts (starts loud and fades away)
41
Q

what is aortic regurgitation treatment?

A
  • medication (ACEi)
  • surgery
    • symptoms & LV dilation
    • valve replacement
42
Q

what is primary and secondary cause of mitral regurgitation?

A

primary leaflet = refers to problems directly related to structure & function of mitral valve leaflets

secondary leaflet = arise from underlying heart failure conditions heart failure problem

Cardio Block (34 decks)

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