Cardiology Flashcards
What are the common indications for aortic valve replacement?
- Severe symptomatic aortic regurgitation (AR)/aortic stenosis (AS). * Infective endocarditis.
What are the possible complications of prosthetic valves?
- Infective endocarditis (early and late) – may present as a new atrioventricular (AV) block, acute heart failure or embolic phenomenon. * Thromboembolism.
- Anticoagulation complications.
- Anaemia (haemolysis, endocarditis, or bleeding).
- Valve failure (heart failure from dehiscence, leaking, calcification or stiffening of valve leaflets).
What do you look for in a patient with metallic valve replacemtn
Median sternotomy scar
Complications of anticogulation
what are the differential diagnosis of ejection systolic murmur
- Aortic stenosis
- aortic sclerosis
- hyperobstructive cardiomyopathy.
4 VSD
Aortic stenosis is lounder on expiration
medical management of aortic stenosis,
Beta-Blockers.
- There are some medications that are very important to avoid in aortic stenosis: o vasodilators (which can increase the gradient across the valve) o ACE inhibitors. o nitrates.
surgical options of aortic valve stenosis ?
- Mechanical aortic valve – this would be more durable; it will last longer but it does require lifelong anticoagulation.
- A tissue aortic valve replacement – this does not require life-long anticoagulation but is not as durable.
- A trans-aortic valve intervention (TAVI) would be appropriate for those patients who are not fit for surgical intervention.
what are the clinical sign of aortic stenosis?
. slow rising low volume pulse
. narrow pulse pressure
. muted or absent second heart sound
. Apex heaving
Investigations of Aortic Stenosis
- ECG: LVH on voltage criteria, conduction defect - prolonged interval
- CXR - Calcified valve
- ECHO: mean gradient >40mmg , aortic valve <1cm and LV function
- CT: Coronary and peripheral artery patency
causes of aortic valve stenosis
- Dystrophic calcification/fibrosis
- Bicuspid aortic valve
- Rheumatic fever
what does s3 sound indicate?
s3 is a low pitched and indicates rapid ventricular filling from LA
what are the complications of Mitral regurg
- AF - due to LA enlargement
- Pulmonary oedema
- Pulmonary hypertension
- Endocarditiis
investigations for mitral regurg
- ECG - p -mitrale, AF and previous infarction ( Q waves )
- CXR: cardiomegaly, nelargement of the LA and pulmonary oedema
- TTE/TOE - LV dilatation and reduced EF
- Cardiac MRI
- Cardiac catheriastiztion
when do you consider MR surgical management
- LVEF<60%
- LVESD >45mm
what are the cardiac features of Marfan’s
Aortic Root Dilatation
Aortic Regurgitation
Mitral Valve Prolapse
Aortic Aneurysm
Arrhythmias:
what are the indication of aortic route replacement in marfarns
- Dilation >50 mm at the aortic route,
- > 45 mm with patients with family history of aortic dissection
- if the aortic route is expanding at a rate of more than 3 mm per year.
what are the cause of new breathlessness in someone with previous valve replacement?
- arrhythmia
- LV dysfunction
- Infective endocarditis
what are the classical phenotypical feature of noonans
o cubitus valgus
o webbed neck
o widely spaced nipples
o short stature.
In a patient with significant pulmonary stenosis, what clinical findings might you expect to see?
- Large A waves in the JVP due to delayed RA emptying in patients with significant pulmonary stenosis.
- A right ventricular heave due to pulmonary hypertension.
- There may be a pansystolic murmur at the LSE due to functional tricuspid regurgitation resulting from right heart dilatation.
- Signs of right-sided heart failure.
- A widely split-second heart sound with a quiet pulmonary component.
what are the causes of pulmonary stenosis
Idiopathic or
o Tetralogy of Fallot
o Williams or Noonan syndrome.
There are also infective causes:
o Infective endocarditis
o Rheumatic fever
o Carcinoid syndrome.
management of pulmonary stenosis
percutaneous pulmonary balloon valvuloplasty or surgery.
pressure gradient classifcation of pulmnoary stenosis
MOD Stenosis : 36 and 64 mmHg: develop dyspnoea and fatigue,
> 64mmHg have severe stenosis and may develop early right ventricular failure and cyanosis.
Can you tell me about any associated conditions?
Marfan syndrome
Ehlers–Danlos syndrome, osteogenesis imperfecta polycystic kidney disease
what are the complications of Eisenmenger’s syndrome?
o Right ventricular failure o Paradoxical embolism
o Infective endocarditis
o Haemoptysis
o Hypoxaemia.
What are the possible complications of prosthetic valves?
FAITH
Failure - Valve dehisscence, wear and tear
Arrhythmia
Infective endocarditis
Thromboembolic phenomena
Haemorrage from anticoagulation and valve related haemolysis
