Cardiology Flashcards
Presenting aortic mechanical valve replacement
Metallic 2nd (aortic, after pulse) heart sound
Flow murmur?
Median sternotomy scar without vein harvesting scars
Ecchymoses due to anticoagulation
Signs of heart failure ?failing valve
Sides of IE?
Heaving apex/LVH of AS? If not, likely AR is aetiology
AF - common in mitral valve disease
Indications for AV replacement
Severe symptomatic AS or AR
Infective endocarditis
Management of mechanical valve patient
Investigate any arrhythmias - ECG, 24 hr tape
Investigate any new murmurs - bloods including cultures, echo
Long term - anticoagulation, serial echo to monitor valve function
Mechanical vs bioprosthetic valave
Mechanical - more durable, lasts longer, needs life long anticoagulation
Median sternotomy scar
CABG + vein harvesting scars
Structural heart disease
Valve replacement
Presenting AS
?AF Low volume pulse JVP Apex displaced/heaving? Systolic murmur, radiating to carotids, quiet second HS
Severity - slow rising pulse, low volume pulse, quiet second heart sound, long duration, high pitched murmur, left ventricular heave, 4th HS, radiate to carotids
Investigations in AS
Echo - valve area, gradient across the valve, LV function
Differential of ESM
AS - loudest on expiration (left) Aortic sclerosis Hypertrophic obstructive cardiomyopathy MR if pan-systolic, radiating to axilla PS - over pulmonary area, right ventricular heave, younger, louder on inspiration (right)
Management of AS
Symptoms in severe AS - referral to surgeons for replacement - mechanical or tissue valve, TAVI
Drugs - beta blockers
Avoid - vasodilators such as nitrates, ACEI, sildenafil
Symptoms of AS
Syncope
Angina
SOB/heart failure
Presenting AR
Early diastolic murmur - loudest at left sternal edge, radiating down
Thrusting and displaced apex beat
Wide pulse pressure, collapsing pulse, displaced apex
Austin Flint murmur - regurgitant jet onto mitral valve causing vibration and late rumbling diastolic murmur
Special signs: Corrigans (distension and collapse of carotids in neck), de mussets (head bobbing), quinkes (pulsation in nail bed), mullers (uvula pulsation)
Causes of AS
Age related calcification
Bicuspid aortic valve
Presenting MR
Pansystolic murmur
Loudest over mitral area, left side, expiration
Displaced apex laterally and forceful
Causes of MR
Mitral valve prolapse Cardiomyopathy LV dilatation Rheumatic heart disease Marfan and CTD Acute - trauma and MI
Causes of AR
Ascending aortic arch dissection IE Chest trauma Prosthetic aortic valve failure CTD Rheum - ank spond, RA, SLE
