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MRCS A > CARDIOLOGY - Valvular Heart Disease and Bacterial Endocarditis > Flashcards

CARDIOLOGY - Valvular Heart Disease and Bacterial Endocarditis Flashcards

1
Q

Short term consequence of valvular inflammation

A

Collagen exposure
Thrombus development

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2
Q

Long term consequence of valvular inflammation

A

Post inflamm scarring

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3
Q

Which side valves are more commonly affected?

A

L

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4
Q

What is the most common cause of valve scarring

A

rheumatic fever

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5
Q

children who get rheumatic fever? clinical picture

A

inv tonsilitis/pharyngitis caused by GAS
ab GAS cross reacts cardiac antigen –> SL myocarditis/pericarditis
–> progressive fibrosis of valve leaflets + chordae tendinae

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6
Q

What is aortic stenosis is most commonly due to?

A

Calcification of congenital bicuspid aortic valve

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7
Q

Congenital cause pulmonary stenosis

A

Fallot’s tetralogy

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8
Q

Congenital cause mitral stenosis

A

Lutembacher’s syndrome

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9
Q

Congenital causes Tricuspid regurg

A

Ebstein’s anomaly

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10
Q

Ischaemic cause mitral regurg

A

Papillary mm dysfunction post infarction

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11
Q

Conditions causing cardiac remodelling (5)

A

SLE
Marfans
Ehler-Danlos
Syphillis
Ankylosing spondylitis

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12
Q

In what position is a patient postitioned to best hear a mitral valve murmur?

A

LHS

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13
Q

pathophysiology mitral stenosis

A

LA can’t empty –> pulmonary HTN
LA becomes hypertrophied+ dilated
Pulm HTN –> RHF
AF develops b/c mm hypertrophy

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14
Q

Sx Mitral stenosis (5)

A

Dyspnoea
Haemoptysis
Fatigue/weakness
Abdo/L limb oedema
Palps

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15
Q

Signs Mitral stenosis (5)

A

Malar flush
Small vol pulse
JV distension
L parasternal heave
Rumbling mid-diastolic murmur (just prior to systole)

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16
Q

Tx Mitral stenosis

A

AF (rate control + anti-coags)
Diuretics
Surgery if these measures fail

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17
Q

Surgical Mx mitral stenosis

A

Balloon valvuloplasty (if valve pliable)
Or
Open valvotomy

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18
Q

Causes mitral regurg

A

Rheumatic scarring
Post infarction papillary mm dysfunction
LV dilation
Mitral prolapse

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19
Q

Sx mitral regurg

A

Palps
dyspnoea/orthopnoea
Fatigue
Features RHF/CCF

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20
Q

Signs mitral regurg

A

lat apex beat w/ systolic thrill
Pansystolic murmur
AF?

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21
Q

Tx mitral regurg

A

Tx AF
Tx HF
Surgery if Sx deteriorate

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22
Q

In what position are aortic murmurs best heard

A

With patient sitting forward
Breath held on expiration

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23
Q

Causes aortic stenosis

A

Calcification
RF
Senile calcific degeneration

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24
Q

Prognosis aortic stenosis

A

2-3yrs - death

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25
Sx aortic stenosis (3)
Exercise induced syncope Dyspnoea Angina
26
Signs aortic stenosis (5)
Small volume, slow rising carotid pulse Narrow pulse pressure Normal apex beat Ejection systolic murmur w/ cresendo' character Signs LVF
27
Tx aortic stenosis
Prompt valve replacement
28
Causes aortic regurg (4)
Post-inflamm scarring Infective endocarditis Age-related calcification Dilation aortic root b/c syphillis,AS
29
Sx Aortic regurg
Asymp Until acute LVF
30
Signs aortic regurg (4)
Bounding/collapsing pulse Wide pulse P Early diastolic murmur w/ decresendo Signs LVF
31
Quinke's sign
Aortic regurg sign severe disease Capillary pulsation in nail beds
32
De Musset's sign
Aortic regurg sign severe disease Head nodding with each heart beat
33
Duroziez's sign
Aortic regurg sign severe disease Murmur on femoral aa if pressure applied distally
34
Pistol shot femorals
Aortic regurg sign severe disease Sharp bang in time w/ heart beat if femorals auscultated
35
Tx aortic regurg
Replace valve
36
When are R sided murmurs louder?
On inspiration
37
PS Tricuspid stenosis
Sx RHF Pre-systolic liver thrill Mid-diastolic murmur
38
PS Tricuspid regurg
Sx RHF Systolic liver thrill Pan-systolic murmur
39
PS Pulmonary stenosis
Sx RHF RV heave Ejection systolic murmur
40
PS Pulmonary regurg
Asymp + diastolic murmur
41
Ix heart murmurs (4)
ECG CXR - hypertrophy, is dilation of aorta present Echo - visualise valves + diagnostic stenosis Doppler - regurgitant flow
42
When are heart catheterisations indicated
If diagnosis of heart murmurs is uncertain after echo
43
What is Eisenmenger syndrome
Persistently raised pulmonary flow 2' to congenital heart disease
44
Why is early detection of Eisenmenger syndrome v important
B/c once pulmn HTN develops - = considered irreversible
45
Sx Eisenmenger syndrome + age onset
Rare before 20 Dyspnoea Fatigue Chest pain Syncope
46
O/E Eisenmenger syndrome
RV heave Clubbing Cyanosis
47
Mx Eisenmenger syndrome
H-L transplant
48
What is infective endocarditis?
Infection of endocardial surface of heart
49
Mortality bacterial endocarditis
15-30%
50
What 2 symptoms are indicative of BE until proven otherwise
Fever New murmur
51
Which patients are at risk of BE?
IVDU Valve replacement Dental patients
52
Most common bacteria causing BE
Strep viridans + staph aureus + HACEK Haemophilus Actinobacillus Cardiobacterium Eikenella Kingella
53
O/E BE - FROM JANE
Fever Roth spots Osler nodes Murmur Janeway lesions Anemia Nail bed haemorrhages Emboli
54
Ix BE
Bloods - FBC/CRP/ESR/U+E Cultures - 3 sets at different times Urinalysis ECG CXR Transthoracic echocardiography
55
What are you looking for - CXR - BE
Evidence HF Abscess/emboli
56
What are Duke's major criteria?
3x +ve culture Endocardial involvement on echo
57
Duke minor criteria
Predisposing factors Fever >38 Vascular phenomena Immunological signs Culture/echo not sufficient for mejor
58
Using Duke's criteria - when can a diagnosis of BE?
2 major 1 major + 3 minor Or all minor
59
Complications infection endocarditis (3)
Systemic emboli Valvular incompetence + CCF Glomerulonephritis
60
Tx BE
ABx - penicillin's 4-6 w
61
If patient w/ suspected BE is not responding to ABx, what other diagnosis should be considered? (4)
PE Abscess Dx reaction Different infection

MRCS A (36 decks)

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