Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MD2 Surgery and Anaesthesia > Heart Valve Disease > Flashcards

Heart Valve Disease Flashcards

1
Q

If untreated, what does severe valve disease lead to?

A

Heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is rheumatic fever?

A

Type II hypersensitivity reaction to Streptococcus pyogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What infections does S pyogenes initially produce in the body?

A

Pharyngitis

Scarlet fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When does rheumatic fever occur after S pyogenes infection?

A

2-3 weeks post-infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In whom is rheumatic fever most common?

A

6-15 year-olds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the clinical features of rheumatic fever?

A 
Fever
Arthritis
- Migratory polyarthritis
- Large joints
Rash - erythema marginatum
Subcutaneous nodules over
- Bones
- Tendons
Murmur
Sydenham's chorea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is rheumatic fever diagnosed?

A

On basis of clinical criteria: Jones criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the management for rheumamtic fever?

A

Abx
NSAIDs
Long-term Abx prophylaxis, as may recur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is echocardiography?

A

High frequency US looking at

  • Chamber size and function = EF
  • Wall thickness
  • Cardiac structure
  • Valve morphology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does transoesophageal echocardiography (TOE) show?

A

Valve details, especially mitral
Atrial thrombus
Endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the left ventricle’s response to regurgitation?

A 
Compensation
- Increased SV
- Increased EF
- Increased end diastolic volume
If severe regurgitation > eventual irreversible deterioration in LV
- High increase in end diastolic volume
- Increased end systolic volume
- Decreased ejection fraction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What chamber is affected in aortic regurgitation?

A

Left ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the load on the heart in aortic regurgitation?

A

Volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the effect of aortic regurgitation to the structure of the left ventricle?

A

Eccentric hypertrophy (enlargement)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When do symptoms occur in aortic regurgitation?

A

Coincide with irreversible LV changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What chamber is affected in mitral regurgitation?

A

LV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the load on the heart in mitral regurgitation?

A

Volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the effect of mitral regurgitation to the structure of the left ventricle?

A

Eccentric hypertrophy (enlargement)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When do symptoms occur in mitral regurgitation?

A

Coincide with irreversible LV changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are other effects of mitral regurgitation?

A

Pulmonary HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the chamber affected in aortic stenosis?

A

LV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the load on the heart in aortic stenosis?

A

Pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the effect of aortic stenosis on the structure of the left ventricle?

A

Concentric hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the next step in treatment when symptoms occur in aortic stenosis?

A

Trigger for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Is left ventricular hypertrophy due to aortic stenosis affected after surgery?
Yes, it regresses
26
What chamber is affected in mitral stenosis?
LA
27
What is the load on the heart in mitral stenosis?
Pressure
28
What is the effect of mitral stenosis on the structure of the heart?
LA enlargement
29
What is the next step in treatment when symptoms occur in mitral stenosis?
Surgery
30
What are the other effects of mitral stenosis?
Pulmonary HTN
31
What are the options for valve replacement?
``` Mechanical - Last forever - Need anticoagulants Bioprosthetic - Shorter lifespan - Don't need anticoagulants - Pig valve - Calf pericardium - Human valve ```
32
Can valves be repaired surgically?
Yes, especially if mitral valve prolapse
33
For what valve disease is valvuloplasty indicated?
Stenosis
34
What is the commonest valve lesion needing surgery?
Aortic stenosis
35
What are the causes of aortic stenosis?
``` Calcific - Commonest cause - Increases with age Congenital - Stenosed at birth - Bicuspid aortic valve may become stenotic later in life Rheumatic fever - Rare ```
36
What are the symptoms of aortic stenosis?
SOB on exertion Chest pain on exertion Syncope
37
When do symptoms of aortic stenosis appear?
When stenosis severe
38
What are the signs of aortic stenosis?
``` Carotid pulse - Slow upstroke = plateau pulse - Indicative of reduced systolic ejection Apex beat - Not displaced - Heaving Thrill - If loud murmur - Over upper R sternal edge ```
39
What are the characteristics of a murmur due to aortic stenosis?
Systolic Crescendo-decrescendo = ejection systolic Best heard at upper R sternal edge Loud murmur may also be heard at apex
40
What is the management of aortic stenosis?
Mild-moderate/no symptoms - Observe Severe on echo + symptoms - Replace valve - Open operation: aortic valve replacement - Transcatheter aortic valve implant (TAVI)
41
What are the causes of aortic regurgitation?
``` Aortic leaflet damage - Endocarditis - Rheumatic fever Aortic root dilated > leaflets don't close - Marfan's syndrome - Aortic dissection - Collagen vascular disorders - Syphilis ```
42
What are the symptoms of aortic regurgitation?
Even severe AR causes no symptoms unless LV decompensates Then symptoms of heart failure - SOB - Ankle oedema
43
What are the signs of aortic regurgitation?
Collapsing pulse Wide pulse pressure Early diastolic murmur
44
What is the management of aortic regurgitation?
Severe - Follow-up with echocardiography every 6-12 months When echo indicates early LV decompensation = increased LV size, decreased LV function - Trigger for operation - Before symptoms occur
45
What are the causes of mitral regurgitation?
Myxomatous degeneration > mitral valve prolapse Ruptured chordae tendinae > flail leaflet Infective endocarditis Myocardial infarct > ruptured papillary muscle Rheumatic fever Collagen vascular disease Cardiomyopathy > change in ventricular shape
46
What are the symptoms of mitral regurgitation?
Even severe MR doesn't cause symptoms unless LV decompensates Then symptoms of heart failure - SOB - Ankle oedema
47
What are the characteristics of a murmur due to mitral regurgitation?
Pan-systolic Best heard in 5th intercostal space in mid-clavicular line Can radiate to axilla
48
What is the management for mitral regurgitation?
Follow-up with echocardiography every 6-12 months for severe MR When echo indicates early LV decompensation: increased LV size, decreased LV function/pulmonary HTN - Trigger for operation - Mitral valve replacement - Mitral valve repair - Before symptoms occur
49
What are the causes of mitral stenosis?
Rheumatic fever
50
What is the most common lesion due to rheumatic fever?
Mitral stenosis, especially in women
51
What are the symptoms of mitral stenosis?
When severe - SOB - Oedema
52
What are the signs of mitral stenosis?
In severe prolonged MS - Mitral facies = facial flushing - Tapping apex beat - correlates with loud S1
53
What are the characteristics of a murmur due to mitral stenosis?
Diastolic rumbling - best heard with bell
54
What are the complications of mitral stenosis?
``` Atrial dilatation AF Thrombo-embolism Pulmonary congestion and oedema Pulmonary HTN - Chronic hypoxia > pulmonary vasoconstriction Right heart failure ```
55
What is the management for mitral stenosis?
``` Follow-up with echocardiography - Mitral gradient - L atrial size - Pulmonary artery pressure Anticoagulation, especially if AF Treat AF Diuretics Mitral valve intervention ```
56
What are the mitral valve interventions for mitral valve stenosis?
``` Mitral valvotomy - Surgical - Closed = without major open heart surgery - Open - via L atrial incision Balloon valvuloplasty Mitral valve replacement ```
57
What are the causes of tricuspid regurgitation?
Usually response to RV failure - Pulmonary HTN Endocarditis - especially in IVDU Pacemaker lead interference with valve
58
What are the signs of tricuspid regurgitation?
Same as those for RV failure - Peripheral oedema - High JVP - Liver congestion
59
How is tricuspid regurgitation managed?
Diuretics | Tricuspid surgery occasionally needed
60
What is infective endocarditis?
Bacterial infection on heart valve/pacemaker lead
61
What are the common organisms causing infective endocarditis?
Streptococcus viridans Streptococcus bovis Staphylococcus aureus Staphylococcus epidermidis
62
What is the clinical presentation of infective endocarditis?
Fever +/- heart murmur Signs of inflammation/embolisation now rare - Splinter haemorrhages - Osler's nodes
63
How is infective endocarditis diagnosed?
Blood cultures | Echardiogram, especially TOE
64
What do blood results often indicate in infective endocarditis?
Inflammation - High WCC - High ESR - High CRP - Anaemia - Microhaematuria
65
What is the management of infective endocarditis?
``` Specialist team - Cardiologist - Infectious disease physician - Cardiac surgeon Prolonged course of Abx - Via PICC - Often Hospital in the Home Valve replacement surgery - If heart failure/uncontrolled infection ```

MD2 Surgery and Anaesthesia (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions