Heart valves Flashcards

1
Q

What makes 1st heart sound?
2nd?

A

Closure of mitral / tricuspid

Closure of aortic / pulm

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2
Q

Which heart sounds are loudest on inspiration?
Expiration ?

A

Right in or left out

Right (P+T) - as increase in venous flow into right Atrium

Left (A+M) - increase in pulmonary venous return to Left heart

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3
Q

What are the two loudest systolic murmurs

A

AS / MR

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4
Q

Signs of AS

A

Ejection systolic murmur
Radiates to carotids (sclerosis does not radiate)
If very severe – may not hear S2
Heaving apex beat
Narrow pulse pressure

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5
Q

Signs of MR

A

Pansystolic because it leaks throughout systole
Radiates to Axilla
Displaced apex beat

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6
Q

Usual cause of ejection systolic in >70?
<60?
any other causes?

A

Degenerative
bicuspid
Rheumatic, sclerosis, HCM

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7
Q

Differential of MR ?>

A

VSD

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8
Q

When do you hear AR?
Signs on auscultation?

A

Diastole
Radiates to left sternal edge leaning forwards
Displaced apex

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9
Q

Murmur in MS?
Signs on auscultation?
Cause?
what other things do you often get?

A

Mid-diastolic murmur in apex in left lateral position
Tapping apex
Usually rheumatic cause –
classically get AF and pulmonary HTN due to increased LA pressure

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10
Q

Signs with AR?
Name at least 3

A

Quincke’s – nail bed capillary pulsation
Collapsing pulse
Wide pulse pressure
Corrigan’s sign – pulsatile JVP/neck pulsation
De Mussett’s sign – head nodding
Duroziez’s sign – murmur on femoral artery compression
Traube’s – ‘pistol shot’ sound over femorals

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11
Q

What is the criteria for severe AS?

A

Valve area <1cm
Mean valve gradient >40mmHg
EF <40% (heart failure)

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12
Q

Compare mechanical vs Tissue/bioprothetic valve replacement?

A

Mechanical
Better for younger patients as lasts longer (20-25 years)
Lifelong Warfarin
Will hear ‘click’ as heart sound

Tissue
Older patients with higher bleeding risk
No Warfarin
Lasts ~10 years
Heart sounds normal

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13
Q

Risks of valve replacement?

A

Bleeding
Thromboembolism/Stroke
Haemolysis – mechanical destruction against valve
Infective endocarditis – early usually staph infection from skin and later Strep. viridans
Atrial fibrillation
Bradyarrhythmia

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14
Q

Why is Bradyarrhythmia more common with AV replacement?

A

AV node/bundle of his in aortic root (sinus node in RA at base of SVC).

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15
Q

What is a TAVI?
What is main reason this might not be possible?

A

Transcatheter Aortic Valve Implantation

Cannot if calcified aortic root or calcified access

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16
Q

Pros of TAVI?

A

Less invasive, better recovery
Better if high surgical risk (fraility)
Can be used even if Previous cardiac surgery
Over 75 years

HOWEVER
Long term outcomes uncertain

17
Q

What is BAV ? used when?

A

Balloon Aortic Valvuloplasty

Can be a bridging procedure, if unclear exact cause of Sx

May combine with percutaneous coronary intervention (PCI) or if has cardiogenic shock/very unstable

18
Q

What cardiomyopathy is in regurge? Stenosis?

A

Regurge -> Volume overload -> stretch -> DILATED

Stenosis - Muscular hypertrophy

19
Q

Hiw do you work out ejection fraction

A

(EDV-ESV) / EDV