Lecture: valvular disease

Question 1

What often causes mitral stenosis?

Answer 1

Rheumatic heart disease

Question 2

What causes acute mitral regurgitation?

Answer 2

• infective endocarditis
• Ischaemic heart disease
• Mitral valve prolapse
• Chest trauma

Question 3

What are the morphological changes that occur after mitral valve regurgitation?

Answer 3

Leads to atrial dilation and ventricular hypertrophy

Increased pulmonary pressure (pulmonary oedema)

Question 4

What often causes aortic stenosis?

Answer 4

Old age-related valve degeneration

Question 5

What are the three classic symptoms of aortic stenosis?

Answer 5

1. Angina pectoris (average survival drops to 5 years)
2. Chronic heart failure (1-2 years survival)
3. Syncope or sudden death

Question 6

What can cause venous ulcers?

Answer 6

Varicose veins
Previous DVT
Obesity
Pregnancy
Phlebitis

Question 7

What can cause arterial ulcers?

Answer 7

Diabetes
Hypertension
Smoking
Previous vascular disease

Question 8

What can cause neuropathic diabetic ulcers?

Answer 8

Diabetes
Trauma
Prolonged pressure

Question 9

What can cause pressure ulcers?

Answer 9

Limited mobility

Question 10

Where is the ulcer location of venous ulcers?

Answer 10

Area between the lower calf and the medial malleolus

Question 11

Where is the ulcer location of arterial ulcers?

Answer 11

Pressure points
Toes and feet
Lateral malleolus and tibial areas

Question 12

Where is the ulcer location of diabetic ulcers?

Answer 12

Plantar aspect of the foot
Tip of the toe
Lateral to fifth metatarsal

Question 13

Where is the ulcer location of pressure ulcers?

Answer 13

Bony prominences

Heel

Question 14

What is the ulcer characteristic of venous ulcers?

Answer 14

Shallow and flat margins
Moderate-to-heavy exudate
Slough at base with granulation tissue

Question 15

What is the ulcer characteristic of arterial ulcers?

Answer 15

Punched out and deep, irregular shape, unhealthy wound bed, presence of necrotic tissue, minimal exudate unless infection

Question 16

What is the ulcer characteristic of neuropathic diabetic ulcers?

Answer 16

Deep, surrounded by callus, insensate

Question 17

What is the ulcer characteristic of pressure ulcers?

Answer 17

Deep, often macerated

Question 18

What is the condition of the leg of venous ulcers?

Answer 18

Hemosiderin staining, thickening and fibrosis, eczematous and itchy skin

Limb oedema, normal capillary refill

Question 19

What is the condition of the leg of arterial ulcers?

Answer 19

Thin, shiny skin
Reduced hair growth
Cool skin
Pallor on leg elevation
Absent or weak pulses
Delayed capillary refill

Question 20

What is the condition of the leg of neuropathic diabetic ulcers?

Answer 20

Dry, cracked, insensate, calluses

Question 21

What is the condition of the leg of pressure ulcers?

Answer 21

Atrophic skin, loss of muscle mass

Question 22

What is the treatment for venous ulcers?

Answer 22

Compression therapy
Leg elevation
Surgical management

Question 23

What is the treatment for arterial ulcers?

Answer 23

Revascularisation
Anti-platelet medication
Management of risk factors

Question 24

What is the treatment for diabetic ulcers?

Answer 24

Off-loading of pressure

Topical growth factors

Question 25

What is the treatment for pressure ulcers?

Answer 25

Off-loading of pressure
Reduction of excessive moisture, shear and friction
Adequate nutrition