murmur

Question 1

symptoms of aortic stenosis

Answer 1

chest pain, SOB, syncope (esp on exercise)

Question 2

what type of murmur is aortic stenosis

Answer 2

ejection systolic - radiates to carotids

Question 3

what manouvre decreases aortic stenosis

Answer 3

valsava

Question 4

features of severe aortic stenosis (5)

Answer 4

narrow pulse pressure // slow rising pulse // soft or absent S2 // S4 // thrill // LV hypertrophy

Question 5

causes of aortic stenosis (5)

Answer 5

calcification // bicuspid aortic valve // williams syndrome // post-rhemuatic // HOCM

Question 6

most common cause of aortic stenosis in 65+

Answer 6

calcification

Question 7

most common cause of aortic stenosis in <65

Answer 7

bicuspid aortic valve

Question 8

what is treatment for asymptomatic aortic stenosis

Answer 8

observe

Question 9

what feature of asymptomatic aortic stenosis may warrent treatment

Answer 9

valvular gradient >40 mmHg + features of LV systolic dysfunction

Question 10

mx for aortic stenosis

Answer 10

surgical valve replacement in fit patients // catheter in unwell // (balloon children)

Question 11

most common murmur

Answer 11

aortic stenosis

Question 12

RF mitral regurg

Answer 12

female, low BMI, age, renal dsyfunction, previous MI, previous mitral disease, collagen disorder

Question 13

causes of mitral regurg (5)

Answer 13

following coronary artery disease or post MI // mitral valve prolapse // endocarditis // rheumatic fever // congenital

Question 14

murmur of mitral regurg

Answer 14

panysystolic ‘blowing’ // loudest in apex // S1 quiet, S2 may split

Question 15

ECG mitral regurg

Answer 15

broad p wave

Question 16

imaging for mitral regurg

Answer 16

CXR: cardiomegaly // echo

Question 17

medical mx mitral regurg (5)

Answer 17

nitrates // diuretics // positive inotropes // balloon pump // ACEi for HF

Question 18

surgery for mitral regurg

Answer 18

1st = repaire // 2nd = artificial or pig

Question 19

causes mitral stenosis

Answer 19

RHEUMATIC FEVER

Question 20

symptoms mitral stenosis (5)

Answer 20

SOB // haemoptysis // malar flush (in cheeks) // Afib // weak pulse

Question 21

murmur mitral stenosis

Answer 21

mid diastolic (expiration) // loud S1 (snap)

Question 22

severe murmur MS

Answer 22

increased length // opening snap becomes closer to S2

Question 23

imaging mitral stenosis

Answer 23

CXR = LA enlarged // echo

Question 24

mx for mitral stenosis with AF

Answer 24

warfarin

Question 25

mx asymptomatic mitral stenosis

Answer 25

monitor + echos

Question 26

mx symptomatic mitral stenosis

Answer 26

surgery - balloon or replacement

Question 27

what causes valve disease –> aortic regurg

Answer 27

rheumatic fever! // calcified / endocarditis // bicuspid valve // SLE or RA

Question 28

what causes aortic root disease –> aortic regurg

Answer 28

marfans or EDS // bicuspid aortic valve // dissection // hypertension // syphilis

Question 29

murmur aortic regurg

Answer 29

early diastolic

Question 30

signs aortic regurg

Answer 30

wide pulse pressure // collapsing pulse // quinckes sign (nailbed pulse) // De Musset’s sign (head bobbing)

Question 31

invx aortic regurg

Answer 31

echo

Question 32

mx aortic regurg

Answer 32

(mx for HF) // surgery if severe

Question 33

what causes tricuspid regurg

Answer 33

RV infarction // COPD // rheumatic heart // endocarditis (IVDU)

Question 34

murmur tricuspid regurg

Answer 34

pansystolic // JVP // pulsatile hepatomegaly // left parasternal heave

Question 35

what can cause mitral valve prolapse

Answer 35

congenital heart disease // cardiomyopathy // Turners, marfans, fragile X // polycystic kidneys // WPW

Question 36

symptoms mitral valve prolapse

Answer 36

paliptations // mid systolic click (squatting) // late systolic click (standing)

Question 37

biggest con of biological heart valve

Answer 37

degeneration

Question 38

what medication given for biological heart valves

Answer 38

aspirin long term // no need for anticoag (maybe warfarin 3 months)

Question 39

biggest con mechanical valve

Answer 39

thrombosis and life long coag