Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 > Right heart valve disease (CV) > Flashcards

Right heart valve disease (CV) Flashcards

1
Q

What is tricuspid stenosis defined by?

A

Rare condition defined by an abnormally elevated pressure gradient across the tricuspid valve during diastolic filling of the RV

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

What does tricuspid stenosis rarely occur in the absence of?

A

Associated rheumatic mitral and/or aortic disease

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

What is a cause of tricuspid stenosis?

A

Rheumatic fever - which almost always occurs with mitral or aortic valve disease

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

What is tricuspid regurgitation?

A

When blood flows backwards through the tricuspid valve - majority during systole, but severely elevated RV filling pressure can be associated with diastolic TR

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

Who can mild/moderate tricuspid regurgitation affect?

A

Mild/moderate tricuspid regurgitation without abnormal valve anatomy, ventricular function, or pulmonary artery pressure is not necessarily abnormal and is estimated to be present in >50% of asymptomatic young adults (incidental findings)

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

What is the most important form of tricuspid regurgitation clinically?

A

Secondary to left-sided cardiac disease, with tricuspid annular dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How can tricuspid regurgitation be classified? (2)

A
  • primary TR - abnormal valve morphology
  • secondary TR - normal valve morphology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some causes of tricuspid regurgitation? (6)

A
  • functional: RV dilatation e.g. due to pulmonary hypertension
  • rheumatic fever (recent sore throat, chorea, polyarthralgia, erythema marginatum)
  • infective endocarditis in IVDU
  • congenital (e.g. Ebstein’s anomaly - malpositioned tricuspid valve)
  • drugs e.g. ergot-derived dopamine agonists
  • other: carcinoid syndrome, trauma, cirrhosis, iatrogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the features of rheumatic fever (valve disease)? (4)

A
  • recent sore throat
  • chorea - sudden uncontrollable jerky movements of arms, legs, facial muscles
  • polyarthralgia - pain in multiple joints
  • erythema marginatum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is pulmonary stenosis?

A

Obstruction of blood flow from RV into pulmonary bed, resulting in a pressure gradient >10mmHg across the pulmonary valve during systole

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

What is a cause of pulmonary stenosis?

A

Usually congenital e.g. Tetralogy of Fallot

Associated with carcinoid heart disease (Hedinger syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is pulmonary regurgitation?

A

Leakage of blood from pulmonary artery back into RV - rare and infrequently symptomatic

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

What causes pulmonary regurgitation?

A

Any cause of pulmonary hypertension / increased pulmonary artery pressure

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

What are the clinical features of tricuspid stenosis? (2)

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

What might you find on examination of tricuspid stenosis?

A
  • elevated JVP with prominent a-wave + jugular pulsations
  • abdominal swelling and discomfort
  • cyanosis or hypoxaemia
  • ascites, hepatomegaly, oedema
  • mid-diastolic murmur at left lower sternal border, louder during inspiration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What murmur would you hear in tricuspid stenosis?

A

Mid-diastolic murmur - at left lower sternal border, louder during inspiration

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

What are the clinical features of tricuspid regurgitation? (10)

A
  • fatigue
  • dyspnoea/breathlessness
  • lower limb oedema
  • palpitations
  • headaches
  • nausea
  • anorexia
  • epigastric pain - worse on exercise
  • jaundice
  • ascites
18
Q

What might you see on examination in tricuspid regurgitation?

A
  • pulse - irregularly irregular if AF
  • inspection - raised JVP with giant v-waves (which may oscillate earlobes) - caused by transmission of high RV pressures into great veins
  • palpation - parasternal heave
  • auscultation - pansystolic murmur (best heard at lower left sternal edge on inspiration - Carvallo sign) + loud P2 component of second heart sound
  • chest examination - signs of pleural effusion, causes of pulmonary hypertension
  • abdominal examination - palpable liver (tender, smooth, pulsatile), ascites, jaundice
  • legs - pitting oedema
19
Q

What murmur would you hear in tricuspid regurgitation?

A

Pansystolic murmur - left lower sternal edge (4th intercostal left parasternal region) on inspiration

20
Q

What are the clinical features of pulmonary stenosis? (6)

A
  • fatigue
  • dyspnoea
  • chest pain
  • ascites
  • oedema
  • ejection systolic murmur
21
Q

What murmur would you hear in pulmonary stenosis?

A

Ejection-systolic murmur with or without a systolic click - loudest over left upper sternal border

Severe/critical PS - long and harsh murmur peaking later in systole
Critical PS - may be soft due to poor cardiac output

22
Q

What murmur would you hear in pulmonary regurgitation?

A

Early diastolic murmur (low-pitched decrescendo along left sternal border)

23
Q

What is the RILE acronym for heart murmurs?

A
  • Right-sided murmurs louder on Inspiration
  • Left-sided murmurs louder on Expiration
24
Q

How can we remember where to auscultate different murmurs?

A

A Place To Meet 22:45

  • Aortic - right 2nd ICS sternal border
  • Pulmonary - left 2nd ICS sternal border
  • Tricuspid - left 4th/5th ICS sternal border
  • Mitral - left 5th ICS, MCL
25
Q

What are some risk factors for tricuspid stenosis? (5)

A
  • 40-59 years
  • Group A Streptococcal (GAS) pharyngitis
  • metastatic carcinoid tumours
  • artificial tricuspid valve
  • IV drug use
26
Q

What are some risk factors for tricuspid regurgitation? (6)

A
  • left-sided heart failure
  • dilated tricuspid annulus
  • rheumatic heart disease
  • permanent pacemaker
  • endocarditis
  • carcinoid heart disease
27
Q

What are the 1st-line investigations for right heart valve disease? (3)

A
  • echocardiogram - transthoracic, with Doppler
  • ECG
  • CXR
28
Q

What might you see on 2D/Doppler echocardiogram in tricuspid stenosis?

A
  • thickened, fused and doming valve leaflets with restricted motion
  • reduced diameter of valve orifice
  • elevated mean tricuspid valve gradient >2mmHg (peak velocity >0.7m/s)
  • RA enlargement with dilated systemic and hepatic veins
29
Q

What would you see in ECG in tricuspid stenosis? (2)

A
  • tall, peaked P-waves in II, III, V1
  • AF
30
Q

What might you see on echocardiogram in tricuspid regurgitation? (3)

A
  • measure extent with Doppler US
  • annular diameter to measure severity
  • may show valve prolapse and RV dilation
31
Q

What might ECG show in pulmonary stenosis?

A
  • mild - normal/mild RAD
  • moderate - RAD + RV conduction delay
  • severe/critical - extreme RAD, R-wave large for age, RA enlargement with tall and peaked P wave in II and V1-V3
32
Q

What might you see in echocardiogram in pulmonary stenosis?

A

Increased transvalvular gradient across pulmonary valve during systole (>10mmHg)

33
Q

What might you see in CXR in pulmonary regurgitation?

A
  • PA dilation with clear lung fields
  • RV dilation
34
Q

What is the general management for tricuspid stenosis? (2)

A
  • diuretics (fluid and sodium restriction + loop diuretic e.g. furosemide)
  • surgical repair
35
Q

What is the specific management for different types of tricuspid stenosis (congenital, carcinoid heart disease, rheumatic fever, IE)?

A
  • congenital - surgery, preoperative alprostadil, postoperative antiplatelet therapy
  • carcinoid heart disease - fluid and sodium restriction + loop diuretic (furosemide) + somatostatin analogue + valve replacement surgery or balloon dilatation
  • rheumatic fever - fluid and sodium restriction + loop diuretic + surgical repair/replacement (severe)
  • infective endocarditis - antimicrobial therapy + surgery
36
Q

What is the general management for tricuspid regurgitation? (2)

A
  • diuretics (for systemic congestion)
  • tricuspid valve repair/annuloplasty or replacement (repair preferred)
37
Q

How do we manage primary and secondary tricuspid regurgitation?

A
  • primary (mild/moderate) - treat underlying cause + follow up + HF management + risk factor modification
  • primary (severe) or secondary - tricuspid valve replacement/annuloplasty, repair if done with mitral valve disease
38
Q

What is the management for pulmonary stenosis?

A
  • mild - observation
  • moderate/severe/critical:
    • 1st line - percutaneous balloon pulmonary valvuloplasty
    • 2nd line - surgical valvuloplasty
  • if respiratory distress/cyanosis - give supplemental oxygen +/- alprostadil first-line
39
Q

How do we manage pulmonary regurgitation?

A
  • medical management of HF
  • severe - inotropic support + pulmonary valve replacement +/- anticoagulation
40
Q

What are some complications of tricuspid stenosis? (3)

A
  • surgical complications
  • bacterial endocarditis
  • prosthetic valve failure
41
Q

What are some complications of tricuspid regurgitation? (6)

A
  • atrial arrhythmia
  • advanced liver disease
  • AV block
  • MI
  • prosthetic valve thrombosis
  • prosthetic valve endocarditis

Year 3 (148 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions