Valve Disease Flashcards
Aortic Stenosis
- murmur?
- radiates where?
- how do you enhance murmur?
- classic triad of what symptoms?
- most common cause?
- what is diagnostic test?
- ejection systolic murmur
- carotids
- sit forwards: end expiration
- angina, syncope and HF
- senile calcification
- ECHO
Aortic Regurgitation
- murmur?
- enhanced?
- causes: acute and chronic?
- symptoms?
- signs?
- early diastolic
- sit forwards in end expiration
- acute causes: IE,
- chronic causes: CTD, rheumatic fever, marfan’s
- exertional dyspnoea, PND, orthopnoea
- collapsing pulse
Mitral Stenosis
- murmur?
- symptoms?
- signs?
- enhance?
- causes?
- mid diastolic murmur
- dyspnoea, fatigue and haemoptysis
- malar flush
- apex: end expiration
- rheumatic fever, congenital
Mitral Regurgitation
- murmur?
- symptoms?
- causes?
- pan systolic murmur
- dyspnoea, fatigue
- mitral valve prolapse, LV dilatation, Post-MI
A 62-year-old man comes for review. In the past month he has had two episodes of ‘passing out’. The first occurred whilst going upstairs. The second occurred last week whilst he was getting out of a swimming pool. There were no warning signs prior to these episodes. He was told by people who witnessed the episode last week that he was only ‘out’ for around 15 seconds. He reports feeling ‘groggy’ for only a few seconds after the episode. On examination pulse is 90 / minute, blood pressure 110/86 mmHg, his lungs are clear and there is a systolic murmur which radiates to the carotid area. Which one of the following investigations should be arranged first?
24 hour ECG monitor
Echocardiogram
CT head
Carotid doppler
Echocardiogram
The systolic murmur may be a pointer to aortic stenosis (AS). Syncope is a late sign and typically occurs on exertion in patients with AS
how can you distinguish between aortic regurgitation and aortic stenosis using pulse pressure?
AS: narrow pulse pressure
AR: wide pulse pressure
A 65-year-old man is found to have an ejection systolic murmur and narrow pulse pressure on examination. He has experienced no chest pain, breathlessness or syncope. An echo confirms aortic stenosis and shows an aortic valve gradient of 30 mmHg. How should this patient be managed?
routine aortic valve replacement
anticoagulation
aortic valvuloplasty
regular cardiology outpatient review
regular cardiology outpatient review
Aortic stenosis management: AVR if symptomatic, otherwise cut-off is gradient of 40 mmHg
No action should be taken at present as he is currently asymptomatic. If the aortic valve gradient > 40 mmHg or there is evidence of significant left ventricular dysfunction then surgery is sometimes considered in selected asymptomatic patients
A 68-year-old man with a past history of aortic stenosis is reviewed in clinic. Which one of the following features would most guide the timing of surgery?
symptomatic
aortic valve gradient of 36mmHg
pulse pressure
LV ejection fraction
symptomatic
Aortic stenosis management: AVR if symptomatic, otherwise cut-off is gradient of 40 mmHg
What determines if someone is treated for aortic stenosis?
Aortic stenosis management: AVR if symptomatic, otherwise cut-off is gradient of 40 mmHg
which murmur has a slow rising pulse?
Aortic stenosis
An elderly man with aortic stenosis is assessed. Which one of the following would make the ejection systolic murmur quieter?
LV systolic dysfunction
mixed aortic valve disease
expiration
anaemia
LV systolic dysfunction
Left ventricular systolic dysfunction will result in a decreased flow-rate across the aortic valve and hence a quieter murmur
A 66-year-old man presents with shortness-of-breath on exertion. On examination his blood pressure is 128/76 mmHg, pulse 78 / min and regular. Auscultation of his chest reveals an early diastolic murmur. Which one of the following conditions is most associated with this kind of murmur?
MS
AS
AR
MR
AR
A 35-year-old Singaporean female attends a varicose vein pre operative clinic. On auscultation a mid diastolic murmur is noted at the apex. The murmur is enhanced when the patient lies in the left lateral position.
A. Pulmonary stenosis B. Mitral regurgitation C. Tricuspid regurgitation D. Aortic stenosis E. Mitral stenosis F. Aortic sclerosis
Mitral stenosis
A 22-year-old intravenous drug user is found to have a femoral abscess. The nursing staff contact the on call doctor as the patient has a temperature of 39oC. He is found to have a pan systolic murmur loudest at the left sternal edge at the 4th intercostal space.
A. Pulmonary stenosis B. Mitral regurgitation C. Tricuspid regurgitation D. Aortic stenosis E. Mitral stenosis F. Aortic sclerosis
Tricuspid regurgitation
ntravenous drug users are at high risk of right sided cardiac valvular endocarditis. The character of the murmur fits with a diagnosis of tricuspid valve endocarditis.
An 83-year-old woman is admitted with a left intertrochanteric neck of femur fracture. On examination the patient is found to have an ejection systolic murmur loudest in the aortic region. There is no radiation of the murmur to the carotid arteries. Her ECG is normal.
A. Pulmonary stenosis B. Mitral regurgitation C. Tricuspid regurgitation D. Aortic stenosis E. Mitral stenosis F. Aortic sclerosis
aortic sclerosis
The most likely diagnosis is aortic sclerosis. The main differential diagnosis is of aortic stenosis, however as there is no radiation of the murmur to the carotids and the ECG is normal, this is less likely.
