Valve Disease

Question 1

What is a cardiac murmur?

Answer 1

Noise due to turbulent blood flow within the heart

Question 2

Diastolic murmurs are in time with the carotid pulse. True/False?

Answer 2

False

Systolic murmurs are in time with the carotid pulse

Question 3

What are the 5 steps for describing murmurs?

Answer 3

Systole or diastole?
Which type of murmur?
Where is it best heard?
Does it radiate?
What is the grade?

Question 4

Where do aortic murmurs tend (but not always) radiate to?

Answer 4

Carotids

Question 5

Where do mitral murmurs tend (but not always) radiate to?

Answer 5

Axilla

Question 6

Where do tricuspid murmurs tend to radiate?

Answer 6

Nowhere!

Question 7

What is a thrill?

Answer 7

Palpable murmur

Question 8

What is a heave?

Answer 8

Palpable sensation due to ventricular stress/hypertrophy

Question 9

Which murmurs, left or right sided, are louder on inspiration?

Answer 9

Right sided

Question 10

Name the main non-invasive investigation for diagnosing cardiac murmurs

Answer 10

Echocardiography

Question 11

Name an invasive investigation for diagnosing cardiac murmurs

Answer 11

Cardiac catheterisation

Question 12

What are the main causes of aortic stenosis?

Answer 12

Congenital bicuspid valve
Degeneration/calcification with age
Rheumatic disease

Question 13

Can aortic stenosis patients be asymptomatic?

Answer 13

Yes

Question 14

What are some symptoms of aortic stenosis?

Answer 14

Breathlessness
Chest pain
Dizziness[less cardiac output]

Question 15

What are some signs of aortic stenosis?

Answer 15

Slow-rising pulse
Heaving apex
Ejection systolic
Radiates to carotid

Question 16

Name some treatment for aortic stenosis

Answer 16

Valve replacement
Balloon valvotomy
TAVI (valve implantation)

Question 17

What are the main causes of mitral regurgitation?

Answer 17

Rheumatic disease
Myxoma in younger people
Endocarditis
Chorda rupture

Question 18

What are some signs of mitral regurgitation?

Answer 18

Displaced apex
Pansystolic
Radiates to axilla

Question 19

Name some treatment for mitral regurgitation

Answer 19

Valve replacement

Diuretics, ACEi

Question 20

What is the main cause of mitral stenosis?

Answer 20

Rheumatic disease

Question 21

What are some symptoms of mitral stenosis?

Answer 21

Breathlessness
Palpitations
Fatigue

Question 22

What are some signs of mitral stenosis?

Answer 22

Malar flush
Tapping apex
Mid-diastolic rumbling

Question 23

Name some treatment for mitral stenosis

Answer 23

Valve replacement
Balloon valvuloplasty
Diuretics, B blocker, digoxin

Question 24

What are the main causes of aortic regurgitation?

Answer 24

Endocarditis
Connective tissue disorders (SLE, rheumatoid)
Marfan’s syndrome

Question 25

What are some symptoms and signs of aortic regurgitation?

Answer 25

``` SOB Collapsing pulse Displaced apex Early diastolic Wide pulse pressure ```

Question 26

What does the 1st heart sound represent?

Answer 26

Closure of mitral and tricuspid valves | Beginning of systole

Question 27

What does the 2nd heart sound represent?

Answer 27

Closure of aortic and pulmonary valves | End of systole, beginning of diastole

Question 28

Is splitting of the 2nd heart sound physiological?

Answer 28

Only during inspiration - reduced intrathoracic pressure which increases venous return to the right side of the heart = prolonged ventricular ejection time

Question 29

Is a 3rd heart sound physiological?

Answer 29

Only in healthy young adults - represents acceleration and de-acceleration of blood during early passive filling of the ventricle

Question 30

Is a 4th heart sound physiological?

Answer 30

No - refer for ECHO. Represents atrial contraction and rapid blood flow into a less compliant ventricle

Question 31

What are some causes of an innocent heart murmur?

Answer 31

Fever Thyrotoxicosis Pregnancy Anaemia

Question 32

Innocent cardiac murmurs are always...

Answer 32

Systolic

Question 33

Which murmurs are described as systolic?

Answer 33

Aortic stenosis and mitral regurgitation - occur in time with 1st heart sound and carotid pulse

Question 34

Which murmurs are described as diastolic?

Answer 34

Mitral stenosis - just before 1st heart sound Aortic regurgitation - just after 2nd heart sound NOT IN TIME WITH CAROTID PULSE

Question 35

List the classical symptoms suggesting valve disease

Answer 35

``` Chest pain SOB Ankle swelling Collapse/dizzy spells Exertional symptoms ```

Question 36

What classification system is used to assess valve disease?

Answer 36

New York Heart functional classification

Question 37

What are the three types of valvular disease?

Answer 37

Stenosis (don't open properly) Regurgitation (do't close properly) Mixed

Question 38

What are some symptoms of mitral regurgitation?

Answer 38

SOB Peripheral oedema Fatigue

Question 39

Name some treatment for aortic regurgitation

Answer 39

ACEi | LV dilatation valve replacement