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Cardiology > Valves > Flashcards

Valves Flashcards

1
Q

When do you get symptoms with mitral stenosis?

A

Normal valve orifice is 4-6cm2 - symptoms when it decreases to

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2
Q

What are the symptoms of mitral stenosis?

A 
Dyspnoea
Palpitations 
Fatigue 
Chest pain
Haemoptysis and cough
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3
Q

Signs of mitral stenosis x6

A 
Malar flash 
Low-volume pulse 
Tapping apex - non-displaced 
Opening snap 
Loud s1 
Rumbling mid-diastolic murmur (best heard in expiration with patient on their left side)
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4
Q

What are s1 and s2?

A

S1 is closure of mitral and tricuspid valves

S2 is closure of aortic and pulmonary valves

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5
Q

When do you get a loud s1

A

When there is still a lot of pressure on the valves when they come to close
Usually blood has flown into the ventricles and so pressure has decreased
In mitral stenosis - not as much blood can get through therefore no gradual decrease in flow towards end of diastole and valves therefore still at maximum excursion
Also if shortened PR interval and tachycardia - diastolic filling time is shortened

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6
Q

When do you get a soft s1?

A

When diastolic filling time is prolonged (long PR interval)

Or when mitral valve is incompetent - doesn’t close properly - mitral regurge

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7
Q

When do you get a soft s2

A

Aortic stenosis because calcification of the valve

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8
Q

When do you get loud a2?

A

Tachycardia, hypertension

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9
Q

When do you get loud and soft p2?

A

Pulmonary hypertension - loud

Pulmonary stenosis - soft

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10
Q

When do you get splitting of s2?

A

Wide splitting occurs inRBBB, pulmonary stenosis, mitral regurge and ventricular septal defect

Fixed wide splitting - atrial septal defect

Reversed splitting - a2 following p2 - occurs in LBBB, aortic stenosis, right ventricular pacing

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11
Q

What is s3 and when heard?

A

May occur just after s2
From the impact of inflowing blood against a distended or incompliant ventricle in mid-diastole
Best heard with bell over Apex

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12
Q

When do you get high pitched s3?

A

Constrictive pericarditis or restrictive cardiomyopathy

Occurs early

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13
Q

When do you get s4?

A

Occurs just before s1 - represents atrial contraction against a ventricle made stiff by any cause - therefore atria are ejecting blood into a ventricle which cannot expand any further
Eg aortic stenosis or HTN

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14
Q

When do you get an ejection systolic click?

A

Early in systole with bicuspid aortic valves and if hypertension

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15
Q

When do you get mid-systolic click

A

Mitral prolapse

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16
Q

When do you get opening snap?

A

Precedes mid-diastolic murmur of mitral or tricuspid stenosis
Indicates a pliable valve - that can only open partially during rapid filling of mid-diastole

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17
Q

Signs of more severe mitral stenosis

A

Longer murmur

Closer opening snap is to s2

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18
Q

ECG in mitral stenosis

A 
P mitrale (broad and bifid wave) 
Can get RVH and progressive RAD
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19
Q

CXR in mitral stenosis

A

Left atrial enlargement

Pulmonary oedema

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20
Q

Management of mitral stenosis

A

If in AF - warfarin
Diuretics to decrease preload and pulmonary congestion
If sill needed - valve surgery

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21
Q

Complications of mitral stenosis

A

Pulmonary hypertension
Emboli
Pressure from large LA on nearby structures (recurrent laryngeal, bronchus, oesophagus)

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22
Q

Causes of mitral stenosis

A

Mostly rheumatic fever

Rarely congenital or mucopolysaccharidoses

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23
Q

Causes of mitral regurge

A

Functional - LV dilatation
Chordae, annulus or papillary muscle problem
RF, IE
Cardiomyopathy, congenital

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24
Q

Symptoms of mitral regurge

A

Dyspnoea
Fatigue
Palpitations

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25
Q

Signs of mitral regurge x7

A 
AF 
Displaced apex
RV heave 
Soft s1 
Split s2 
Loud p2 
Pansystolic murmur - radiate to Scilla
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26
Q

ECG in mitral regurge

A

AF
P mitrale if in sinus rhythm
LVH

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27
Q

CXR in mitral regurge

A

Big LA and LV

Pulmonary oedema

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28
Q

Management of mitral regurge

A

Control rate if fast AF
Anticoagulation if AF
Diuretics
Surgery if needs be

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29
Q

Causes of mitral valve prolapse and incidence

A

Most common valve abnormality - 5% prevalence

Causes - alone or with other heart defects

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30
Q

Symptoms of mitral prolapse

A

Asymptomatic
Or
Chest pain and palpitations (can also get autonomic symptoms - anxiety, panic attack)

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31
Q

Signs of mitral prolapse

A

Mid systolic click and/Or a late systolic murmur

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32
Q

Complications of mitral prolapse

A

Mitral regurge
Emboli
Arrhythmias
Sudden death

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33
Q

Management of mitral prolapse

A

Beta-blockers can help with pain and palpitations

Surgery if bad

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34
Q

Causes of aortic stenosis

A

Young - bicuspid valve

Old - senile calcification

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35
Q

Presentation of aortic stenosis

A

Triad: syncope, angina and heart failure - usually after 60

Also dizziness

36
Q

Signs of aortic stenosis x8

A 
Slow rising pulse with narrow pulse pressure 
Heaving non-displaced apex beat 
LV heave 
Aortic thrill
Ejection systolic murmur (radiates to carotid) 
Splitting of s2 - severe then reversed 
Quiet a2 
Ejection click or s4
37
Q

ECG in aortic stenosis

A

P mitrale
LVH
LAD - left ant hemiblock, LBBB or complete heart block

38
Q

CXR in aortic stenosis

A

LVH

Post-stenotic dilatation of aorta

39
Q

Management in aortic stenosis

A

Surgery - without it origin sous is poor

40
Q

What is aortic sclerosis and signs?

A

Senile degeneration of valve

Ejection systole murmur but no radiation and normal pulse and normal s2

41
Q

Causes of aortic regurge

A

Acute - IE and more

Chronic - many different systemic things

42
Q

Symptoms of aortic regurge

A 
Dyspnoea 
Orthopnoea 
PND 
Palpitations
Syncope
Angina
43
Q

Signs of aortic regurge

A

Collapsing pulse
Wide pulse pressure
Displaced hyper dynamic apex beat
Early diastolic murmur (expiration with patient sitting forward)

44
Q 
Eponymous signs in aortic regurge
DM do muscular 
Co cow
Qu queens
D dance
T to
A abba
A

De Mussets - head nodding with heart beat
Corrigans sign - carotid pulsation
Quinckes sign - capillary pulsation in nail bed
Duroziezs sign - groin pressing on femoral artery - 2cm distal to stethoscope - diastolic murmur
Traubes sign - pistol shot over femoral arteries

Austin Flint - severe AR

45
Q

ECG in aortic regurge

A

LVH

46
Q

CXR in aortic regurge

A

Cardiomegaly
Dilated ascending aorta
Pulmonary oedema

47
Q

Management of aortic regurge

A

Reduce systolic HTN - ace-I

Surgery if bad

48
Q

Causes of tricuspid regurge

A

Functional - RV dilatation due to pulmonary hypertension caused by LVF
Rheumatic fever
IE (IVDU)
Conventional

49
Q

Symptoms of tricuspid regurge

A 
Fatigue
Hepatic pain
Ascites
Oedema
Dyspnoea + orthopnoea if due to LVF
50
Q

Signs in tricuspid regurge

A

Giant v waves and prominent y descent in JVP
RV Heave
Pan systolic murmur
Jaundice, hepatomegaly (pulsatilla) and ascites

51
Q

Management of tricuspid regurge

A

Treat underlying cause
Diuretics
Replace valve

52
Q

Causes of tricuspid stenosis

A

Main cause is rheumatic fever

Also get mitral or aortic valve disease

53
Q

Symptoms of tricuspid stenosis

A

Fatigue, ascites, oedema

54
Q

Signs of aortic stenosis

A

Giant a wave and slow y descent in JVP
Opening snap
Early diastolic murmur

55
Q

Causes of pulmonary stenosis

A

Usually congenital

Can also be RF

56
Q

Symptoms of pulmonary stenosis

A

Fatigue, ascites, oedema and dyspnoea

57
Q

Signs of pulmonary stenosis

A

Ejection click
Ejection systolic murmur
Widely split s2

58
Q

ECG in pulmonary stenosis

A

P pulmonale - wide p wave
RVH
Rbbb

59
Q

Causes of pulmonary regurge

A

Causes of pulmonary HTN

60
Q

Early diastolic murmur

A

Aortic regurge

61
Q

Displaced apex beat

A

Aortic or mitral regurgitation

62
Q

Ejection systolic murmur

A

Aortic stenosis

63
Q

Mid-diastolic murmur

A

Mitral stenosis

64
Q

Pan systolic murmur

A

Mitral regurge

65
Q

Collapsing pulse

A

Aortic regurge

66
Q

Slow rising pulse

A

Aortic stenosis

67
Q

What valvuloplasty and when used?

A

In mitral or pulmonary stenosis

Balloon catheter inserted across the valve and inflated

68
Q

What is valvotomy

A

Cutting of stenosed valve

69
Q

Difference between mechanical valves and xenografts

A

Mechanical more durable but need lifelong anticoagulation

70
Q

Complications of prosthetic valves

A 
Emboli 
IE
Haemoptysis
Structural valve failure
Arrhythmias
71
Q

When do you consider cardiac transplant

A

When severely curtailing quality of life

And life expectancy not beyond 6-12 months

72
Q

Fever + new murmur

A

IE until proven otherwise

73
Q

Chief cause of IE on normal valve

A

Staph aureus

Acute infection with acute heart failure

74
Q

Risk factors for IE if normal valves

A 
Dermatitis 
IVDU 
Renal failure
Organ transplantation
DM
Post op wounds
75
Q

Cause of IE in abnormal valves and presentation

A

Strep viridans

Sub acute course!!

76
Q

Two types of Endocarditis on prosthetic valves

A

Early - during surgery + poor prognosis

Late - haematogenous

77
Q

Septic signs of IE

A

Septic - fever, rigours night sweats, malaise, weight loss, anaemia, splenomegaly

78
Q

Cardiac signs of IE

A

New murmur or changing pre-existing murmur

Abscess can cause prolonged PR

79
Q

Immune complex deposition signs in IE

A

Vasculitis
Microscopic haematuria
Roth spots - boat shaped retinal haemorrhages
Splinter haemorrhages
Oslers nodes (painful pulp infarcts in fingers or toes)

80
Q

Embolic signs of IE

A

Abscesses (brain, heart, spleen, kidney, gut - lung if right sided)
Or skin - janeways lesions

81
Q

Major criteria for diagnosis IE - duke criteria

A

Positive blood culture (2 separate cultures of persistently +ve)
Endocardium involved - positive echo (vegetation, abscess, dehiscence of prosthetic valve) or new valve regurgitation

82
Q

Minor criteria needed for IE diagnosis - duke criteria

A 
Predisposition
Fever >38
Vascular/immunological signs 
Positive blood culture - doesn't meet major criteria
Echo that doesn't meet major criteria
83
Q

Criteria needed for diagnosis

A

2 major
1 major 3 minor
All 5 minor

84
Q

Anaemia in IE

A

Normochromic, normocytic
Neutrophillia
High ESR and CRP

85
Q

Treatment of IE

A

Antibiotics

86
Q

When surgery in IE

A

If heart failure
Valvular obstruction
Repeated emboli
Abscess

87
Q

Prevention of IE

A

No antibiotic prophylaxis recommended for IE

Cardiology (9 decks)

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