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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
Signs of mitral regurge x7
``` AF Displaced apex RV heave Soft s1 Split s2 Loud p2 Pansystolic murmur - radiate to Scilla ```
26
ECG in mitral regurge
AF P mitrale if in sinus rhythm LVH
27
CXR in mitral regurge
Big LA and LV | Pulmonary oedema
28
Management of mitral regurge
Control rate if fast AF Anticoagulation if AF Diuretics Surgery if needs be
29
Causes of mitral valve prolapse and incidence
Most common valve abnormality - 5% prevalence | Causes - alone or with other heart defects
30
Symptoms of mitral prolapse
Asymptomatic Or Chest pain and palpitations (can also get autonomic symptoms - anxiety, panic attack)
31
Signs of mitral prolapse
Mid systolic click and/Or a late systolic murmur
32
Complications of mitral prolapse
Mitral regurge Emboli Arrhythmias Sudden death
33
Management of mitral prolapse
Beta-blockers can help with pain and palpitations | Surgery if bad
34
Causes of aortic stenosis
Young - bicuspid valve | Old - senile calcification
35
Presentation of aortic stenosis
Triad: syncope, angina and heart failure - usually after 60 | Also dizziness
36
Signs of aortic stenosis x8
``` 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
ECG in aortic stenosis
P mitrale LVH LAD - left ant hemiblock, LBBB or complete heart block
38
CXR in aortic stenosis
LVH | Post-stenotic dilatation of aorta
39
Management in aortic stenosis
Surgery - without it origin sous is poor
40
What is aortic sclerosis and signs?
Senile degeneration of valve | Ejection systole murmur but no radiation and normal pulse and normal s2
41
Causes of aortic regurge
Acute - IE and more | Chronic - many different systemic things
42
Symptoms of aortic regurge
``` Dyspnoea Orthopnoea PND Palpitations Syncope Angina ```
43
Signs of aortic regurge
Collapsing pulse Wide pulse pressure Displaced hyper dynamic apex beat Early diastolic murmur (expiration with patient sitting forward)
44
``` Eponymous signs in aortic regurge DM do muscular Co cow Qu queens D dance T to A abba ```
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
ECG in aortic regurge
LVH
46
CXR in aortic regurge
Cardiomegaly Dilated ascending aorta Pulmonary oedema
47
Management of aortic regurge
Reduce systolic HTN - ace-I | Surgery if bad
48
Causes of tricuspid regurge
Functional - RV dilatation due to pulmonary hypertension caused by LVF Rheumatic fever IE (IVDU) Conventional
49
Symptoms of tricuspid regurge
``` Fatigue Hepatic pain Ascites Oedema Dyspnoea + orthopnoea if due to LVF ```
50
Signs in tricuspid regurge
Giant v waves and prominent y descent in JVP RV Heave Pan systolic murmur Jaundice, hepatomegaly (pulsatilla) and ascites
51
Management of tricuspid regurge
Treat underlying cause Diuretics Replace valve
52
Causes of tricuspid stenosis
Main cause is rheumatic fever | Also get mitral or aortic valve disease
53
Symptoms of tricuspid stenosis
Fatigue, ascites, oedema
54
Signs of aortic stenosis
Giant a wave and slow y descent in JVP Opening snap Early diastolic murmur
55
Causes of pulmonary stenosis
Usually congenital | Can also be RF
56
Symptoms of pulmonary stenosis
Fatigue, ascites, oedema and dyspnoea
57
Signs of pulmonary stenosis
Ejection click Ejection systolic murmur Widely split s2
58
ECG in pulmonary stenosis
P pulmonale - wide p wave RVH Rbbb
59
Causes of pulmonary regurge
Causes of pulmonary HTN
60
Early diastolic murmur
Aortic regurge
61
Displaced apex beat
Aortic or mitral regurgitation
62
Ejection systolic murmur
Aortic stenosis
63
Mid-diastolic murmur
Mitral stenosis
64
Pan systolic murmur
Mitral regurge
65
Collapsing pulse
Aortic regurge
66
Slow rising pulse
Aortic stenosis
67
What valvuloplasty and when used?
In mitral or pulmonary stenosis | Balloon catheter inserted across the valve and inflated
68
What is valvotomy
Cutting of stenosed valve
69
Difference between mechanical valves and xenografts
Mechanical more durable but need lifelong anticoagulation
70
Complications of prosthetic valves
``` Emboli IE Haemoptysis Structural valve failure Arrhythmias ```
71
When do you consider cardiac transplant
When severely curtailing quality of life | And life expectancy not beyond 6-12 months
72
Fever + new murmur
IE until proven otherwise
73
Chief cause of IE on normal valve
Staph aureus | Acute infection with acute heart failure
74
Risk factors for IE if normal valves
``` Dermatitis IVDU Renal failure Organ transplantation DM Post op wounds ```
75
Cause of IE in abnormal valves and presentation
Strep viridans | Sub acute course!!
76
Two types of Endocarditis on prosthetic valves
Early - during surgery + poor prognosis | Late - haematogenous
77
Septic signs of IE
Septic - fever, rigours night sweats, malaise, weight loss, anaemia, splenomegaly
78
Cardiac signs of IE
New murmur or changing pre-existing murmur | Abscess can cause prolonged PR
79
Immune complex deposition signs in IE
Vasculitis Microscopic haematuria Roth spots - boat shaped retinal haemorrhages Splinter haemorrhages Oslers nodes (painful pulp infarcts in fingers or toes)
80
Embolic signs of IE
Abscesses (brain, heart, spleen, kidney, gut - lung if right sided) Or skin - janeways lesions
81
Major criteria for diagnosis IE - duke criteria
Positive blood culture (2 separate cultures of persistently +ve) Endocardium involved - positive echo (vegetation, abscess, dehiscence of prosthetic valve) or new valve regurgitation
82
Minor criteria needed for IE diagnosis - duke criteria
``` Predisposition Fever >38 Vascular/immunological signs Positive blood culture - doesn't meet major criteria Echo that doesn't meet major criteria ```
83
Criteria needed for diagnosis
2 major 1 major 3 minor All 5 minor
84
Anaemia in IE
Normochromic, normocytic Neutrophillia High ESR and CRP
85
Treatment of IE
Antibiotics
86
When surgery in IE
If heart failure Valvular obstruction Repeated emboli Abscess
87
Prevention of IE
No antibiotic prophylaxis recommended for IE

Cardiology (9 decks)

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