Valves/ Infective endocarditis - Disease profiles Flashcards
What is the first heart sound due to?
- Mitral and tricuspid valve closing
- Start of systole
What is the Second heart sound due to?
- Aortic and pulmonary valves closing
- Start of diastole
What is diastolic murmur?
Early - aortic regurgitation
Mid - mitral stenosis
What is systolic Murmur?
Ejection - Aortic stenosis
Pansystolic - mitral regurgitation
What grades hear thrills?
IV, V
What murmur do you hear with the 2nd heart sound splitting?
aortic stenosis
What murmur do you hear with the 4th heart sound?
mitral stenosis
What murmur do you hear with the 3rd heart sound?
aortic regurgitation
What murmur do you hear with systolic clicks?
continuous murmur
What murmur do you hear with Innocent murmurs?
Triscucipside reguritation
What murmur do you hear with mitral regurgitation
Pericardial Rub
Valves that do not open properly are what?
stenosis
Valves that do not close properly are what?
reguritation
Investigations for aortic stenosis
CXR + ECG > left ventricular hypertrophy
Echocardigam
Symptoms of aortic regurgitation
Angina, breathlessness, more develop after LV failure
What is used to help mitral regurgitation? and a backup
Percutaneous→ clips in infancy which show encouraging results
MitraClip if can’t tolerate open heart surgery
Describe innocent murmur
Tend to be quite soft so no thrills or heaves
Only in early systolic murmur
Come on via exercise
A 70-year-old man was successfully thrombolysis for an inferior myocardial infarction two weeks ago and was subsequently discharged five days after the thrombolysis. He has now returned and is re-admitted with symptoms of hypotension, tachycardia, and pulmonary oedema. An echocardiogram shows severe mitral regurgitation.
What is the most likely diagnosis?
Papillary muscle rupture
A 61-year-old female patient is being treated for infective endocarditis in the cardiology ward. She has been on antibiotics for the past 5 days but has suddenly become acutely short of breath whilst mobilising to the toilet. She has a proven mitral valve vegetation on trans oesophageal echocardiogram and s.viridans positive blood cultures from 2 different sites.
On examination she is acutely short of breath and is saturating 94% on 3 litres of oxygen with a respiratory rate of 25 breaths/min, she has bilateral crackles on lung auscultation and her JVP is elevated. Her heart rate is 107 bpm and her blood pressure is 111/63 mmHg with a pan systolic murmur audible at the apex which you think is louder than on previous days. She is afebrile.
What would be your next management step with this patient? and why
Referral for mitral valve replacement
= The above situation represents that of acute mitral regurgitation, likely secondary to a known vegetation present upon this patient’s mitral valve
A 70-year-old woman presents to the cardiology clinic for review following an echocardiogram. Her echocardiogram reports an aortic root diameter of 4.1cm. She is currently asymptomatic.
What would be the most appropriate management of this patient?
3 monthly surveillance
= Reserved for patients with 4.5-5.4cm aortic root dilation.
What is the most sensitive imaging modality for detecting vegetation on the heart valves?
Transoesophageal echocardiogram
Which feature would be an indication for surgical repair in this patient?
Prolonged PR interval on ECG, with evidence of any valve involvement on echocardiogram
A 60-year-old former intravenous drug user presents to his GP with a fever and worsening shortness of breath over the past 3 days. Examination reveals a pan systolic murmur loudest over the lower left sternal edge. Blood cultures grow Streptococcus bovis. A transthoracic echocardiogram (TTE) reveals vegetation on the tricuspid valve.
Which of the following investigations is necessary to investigate the underlying cause of his bacteraemia?
Colonoscopy
Streptococcus bovis infection is associated with colorectal carcinoma; hence a colonoscopy should be performed to rule this out. S. bovis is part of the normal gut flora, and this may indicate haematogenous spread of bacteria from the colon due to breakdown of the gut wall
What is also known as a collapsing pulse and what does that relate to?
Water hammer pulse
= aortic regurgitation
