Valvular Disease Flashcards by Zoe Doak

When does Rheumatic Fever usually occur?

Age 5-15 years
2-4 weeks after Group A Strep infection

How well did you know this?

Not at all

Perfectly

What happens on a cellular level to cause rheumatic fever and valvular damage?

Antibody of Group A strep cell wall reacts with valvular tissue

How well did you know this?

Not at all

Perfectly

MAJOR criteria for diagnosis of Rheumatic Fever

Carditis - high HR, murmur, pericardial rub, CCF, cardiomegaly

Arthritis - multiple large joints

Subcutaneous Nodules - extensor joint surfaces and spine

Erythema marginatum - rash on trunk, thighs, arms

Chorea - LATE sign

How well did you know this?

Not at all

Perfectly

MINOR criteria for Rheumatic Fever

Fever
Raised inflammatry markers
Arthralgia
Long PR interval
Previous diagnosis of Rheumatic Fever

How well did you know this?

Not at all

Perfectly

Management of Rheumatic Fever

Bed rest whilst CRP high
Penicillin
Analgesia
Haloperidol/diazepam if chorea

How well did you know this?

Not at all

Perfectly

How long does an acute episode of rheumatic fever usually last?

3 months

How well did you know this?

Not at all

Perfectly

What can trigger an acute episode of rheumatic fever?

Further Group A strep infection
pregnancy
COCP

How well did you know this?

Not at all

Perfectly

Name at least 3 causes of Mitral Regurgitation (MR)

LV dilatation
Calcification
Rheumatic Fever
Infective endocarditis
Valve prolapse
Papillary muscle rupture
Chorda tendinae rupture
Connective tissue disease - Ehlers Danlos/Marfans
Congenital

How well did you know this?

Not at all

Perfectly

Symptoms of Mitral regurg

SOB
Fatigue
Palpitations
Symptoms of causative factor (e.g. fever)

How well did you know this?

Not at all

Perfectly

Signs of MR on examination

AF
displaced apex beat
pansystolic murmur at apex radiating to axilla
soft S1, split S2

How well did you know this?

Not at all

Perfectly

What could you see on the ECG and CXR in MR

ECG - AF, LVH
CXR - large LA/LV, pulmonary oedema

How well did you know this?

Not at all

Perfectly

Treatment of MR

Treat the AF
Diuretics improve symptoms
Valve replacement if severe

How well did you know this?

Not at all

Perfectly

Causes of Mitral Stenosis

Rheumatic fever
congential
malignant carcinoid
prosthetic valve

How well did you know this?

Not at all

Perfectly

What is the normal size of the mitral valve opening, and what size is it in symptomatic Mitral stenosis?

Normal - 4-6cm
Stenosed and symptomatic <2cm

How well did you know this?

Not at all

Perfectly

Symptoms of mitral stenosis

SOB due to pulmonary hypertension
Haemoptysis
Chronic bronchitis type picture
Palpitations/ chest pain

How well did you know this?

Not at all

Perfectly

In mitral stenosis the LA may be dilated and cause symptoms by compressing surrounding structures. GIve examples

Hoarseness - recurrent laryngeal nerve compression

Dysphagia - compressing oeseophagus

Bronchial obstruction - compressing left lower lobe

How well did you know this?

Not at all

Perfectly

Signs of Mitral Stenosis

Malar flush
AF
tapping apex beat
Palpable S1
RV Heave
Opening SNAP S1
Rumbling mid diastolic murmur

How well did you know this?

Not at all

Perfectly

What could you see on ECG and CXR in mitral stenosis

ECG - AF, RVH, Right axis deviation
CXR - Large LA, pulmonary oedema

How well did you know this?

Not at all

Perfectly

Management of mitral stenosis

Treat AF
Diuretics for symptom control
Balloon valvuloplasty
Valvulotomy
Valve replacement

How well did you know this?

Not at all

Perfectly

Causes of aortic stenosis

Calcification of valve
bicuspid valve (congenital)
Rheumatic fever

Symptoms of Aortic stenosis

chest pan
syncope
SOBOE

Signs of Aortic stenosis on examination

Sow-rising pulse
narrow pulse pressure
LV heave
Aortic thrill
Ejection systolic murmur radiating to carotids

What can be seen on the ECG and CXR of a patient with Aortic Stenosis?

ECG
- LVH
- Left axis deviation
- Poor R wave progression
- LBBB
- Complete AV Block

CXR
- Large left ventricle
- calcified aortic valve may be visible
- post stenotic aortic dilatation

What investigation is diagnostic of aortic stenosis (and most other vavular disease)?

ECHO

Management of aortic stenosis

Surgery (prognosis without is poor) Transcatheter Aortic Valve Replacement (TAVI) if unfit for surgery

List some ACUTE and CHRONIC causes of aortic regurgitation

ACUTE - Infective endocarditis - ascending aortic dissection - chest trauma CHRONIC - congenital - connective tissue disorder - rheumatic fever - vasculitis - Systemic Disease (RA, SLR, Seronegative arthritis) - HTN - osteogenesis Imperfecta

Symptoms of Aortic regurg

SOBOE orthopnoea PND Palpitations Angina Syncope CCF

Signs of aortic regurg on examination

Collapsing pulse wide pulse pressure displaced, hyperdynamic apex beat high pitched, early diatsolic murmur (best heard sat forward in expiration)

Corrigans sign (AR)

Carotid pulsation

Head nodding with heart beat

de Musset's sign

Quincke's sign

capillary pulsations in nail beds

Name given to severe AR murmur

Austin Flint

Describe the findings on ECG and CXR in a patient with aortic regurg

ECG - LVH CXR - cardiomegaly, dilated ascending aorta, pulmonary oedema

Management of Aortic Regurg

reduce systolic hypertension ACEi ECHO every 6-12 months to monitor

When would a patient with Aortic regurg need surgery?

- enlarged ascending aorta - increasing symptoms - enlarging LV or reduced LV function on ECHO - infective endocarditis not responding to medical Tx

Name at least 3 causes of tricuspid regurgitation

RV dilatation (Pulmonary HTN, LV failure, PE) Rheumatic Fever Infective Endocarditis (IVDU) Carcinoid syndrome Congenital Drugs

Symptoms of tricuspid regurg

fatigue Hepatic pain on exertion (due to hepatic congestion) ascites/oedema

Signs of TR

raised JVP RV heave pansystolic murmur hepatosplenomegaly jaundice ascites

Mx of Tricuspid regurgitation or stenosis

Diuretics for congestion Valve repair/replacement

Causes of Tricuspid Stenosis

Rheumatic Fever Endocarditis Congenital

Symptoms of Tricuspid stenosis

Fatigue Ascites Oedema

Signs of tricuspid stenosis

raised JVP opening SNAP early diastolic murmur AF

Causes of pulmonary stenosis

Congenital (Turners, Tetralogy of Fallot) Rubella Rheumatic Fever Carcinoid

Symptoms of pulmonary stenosis

SOB Fatigue oedema ascites

Signs of pulmonary stenosis

raised JVP RV heave ejection click Ejection systolic murmur radiating to LEFT shoulder Wide split S2

Signs of pulmonary stenosis on ECG/CXR

ECG - right axis deviation, RVH, RBBB CXR - promninent pulmonary arteries

Main cause of Pulmonary Regurgitation

Pulmonary hypertension

Signs of pulmonary regurg on examination

Descrescendo murmur in early daistole