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MRCP Cardiology > Valvular Disease > Flashcards

Valvular Disease Flashcards

1
Q

When does Rheumatic Fever usually occur?

A

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

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2
Q

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

A

Antibody of Group A strep cell wall reacts with valvular tissue

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3
Q

MAJOR criteria for diagnosis of Rheumatic Fever

A

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

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4
Q

MINOR criteria for Rheumatic Fever

A

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

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5
Q

Management of Rheumatic Fever

A

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

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6
Q

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

A

3 months

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7
Q

What can trigger an acute episode of rheumatic fever?

A

Further Group A strep infection
pregnancy
COCP

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8
Q

Name at least 3 causes of Mitral Regurgitation (MR)

A

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

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9
Q

Symptoms of Mitral regurg

A

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

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10
Q

Signs of MR on examination

A

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

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11
Q

What could you see on the ECG and CXR in MR

A

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

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12
Q

Treatment of MR

A

Treat the AF
Diuretics improve symptoms
Valve replacement if severe

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13
Q

Causes of Mitral Stenosis

A

Rheumatic fever
congential
malignant carcinoid
prosthetic valve

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14
Q

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

A

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

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15
Q

Symptoms of mitral stenosis

A

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

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16
Q

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

A

Hoarseness - recurrent laryngeal nerve compression

Dysphagia - compressing oeseophagus

Bronchial obstruction - compressing left lower lobe

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17
Q

Signs of Mitral Stenosis

A

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

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18
Q

What could you see on ECG and CXR in mitral stenosis

A

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

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19
Q

Management of mitral stenosis

A

Treat AF
Diuretics for symptom control
Balloon valvuloplasty
Valvulotomy
Valve replacement

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20
Q

Causes of aortic stenosis

A

Calcification of valve
bicuspid valve (congenital)
Rheumatic fever

21
Q

Symptoms of Aortic stenosis

A

chest pan
syncope
SOBOE

22
Q

Signs of Aortic stenosis on examination

A

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

23
Q

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

A

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

24
Q

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

A

ECHO

25
Q

Management of aortic stenosis

A

Surgery (prognosis without is poor)

Transcatheter Aortic Valve Replacement (TAVI) if unfit for surgery

26
Q

List some ACUTE and CHRONIC causes of aortic regurgitation

A

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

27
Q

Symptoms of Aortic regurg

A

SOBOE
orthopnoea
PND
Palpitations
Angina
Syncope
CCF

28
Q

Signs of aortic regurg on examination

A

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

29
Q

Corrigans sign (AR)

A

Carotid pulsation

30
Q

Head nodding with heart beat

A

de Musset’s sign

31
Q

Quincke’s sign

A

capillary pulsations in nail beds

32
Q

Name given to severe AR murmur

A

Austin Flint

33
Q

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

A

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

34
Q

Management of Aortic Regurg

A

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

35
Q

When would a patient with Aortic regurg need surgery?

A
  • enlarged ascending aorta
  • increasing symptoms
  • enlarging LV or reduced LV function on ECHO
  • infective endocarditis not responding to medical Tx
36
Q

Name at least 3 causes of tricuspid regurgitation

A

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

37
Q

Symptoms of tricuspid regurg

A

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

38
Q

Signs of TR

A

raised JVP
RV heave
pansystolic murmur
hepatosplenomegaly
jaundice
ascites

39
Q

Mx of Tricuspid regurgitation or stenosis

A

Diuretics for congestion
Valve repair/replacement

40
Q

Causes of Tricuspid Stenosis

A

Rheumatic Fever
Endocarditis
Congenital

41
Q

Symptoms of Tricuspid stenosis

A

Fatigue
Ascites
Oedema

42
Q

Signs of tricuspid stenosis

A

raised JVP
opening SNAP
early diastolic murmur
AF

43
Q

Causes of pulmonary stenosis

A

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

44
Q

Symptoms of pulmonary stenosis

A

SOB
Fatigue
oedema
ascites

45
Q

Signs of pulmonary stenosis

A

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

46
Q

Signs of pulmonary stenosis on ECG/CXR

A

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

47
Q

Main cause of Pulmonary Regurgitation

A

Pulmonary hypertension

48
Q

Signs of pulmonary regurg on examination

A

Descrescendo murmur in early daistole

MRCP Cardiology (10 decks)

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