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phase 2 cardio > Valvular Disease > Flashcards

Valvular Disease Flashcards

1
Q

What is the most common valvular defect?

A

Aortic stenosis 2-7% of over65s

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2
Q

What are the causes of aortic stenosis ?

A

Rheumatic heart disease, senile calcification, congenital I.e. Bicuspid valve

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3
Q

What sort of symptoms can you expect in atrial stenosis ?

A

Syncope followed by angina followed by HF also SOB and CP

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4
Q

What signs can you expect to see on examination in someone with AS ?

A

Ejection systolic murmur, loudest on expedition and radiating to carotid arteries (bell)
Slow raising pulse
Signs of left hypertrophy

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5
Q

Name 3 major investigations and findings when diagnosing AS

A

ECG: LEFT hypertrophy, p-mitrale, AV block
Echocardiogram: flow obstruction
CXR: cardio eagle if HF, AORTIC ring calcification, post stenosis dilation of aorta

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6
Q

What is the non-surgical management of AS and how good is it ?

A

Survival 1-3 years
Risk reduction: diet and exercise
Medication: statins, anti-IHD and HTN therapy
Symptom treatment I.e. AF, HF

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7
Q

What are the surgical options of As treatment

A

Transcatheter aortic valve implant(TAVI): good method for frail with 30 day mortality of 5-15%. May be complicated by VT, temponade, stroke, aortic dissection

Aortic valve replacement (AVR): definitive therapy but higher risk

Balloon valvyloplasty: short term solution in patients unfit for surgery

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8
Q

What complications can you expect in AS

A

Sudden death, HF, CCF, pulmonary oedema, infective endocarditis, emboli

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9
Q

What are the causes of aortic regargitation

A

Rheumatic heart disease, congenital, degenerative

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10
Q

What are the symptoms of AR

A

Dyspnoea , Orthopnoea paraxysmal nocturnal dyspnoea palpitations, angina, syncope

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11
Q

What are the major signs of AR

A

Early diastolic decrushendo high peach murmur
Wide pulse pressure
Hypertrophic displaced apex

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12
Q

What are the key investigations for AR

A

ECG: LVH
CXR
ECHO

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13
Q

How would you exacerbate left sided heart murmur?

A

Loudest on expiration

Right sided murmurs are louder on inspiration

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14
Q

What are the major causes of valvular disease

A
  • Rheumatic fever
  • Congenital
  • Except AS: SLE, infective endocarditis
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15
Q

what are the major investigations for valvular heart disease

A

ECG,CXR and ECHO

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16
Q

What does TAVI stands for

A

Transcatheter aortic valve implantation

17
Q

What does AVR stands for

A

Aortic valve replacement

18
Q

what is the management of ARE based on risk assessment

A
  • Severe symptoms => surgery

* Less severe: ECHO every 2 years or more frequently with ↑symptoms

19
Q

what are the indications for surgery in AR

A

symptoms and LVEF

20
Q

what sort of surgery is available for AR

A

aortic valve replacement or repair

21
Q

What is the role of medications in AR

A

manage symptoms

22
Q

what is the prognosis of AR

A
  • If severe => haemodynamic instability
  • LV dilation and HF
  • Mortality in symptomatic patients: 10-20%
23
Q

what are the causes of MS

A
  • Rheumatic fever (the most common cause).
  • Degenerative calcification (elderly).
  • Congenital
  • Rheum: SLE, RA
  • Infective endocarditis (large vegetation)
24
Q

what are the symptosm o MS

A 
•	Dyspnoea (on exercise)
o	Orthopnoea 
o	Paroxysmal nocturnal dyspnoea 
•	Atrial fibrillation/palpitations 
•	Haemoptysis: (chronic bronchitis-like picture)
•	Chest pain 
•	Symptoms of emboly
25
Q

what are the signs of MS

A
  • Malar flash of cheeks (↓CO)
  • Low-volume pulse, AF
  • Rumbling mid-diastolic murmur: on expiration and patient on the left with (bell)
  • Opening snap
  • ↑JVP
  • RV heave and Signs of RV failure
26
Q

what are the investigations for MS and the findings

A
  • ECG: AF, RV hypertrophy, P-mitrale
  • CXR: oedema, LA hypertrophy, valve calcification, prominent pulmonary vessels
  • Echocardiogram: Evaluation of stenosis and pulmonary pressure
27
Q

what is the purpose of medical management of MS

A

symptom control

28
Q

what does PMC stand for and what is it

A

Percutaneous mitral commissurotomy

29
Q

what are the indications for PMC

A

symptomatic patients and with pulmonary hypertension

30
Q

what are the complications of PMC

A

emboli, severe regerg, hemopericardiun

31
Q

what are the complications of untreated MS

A 
Pulmonary hypertension
•	    Dilated left atrium
•	    Atrial fibrillation
•	    Thromboembolic events
•	    Right heart failure
•	    Infective endocarditis
32
Q

what is the prognosis of MS

A
  • 5 year survival in symptomatic patients without valvotomy: 44%
  • No symptoms/minimal 80% at ten years
  • Less than 3 year survival with pulmonary hypertension
33
Q

what are the primary causes of MR

A

IHD, prosthetic valve dysfunction, SLE, Rheumatic fever, congenital

34
Q

what are the secondary causes of MR

A

Idiopathic or ischaemic cardiomyopathy

35
Q

What are the symptoms of MR

A
  • Dyspnoea, Fatigue, Palpitations

* Infective endocarditis

36
Q

What are the signs of MR

A
  • Pansystolic murmur at the apex radiating to axilla
  • AF, Displaced hyperdynamic apex
  • RV heave, Pulmonary hypertension
37
Q

what investigations are useful in diagnosis of MR and what are the results

A
  • ECG: AF, P-mitrale, LVH
  • CXR: left cardiomegaly, calcification, pulmonary oedema
  • Echocardiogram/Doppler echo
  • BNP levels
  • Angiography: CAD disease
38
Q

What is the management for MR

A

Management
Medical: symptoms control
• Rate control and anticoagulation with fast AF

phase 2 cardio (5 decks)

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