Valvular Disease Flashcards

1
Q
Mitral Stenosis
Causes
Presentation
Signs
Tests 
Management
A

Rheumatic, congenital etc
Symptoms begin when orifice is >2cm2: dyspnoea, fatigue, palpitations, chest pain, systemic emboli.
Signs: malar flush on cheeks (due to decrease CO); low-volume pulse; AF; TAPPING, NON-DISPLACED APEX BEAT; loud S1; opening snap; rumbling, MID DIASTOLIC murmur.
Tests: ECG; CXR; Echo is diagnostic.
Management: if AF, rate control; anticoagulate with warfarin; diuretic to reduce preload & pulmonary venous congestion.

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2
Q
Mitral Regurgitation
Causes
Symptoms & signs
Tests
Echo?
Management
A

Causes: function (LV dilatation); annular calcification (elderly); rheumatic fever; infective endocarditis.
S&S: dyspnoea; fatigue; palpitations; infective endocarditis; AF; DISPLACED, HYPERDYNAMIC APEX; RV heave; PANSYSTOLIC murmur at APEX, radiating to AXILLA.
Tests: ECG; CXR; Echo - to assess LV function & aetiology.
Management: control rate if fast AF; anticoagulate if AF/Hx of embolism; diuretics to improve symptoms; surgery for deteriorating symptoms.

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3
Q
Mitral Valve Prolapse
Epidemiology
What does it tend to occur with if not alone?
Symptoms & signs
Tests 
Rx
Complications
A

Most common valvular abnormality.
Occurs alone or with: ASD; patent ductus arteriosus; cardiomyopathy; Turner’s syndrome; Marfan’s syndrome; osteogenesis.
Symptoms: asymptomatic or atypical chest pain & palpitations.
Symptoms: mid-systolic click.
Tests: Echo is diagnostic; ECG may show T wave inversion.
Rx: B-blocker may help palpitations & chest pain; if symptoms are severe, surgery may be needed,
Complications: Mitral regurgitation; cerebral emboli; arrhythmias; sudden death.

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4
Q
Aortic Stenosis
Causes 
Presentation (classic triad?)
Signs 
Tests 
Differential
Management
A

Causes: senile calcification is the commonest; congenital; rheumatic.
Presentation: always think AS is elderly with chest pain, exertional dyspnoea or syncope. Classic triad is angina, syncope and heart failure.
Signs: SLOW RISING PULSE with narrow pulse pressure; heaving, NON DISPLACED APEX BEAT; LV heave; aortic thrill; ejection systolic murmur (heard at the base, sternal edge and aortic area, RADIATING TO THE CAROTIDS.
Tests: ECG - p-mitrale, LVH etc; CXR - LVH, calcified aortic valve; echo is diagnostic.
Differential: hypertrophic myopathy.
Management - prognosis is poor without surgery; surgical replacement is curative; if patient is not fit for surgery, percutaneous valvuloplasty/replacement may be performed.

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5
Q

Aortic Sclerosis
How does it occur?
Describe the murmur.

A

Caused be senile degeneration of the valve.

EJECTION SYSTOLIC murmur, no carotid radiation, normal pulse.

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6
Q
Aortic Regurgitation
Acute & chronic causes
Symptoms
Signs 
Tests 
Management
A

Acute: infective endocarditis; ascending aortic dissection; chest trauma.
Chronic: congenital; connective tissue disorders; (Marfan’s syndrome, Ehlers-Danlos); rheumatic fever; Takayasu arteritis.
Symptoms: exertional dyspnoea, orthopnoea; PND; palpitations; angina; syncope.
Signs: COLLAPSING (water hammer) pulse; DISPLACED, HYPERDYNAMIC apex beat; Corrigan’s sign - carotid pulsation; de Musset’s sign - head nodding with each heart beat etc.
Tests - ECG, CXR - cardiomegaly; dilated ascending aorta; pulmonary oedema; Echo is diagnostic.
Management: main goal is to reduce systolic hypertension; ACEI are helpful; monitor every 6-12 months; may need surgery to replace the valve.

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7
Q
Tricuspid Regurgitation 
Causes
Symptoms
Signs 
Management
A

Causes: functional (RV dilatation e.g. due to pulmonary hypertension); rheumatic fever; infective endocarditis (think IV drug users); congenital.
Symptoms: fatigue; hepatic pain on exertion; ascites.
Signs: Giant V waves and prominent Y descendant in JVP; ; RV heave; pansystolic murmur; best heard at lower sternal age on inspiration.
Management: treat underlying cause; drugs - diuretics, digoxin, ACEI; valve replacement.

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8
Q
Tricuspid Stenosis
Causes
Symptoms 
Signs 
Diagnosis
Treatment
A
Causes: rheumatic fever. 
Symptoms: fatigue, ascites, oedema. 
Signs: giant A wave and slow Y descent in JVP; opening snap; early diastolic murmur heard at left sternal edge on inspiration. 
Diagnosis: echo. 
Treatment: diuretics, surgical repair.
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9
Q
Pulmonary Stenosis
Causes
Symptoms
Signs
Tests
Treatment
A

Causes: usually congenital (Turners syndrome, Fallots tetraology etc); rheumatic; carcinoid.
Symptoms: dyspnoea; fatigue; oedema; ascites.
Signs: ejection click; ejection systolic murmur.
Tests: ECG; CXR; cardiac cathaterisation is diagnostic.
Treatment: pulmonary valvuloplasty or valvotomy.

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10
Q

Pulmonary Regurgitation
Cause
Describe murmur

A

Caused by any cause of pulmonary hypertension.

A decrescendo murmur is heard in early diastole at the left sternal edge.

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11
Q
Rheumatic Fever
Epidemiology
Jones Criteria for Diagnosis
Management
Prognosis
Secondary prophylaxis
A

Common in developing countries; peak incidence 5-15 years; tends to recur unless prevented.
Diagnosis
- Evidence of group A B-haemolytic strep infection; positive throat culture (usually gone by the time symptoms appear)
- Carditis: tachycardia, murmurs, pericardial rub, CCF, cardiomegaly
- Arthritis: migratory polyarthritis, usually affecting larger joints
- Subcutaneous nodules: small, painless nodules on extensor surfaces of joints & spine
- Erythema marginatum: rash in trunk, thighs & arms
Management
- Bed rest until CRP normal for 2 weeks (may be 3 months)
- Benzylpenicillin IV, then penicillin oral
- Analgesia - aspirin
- Immobilise joints in severe arthritis
Prognosis - 60% with carditis develop rheumatic heart disease.
Secondary prophylaxis is penicillin.

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12
Q

What is the most common causative organism in post rheumatic calcified aortic valve endocarditis?

A

Streptococcus viridans

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13
Q

What is the most common causative organism in patients with endocarditis from a prosthetic valve replacement?

A

Staphylcoccus aureus

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14
Q

Left atrial enlargement is a risk factor for developing what?

A

AF

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15
Q

What clinical finding would you expect to find alongside congenital coarctation of the aorta?

A

Notching of the inferior margins of the ribs, caused by enlarged intercostal arteries

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16
Q

What is the best place to auscultate if there is pre subclavian coarctation of the aorta?

A

Left of the inter-scapular area

17
Q

What is low volume pulse associated with?

A

Mitral stenosis

18
Q

What is left subclavicular thrill associated with?

A

Patent ductus arteriosus

19
Q

What is wide pulse pressure associated with?

A

Aortic regurgitation or patent ductus arteriosus

20
Q

Which murmurs are associated with inspiration and which with expiration?

A

Left sided on expiration

Right sided on inspiration

21
Q

What is the fourth heart sound associated with?

A

Atrial contraction - always pathological

22
Q

What is the third heart sound associated with?

A

Rapid ventricular filling

23
Q

What kind of murmur is dilated cardiomyopathy likely to show?

A

Mitral regurgitation

24
Q

What murmur can come secondary to endocarditis?

A

Aortic regurgitation

25
Q

What kind of murmur does patent ductus arteriosus cause?

A

Continuous machinery murmur loudest during systole

26
Q

What is the most common cardiac murmur secondary to rheumatic fever?

A

Mitral stenosis

27
Q

Which valve is a JVP “v” wave associated with?

A

Tricuspid

28
Q

What does an early opening snap suggest?

A

Mitral stenosis

29
Q

What is an early systolic ejection click associated with?

A

A bicuspid aortic valve