Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CardioResp > Valvular disease > Flashcards

Valvular disease Flashcards

1
Q

Which murmurs are systolic

A

Aortic stenosis

Mitral regurg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What causes aortic stenosis

A

Bicuspid aortic valve
age related calcification
Rheumatic fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How would aortic stenosis present

A 
Exertional dyspneoa 
Syncope
Exertional angina 
Chest pain 
Dizziness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the signs on examination in aortic stenosis

A 
Pulse:
Slow rising pulse 
low volume with narrow pulse pressure 
Palpation:
heaving apex beat 
aortic thrill
Auscultation:
Ejection systolic murmur 
Radiating to carotids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What may be seen on CXR in a patient with aortic stenosis

A

Relatively small heart
Dilated ascending aorta - post stenotic dilation
Calcified aortic valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What might an ECG show in a patient with aortic stenosis

A

Left ventricular hypertrophy
Left ventricular strain pattern - depressed ST segments and T wave inversion in leads oreintated towards the left ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is aortic stenosis treated

A

Valve replacement

If not fit for surgery - TAVI - transcatheter aortic valve implantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which investigations would be done in suspected aortic stenosis

A

Bedside obs: HR, BP
ECG
CXR
Echo - diagnostic - shows ejection fraction , and strucutre of heart and if there is any Lv dysfunction, valve area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is aortic sclerosis

A

Senile degeneration of aortic valve

Ejection systolic murmur but no radiation to carotids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the causes of mitral regurgitation

A

Prolapsing mitral valve
Rheumatic MR - cusps are shrunken and fibrotic
Papillary muscle rupture
Cardiomyopathy
Connective tissue disorders - Marfans, Ehlers Danlos, Osteogenesis imperfecta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How might mitral regurg present

A

May be asymptomatic
Severe MR - Dilated LV - HF –> exertional dyspneoa
Acute MR (papillary muscle rupture) -> rapid pulmonary oedema –> emergency valve repair - SOB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What would be found upon examination of a patient with MR

A

Pulse - sinus rhythm
Face - Malar flush
Palpation - displaced apex beat (volume overload) Palpable thrill
Auscultation - Pansystolic murmur that radiates to axilla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What might be seen on CXR in Mitral Regurg

A

Cardiomegaly - due to left atrial and let ventricle enlargement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What would be the features on ECG if a patient had MR

A

Bifid P Waves

Left ventricular hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What happens in Aortic regurg

A

Reflux of blood from aorta to LV during systole so cardiac output drops
for cardiac output to be maintained total volume pumped into aorta must increases there for LV increase - left ventricula hypertrophy (eccentric) - the chamber gets bigger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What causes aortic regurg

A 
Rheumatic fever 
Bicupid valve
Aortic root dilation 
infective endocarditis 
Marfans 
Tertiary syphilis
17
Q

How does aortic regurg present

A

Dyspneoa on exertion

Syncope

18
Q

What would be found on examination in a patient with aortic Regurgitation

A

Pulse - collapsing pulse and wide pulse pressure
Quinkes sign - pulsating capillaries in nailbed
De Mussets sign - Head nodding with each beat
Pistol shot femorals - a sharp bang heard on auscultation over femorals in time with each heart beat
Palpation - Displaced beat
Auscultation- High pitched early diastolic murmur best heard at left sternal edge in 4th ICS with patient leaning forward and expiring

19
Q

What would an ECG show in a patient with aortic regurgitation

A

left ventricular hypertrophy

20
Q

What are the effects of mitral stenosis

A

High LA pressure -> pulmonary venous HTN –> Pulmonary arterial HTN –> RV hypertrophy (left parasternal heave) –> tricuspid regurg –> R sided heart failure - raised JVP, oedema and ascites

21
Q

What are the causes of mitral stenosis

A

50% have a hx of rheumatic fever or chorea

Old age and calcification

22
Q

What are the signs of mitral stenosis

A

Pulse - AF, irregularly irregular
Face - Malar flush
Palpation - tapping apex beat due to palpable 1st heart sound
Auscultation - Loud S1 (high LA pressure keeps the valve open until late in diastole)
Opening snap (high pitched sound just after S2)
Rumbling Mid diastolic murmur - best heard with the bell at apex with patient rolled to the left

23
Q

What would you see on CXR

A

Pulmonary oedema

Normal sized heart with enlarged LA

24
Q

What would an ECG show if a patient had mitral stenosis

A

AF

Bifid P waves

25
Q

What is infective endocarditis

A

Microbial infection of

  • normal heart valves
  • Prosthetic valves
  • Endothelial surfaces of the heart
  • congenital defects = ventricular septal defect, patent ductus arteriosus, valve defect
26
Q

Which organisms often cause infective endocarditis

A

Streptococcus viridans

Others: Staph Aureus - from skin infections, abscesses, central lines, IV drug user

27
Q

How might infective endocarditis

A 
Variable presentation
HEART MURMUR AND FEVER
Acute, rapidly progressing or
Subacute/Chronic with non specific symptoms 
- fever
- fatigue 
- Flu like 
- weight loss
- loss of appetite 
- Back pain 
- pleuritic pain

Changing murmur

  • aortic regurg
  • mitral regurg
  • HF
  • Conduction abnormalities

Embolisation

  • Cerebral
  • pulmonary
  • Coronary
  • Renal

Immune vasculitis

  • roth spots - retinal infarcts with surrounding haemorrhage
  • oslers nodes
  • janeway lesions
  • clubbing
  • splinter haemorrhages
  • glomerulonephritis
28
Q

What is the major criteria for diagnosis of infective endocarditis

A

A: positive blood culture for infective endocarditis
- typical organism in 2 separate cultures
OR
- persistent positive culture (3Sets)

B: Evidence of endocardial involvement
- positive echocardiogram (vegetation, abscess, prosthetic valve damage)
or
- new valvular regurgitation

29
Q

What are the minor criteria for diagnosis of infective endocarditis

A

1 predisposition

  1. Fever >38
  2. Vascular/immunological signs
  3. Positive blood culture (but does not meet major criteria)
  4. Positive echo (but does not meet major criteria)
30
Q

What is needed to define infective endocarditis

A

2 Major dukes criteria
1 major and 3 minor
5 minor

31
Q

What is the pathophysiology of infective endocarditis

A
  1. Endothelial damage/damaged valve
  2. platelets and fibrin are deposited
  3. Bacteraemia - delivers bacteria to the surface of the valve
  4. Adherence and colonisation of the bacteria
  5. Fibrin aggregates protect the bacteria vegetation from host defence mechanisms
32
Q

Which investigations are done in suspected infective endocarditis

A 
Bloods 
- FBC 
- U+Es
- LFTs 
- CRP
Blood cultures x3 
CXR
ECG
Echo 
Urine dip
33
Q

What is the treatment for infective endocarditis

A

A-E assesment
if hypoxic give oxygen
Involve both cardiology and microbiology
Empirical treatment is: Benzylpenicillin aand Gentamicin - 4 weeks IV

34
Q

Who is more at risk of developing infective endocarditis

A

Structural congenital heart disease
Acquired valve disease
Prosethetic valves
Previous endocarditis

35
Q

What should be explained to a patient about prevention of infective endocarditis

A

No longer give prophylactic abx
importance of maintaining good oral health
Tell them the symptoms and whne to seek advice should this happen
Risks of undergoing invasive procedures including body piercing or tattoing

CardioResp (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions