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Cardioresp > Valvular disease > Flashcards

Valvular disease Flashcards

1
Q

What is an aortic stenosis murmur?

A

Ejection systolic
Crescendo-decrescendo
Radiation to the carotid

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2
Q

What intensifies an aortic murmur?

A

Amyl nitrate
Raising legs
Squatting
Expiration

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3
Q

What reduces an aortic murmur?

A

Valsalva manœuvre

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4
Q

What is De Musset’s sign?

A

Head bobbing with each heart beat

Aortic regurgitation

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5
Q

What is Corrigan’s sign?

A

Exaggerated carotid pulse

Aortic Regurgitation

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6
Q

What is Quinke’s sign?

A

Nailbed pulsation

Aortic regurgitation

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7
Q

What causes aortic regurgitation?

A 
Due to valve disease:
Rheumatic fever
Infective endocarditis
Connective tissue disease 
Bicuspid valve
Due to aortic root:
Aortic dissection
Ankylosing spondylitis
Hypertension
Syphilis
Marfan's 
Ehler-Danlos
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8
Q

What heart sound do you hear when you feel the pulse?

A

S1

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9
Q

Order of valve closure?

A

Left sided valves first, right second - important when they split

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10
Q

Non-pathological murmurs?

A

High flow through normal valve
Pregnancy
Anaemia
Thyrotoxicosis

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11
Q

A fixed split S2?

A

Atrial septal defect

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12
Q

Cause of S4?

A

LVH - pressure wave of atria contracting to push blood into ventricles
Occurs late in diastole
‘A-stiff-wall’

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13
Q

Cause of S3?

A

Blood oscillation in ventricles
Heart failure, constrictive pericarditis, mitral regurgitation
Mid in diastole
‘slosh-ing-IN’

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14
Q

Causes of aortic stenosis?

A

Congenital, bicuspid valve
Rheumatic fever
Calcification - most common

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15
Q

Symptoms of aortic stenosis?

A

Angina
Syncope
Congestive heart failure

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16
Q

What is a thrill?

A

Palpable murmur

Feels like a vibration

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17
Q

Other sounds in aortic stenosis?

A

Systolic ejection click
Soft S2
Splitting of S2 on expiration
S4

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18
Q

Pulse in aortic stenosis?

A

Small and slow rising

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19
Q

Aortic regurgitation murmur?

A

High pitched
Early diastolic
Decrescendo

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20
Q

What is Hill’s sign?

A

Popliteal systolic blood pressure exceeding brachial by >60 mmHG
Aortic Regurgitation

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21
Q

Pulse in aortic regurgitation?

A

Bounding or collapsing

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22
Q

What is mitral stenosis?

A

Thickening of the valve, cusp fusions, and calcium deposition resulting in a narrowed orifice and progressive immobility of the valve cusps

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23
Q

Causes of mitral stenosis?

A 
Aortic valve disease
Rheumatic fever
Congenital
Lutembacher's syndrome
SLE
RA
Carcinoid
Infective endocarditis
Amyloid deposition
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24
Q

Symptoms of mitral stenosis?

A 
Dyspnoea
Cough
Haemoptysis
Weakness
Fatigue oedema
Arrhythmia
Malar flush
25
Q

Mitral stenosis murmur?

A

Mid diastolic rumble
Opening snap
Heard best in left lateral decubitus position

26
Q

Causes of mitral regurgitation?

A 
Aortic valve disease
Rheumatic fever
Myocarditis
Dilated cardiomyopathy
Hypertensive heart disease
Ischaemic heart disease
Infective endocarditis
Rupture of the chordae tendinae
27
Q

What is lutembacher’s syndrome?

A

Acquired mitral stenosis and an atrial septal defect

28
Q

Mitral regurgitation murmur?

A

Pansystolic murmur
Blowing
High pitched
Quiet S1

29
Q

ECG finding in mitral stenosis?

A

Bifid p wave - atrial enlargement

30
Q

Native valve endocarditis pathogens?

A

Streptococci viridans
Enterococci
Staphylococci

31
Q

IV drug user endocarditis pathogens?

A 
Right sided valvular involvement
Staph Aureus
Streptococci
Gram -ve bacilli
Polymicrobial
32
Q

Prosthetic valve endocarditis pathogens?

A

Coagulase negative staphylococci
Staph Aureus
Enterococci
Staphylococcus epidermidis - early infection

33
Q

Major duke criteria?

A 
\+ve blood cultures
Echo findings:
Endocardial vegetation
Perivalvular abscess
Dehiscence of prosthetic valve
New valvular regurgitation
34
Q

Minor duke criteria?

A 
IV drug user
Prosthetic valve
Fever
Arterial emboli
Mycotic aneurysm
Septic pulmonary infarcts
Conjunctival haemorrhages
Janeway lesions
35
Q

What is the dukes criteria?

A

Diagnostic criteria for endocarditis

36
Q

Symptoms of endocarditis?

A 
Fever/chills
Night sweats
Malaise/fatigue
Anorexia/Weight loss
New regurgitant murmur
Janeway lesion
Osler nodes
Roth spots
Rheumatoid factor
Splinter haemorrhages
37
Q

What is a Janeway lesion?

A

Haemorrhagic, macular, painless plaques on palms and soles

38
Q

What are Osler nodes?

A

Small painful nodular lesions usually found on the pads of the fingers or toes

39
Q

What are Roth spots?

A

Oval, pale retinal lesions surrounded by haemorrhage

40
Q

Complications of infective endocarditis?

A

Congestive heart failure
Systemic embolisation
Mycotic aneurysm
Splenic abscess

41
Q

What is mycotic aneurysm?

A

Infected aneurysm arising from bacterial infection of the arterial wall

42
Q

Consequences of mitral stenosis?

A

Left atrial hypertrophy
Pulmonary oedema
Right sided heart failure
Tricuspid regurgitation

43
Q

Consequence of mitral regurgitation?

A

Left atrial dilatation

Pulmonary hypertension

44
Q

What is Barlow’s syndrome?

A 
Prolapsing mitral valve
Excessively large mitral valve leaflets
Enlarged mitral annulus
Long cordae
Disordered papillary muscle contraction
45
Q

Causes of tricuspid stenosis?

A

Uncommon
Rheumatic heart disease
With other mitral/aortic disease presnet
Carcinoid syndrome

46
Q

Consequence of tricuspid stenosis?

A 
Reduced cardiac output
Increased right atrial pressure
Hepatomegaly
Ascites
Oedema
47
Q

Tricuspid stenosis murmur?

A

Mid diastolic

Louder on inspiration

48
Q

Functional tricuspid regurgitation?

A

Right ventricle dilatation
Cor pulmonale
MI
Pulmonary hypertension

49
Q

Organic tricuspid regurgitation?

A

Rheumatic heart disease
Infective endocarditis
Carcinoid syndrome
Ebstein’s anomaly

50
Q

What is ebstein’s anomaly?

A

Congenitally malpositioned tricuspid valve

51
Q

Tricuspid regurgitation murmur?

A

Blowing
Pansystolic
Heard on inspiration

52
Q

Causes of pulmonary stenosis?

A

Congenital
Rheumatic fever
Carcinoid syndrome

53
Q

Consequences of pulmonary stenosis?

A

Obstructed right ventricular emptying

Right ventricular hypertrophy

54
Q

Pulmonary stenosis murmur?

A

Hard, mid systolic ejection murmur
Thrill
Pulmonary closure delayed and soft

55
Q

Pulmonary regurgitation?

A

Most common acquired lesion of the pulmonary valve

Dilation of pulmonary ring secondary to pulmonary hypertension

56
Q

Pulmonary regurgitation murmur?

A

Decrescendo diastolic murmur

57
Q

Symptoms of mitral prolapse (Barlow’s syndrome)?

A

Atypical chest pain - submammary or substernal

58
Q

Murmur of mitral valve prolapse?

A

Mid-systolic click

Cardioresp (8 decks)

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