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Y4 Cardio > Valvular disease > Flashcards

Valvular disease Flashcards

1
Q

what triad of symptoms will AS have?

A

angina, dyspnoea, syncope

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2
Q

what is the pulse like for AS?

A

Slow rising pulse ̄c narrow PP

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3
Q

is the apex displaced with AS?

A

no

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4
Q

how is the murmur described with AS?

A

ejection systolic murmur

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5
Q

what is the difference between aortic stenosis and aortic sclerosis murmurs?

A

aortic stenosis ESM radiates to carotids

aortic sclerosis ESM doesn’t radiate

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6
Q

what investigation diagnoses AS?

A

echo and doppler

- Thickened, calcified, immobile valve cusps

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7
Q

what is the pressure gradient, jet velocity and have area of severe AS?

A 
Severe AS (AHA / ACC 2006 guidelines):
􏰁 Pressure gradient >40mmHg

􏰁 Jet velocity >4m/s (or ↑ by 0.3m/s in a yr) 􏰁

Valve area <1cm2

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8
Q

what medication should be avoided in AS?

A

nitrates

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9
Q

what are the indications of valve replacement ?

A

Severe symptomatic AS

􏰁 Severe asymptomatic AS ̄c ↓ EF (<50%)

􏰁 Severe AS undergoing CABG or other valve op

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10
Q

do mechanical or prothesis valves require anticoagulants?

A

mechanical valves

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11
Q

what two procedures can be done for patients unfit for valve replacement?

A

balloon valvuloplasty

transcatheter aortic valve implantation (TAVI)

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12
Q

what is TAVI?

A

Folded valve deployed in aortic root.

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13
Q

state some acute causes of AR?

A

IE

type A aortic dissection

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14
Q

state some chronic causes of AR?

A

bicuspid aortic valve
rheumatic heart disease
connective tissue disorder
ankylosing spondylitis and RA

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15
Q

what are the symptoms of AR?

A

Exertional dyspnoea, PND, orthopnoea

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16
Q

state some characteristic signs of AR?

A

Corrigan’s sign: carotid pulsation

􏰀De Musset’s: head nodding

􏰀Quincke’s: capillary pulsation in nail beds

Traube’s: pistol-shot sound over femorals

Austin-Flint murmur
􏰁 Rumbling MDM @ apex due to regurgitant jet fluttering the ant. mitral valve cusp.
􏰁 = severe AR

Duroziez’s
􏰁Systolic murmur over the femoral artery ̄c proximal compression.
􏰁Diastolic murmur ̄c distal compression

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17
Q

is the apex displaced with AR?

A

yes

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18
Q

what three things are measured with the ECHO to determine severity of AR?

A

Jet width (>65% of outflow tract = severe) 􏰁

Regurgitant jet volume

Premature closing of the mitral valve

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19
Q

what are the symptoms of MS?

A 
Dyspnoea
􏰀 Fatigue
􏰀 Chest pain
􏰀 AF → palpitations + emboli
􏰀 Haemoptysis: rupture of bronchial veins
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20
Q

what is the normal size of the mitral valve?

A

4-6cm

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21
Q

at what size of the mitral valve do symptoms start?

A

<2cm

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22
Q

what does the JVP look like with MS?

A

Prominent a waves: PHT 􏰁
Large v waves: TR (tricuspid regurg)
􏰁Absent a waves: AF

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23
Q

is the apex displaced with MS?

A

no

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24
Q

what heart sounds are heard with mitral stenosis?

A

Loud S1
􏰁 Loud P2 (if PHT)
􏰁 Early diastolic opening snap

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25
Q

what is the Graham Steell murmur

A

soft, blowing, decrescendo early diastolic murmur of pulmonary incompetence caused by pulmonary hypertension

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26
Q

what are the complications of mitral stenosis?

A

Pulmonary HTN
􏰀 Emboli: TIA, CVA, PVD, ischaemic colitis
􏰀 Hoarseness: rec laryngeal N. palsy = Ortner’s Syn
􏰀 Dysphagia (oesophageal compression)
􏰀 Bronchial obstruction

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27
Q

what three things are measured on ECHO for severe MS?

A

Valve orifice <1cm2
􏰁 Pressure gradient >10mmHg
􏰁 Pulmonary artery systolic pressure >50mmHg

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28
Q

what is the treatment for MS?

A

Percutaneous balloon valvuloplasty
valve repair
valve replacement

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29
Q

what is a CI for Percutaneous balloon valvuloplasty?

A

left atrial mural thrombus

30
Q

what are the symptoms of MR?

A 
Dyspnoea, fatigue
pulmonary congestion (HTN and oedema)
31
Q

is the apex displaced for MR ?

A

yes

32
Q

what is the murmur for MR like?

A

blowing pan systolic murmur which radiates to axilla

33
Q

what are DD for MR?

A

AS 􏰀
TR 􏰀
VSD

34
Q

what is the syndrome of mitral valve prolapse ?

A

barlow syndrome

35
Q

what three things are measured with the ECHO with MR to determine severity?

A

Jet width (vena contracta) >0.6cm

􏰁 Systolic pulmonary flow reversal

􏰁 Regurgitant volume >60ml

36
Q

what are the symptoms of mitral valve prolapse ?

A

Usually asymptomatic
􏰀 Autonomic dysfunction: Atypical chest pain,
palpitations, anxiety, panic attack
􏰀 MR: SOB, fatigue

37
Q

what heart sounds are heard with mitral valve prolapse ?

A

Mid-systolic click ± late-systolic murmur

38
Q

what are the complications of mitral valve prolapse ?

A

MR
Cerebral emboli
Arrhythmias → sudden death

39
Q

state some causes of tricuspid regurg?

A

Functional: RV dilatation
Rheumatic fever
􏰀Infective endocarditis
􏰀Carcinoid syndrome

40
Q

what are the symptoms of TR?

A

Fatigue
􏰀 Hepatic pain on exertion
􏰀 Ascites, oedema

41
Q

what are the signs of TR?

A

RV heave
increased JVP
pulsatile hepatomegaly
jaundice

42
Q

what are the symptoms of tricuspid stenosis ?

A

Fatigue
􏰀 Ascites
􏰀 Oedema

43
Q

what are the management options for TR?

A

Medical: diuretics, ACEi, digoxin

􏰀 Surgical: valve replacement

44
Q

what are the management options for TS?

A

Medical: diuretics
Surgical: repair, replacement

45
Q

what murmur is heard with pulmonary regurg?

A

Graham-Steell murmur

46
Q

what cause pulmonary regurg?

A

pulmonary hypertension

47
Q

state some cause of pulmonary stenosis

A

Usually congenital: e.g. Turner’s, Fallot’s
􏰀 Rheumatic fever
􏰀 Carcinoid syndrome

48
Q

what are the symptoms of PS?

A

Dyspnoea, fatigue
􏰀 Ascites
􏰀 Oedema

49
Q

what valve disease is Carvallo’s sign seen?

A

TR

- left lower sternal edge in inspiration

50
Q

what murmur is heard with PS?

A

Ejection (systolic murmur) click, soft P2

heard at upper left sternal edge which radiates to left shoulder

51
Q

what murmur is heard with PR?

A

Decrescendo EDM @ ULSE

52
Q

how is PS diagnosed ?

A

catheterisation

53
Q

what is the treatment for PS?

A

Mx: valvuloplasty or valvotomy

54
Q

what bacteria cause IE?

A 
S. viridans (>35%)
􏰀 S. bovis
􏰀 S. aureus
􏰀 S. epidermidis
􏰀 Enterococci
􏰀 Pseudomonas
55
Q

what culture negative organisms cause IE?

A 
Haemophilus 
Actinobacillus 
Cardiobacterium 
Eikenella 
Kingella 
Coxiella 
Chlamydia
56
Q

what are the RFs for IE?

A 
Prosthetic valves
􏰀 Degen. valvulopathy
􏰀 VSD, PDA, CoA (congenital heart disease) 
􏰀 Rheumatic fever
IVDU (tricuspid valve)
57
Q

what valve IE is IVDU associated with?

A

tricuspid

58
Q

state some clinical signs of IE?

A 
roth spots
janeway lesions 
oslers nodes 
splenomegaly
micro haematuria 
vasculitis 
splinter haemorrhages
59
Q

what are roth spots ?

A

boat-shaped retinal haemorrhages ̄c pale centre

60
Q

what are janeway lesions

A

painless palmer macules

61
Q

what are Oslers nodes ?

A

painful, purple papules on finger pulps

62
Q

what criteria is used for IE?

A

Dukes criteria

63
Q

what are the 2 major criteria for IE?

A

+ blood culture
endocardium involved
- pos ECHO, new valvular regurg

64
Q

what are the 5 minor criteria for IE?

A
  1. Predisposition: cardiac lesion, IVDU
  2. Fever >38
  3. Emboli: septic infarcts, splinters, Janeway lesions
  4. Immune phenomenon: GN, Osler nodes, Roth spots, RF
  5. +ve blood culture not meeting major criteria
65
Q

what is required for diagnosis of IE?

A

Dukes criteria:
2 major
1 major + 3 minor
􏰀 All 5 minor

66
Q

what investigations should be done for IE?

A

Bloods - FBC, ESR, CRP, culture, serology, + IgG RF

urine (micro haematuria)

ECG (AV block)

ECHO (TOE more sensitive than TTE)

67
Q

what is the empirical treatment for subacute and acute IE?

A

Acute severe: Fuclox + gent IV 􏰁

Subacute: Benpen + gent IV

68
Q

what is the treatment for staph IE?

A

Staphs: fluclox ± rifampicin IV

69
Q

what is the treatment for enterococci IE?

A

Enterococci: amoxicillin + gent IV

70
Q

what is the treatment for streps IE?

A

Streps: benpen + gent IV

71
Q

what is the treatment for fungi IE?

A

􏰀 Fungi: flucytosine IV + fluconazole PO.

72
Q

what should surgery be considered for IE?

A

Heart failure
􏰀 Emboli
􏰀 Valve obstruction
􏰀 Prosthetic valve

Y4 Cardio (10 decks)

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