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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
what is the Graham Steell murmur
soft, blowing, decrescendo early diastolic murmur of pulmonary incompetence caused by pulmonary hypertension
26
what are the complications of mitral stenosis?
Pulmonary HTN 􏰀 Emboli: TIA, CVA, PVD, ischaemic colitis 􏰀 Hoarseness: rec laryngeal N. palsy = Ortner’s Syn 􏰀 Dysphagia (oesophageal compression) 􏰀 Bronchial obstruction
27
what three things are measured on ECHO for severe MS?
Valve orifice <1cm2 􏰁 Pressure gradient >10mmHg 􏰁 Pulmonary artery systolic pressure >50mmHg
28
what is the treatment for MS?
Percutaneous balloon valvuloplasty valve repair valve replacement
29
what is a CI for Percutaneous balloon valvuloplasty?
left atrial mural thrombus
30
what are the symptoms of MR?
``` Dyspnoea, fatigue pulmonary congestion (HTN and oedema) ```
31
is the apex displaced for MR ?
yes
32
what is the murmur for MR like?
blowing pan systolic murmur which radiates to axilla
33
what are DD for MR?
AS 􏰀 TR 􏰀 VSD
34
what is the syndrome of mitral valve prolapse ?
barlow syndrome
35
what three things are measured with the ECHO with MR to determine severity?
Jet width (vena contracta) >0.6cm 􏰁 Systolic pulmonary flow reversal 􏰁 Regurgitant volume >60ml
36
what are the symptoms of mitral valve prolapse ?
Usually asymptomatic 􏰀 Autonomic dysfunction: Atypical chest pain, palpitations, anxiety, panic attack 􏰀 MR: SOB, fatigue
37
what heart sounds are heard with mitral valve prolapse ?
Mid-systolic click ± late-systolic murmur
38
what are the complications of mitral valve prolapse ?
MR Cerebral emboli Arrhythmias → sudden death
39
state some causes of tricuspid regurg?
Functional: RV dilatation Rheumatic fever 􏰀Infective endocarditis 􏰀Carcinoid syndrome
40
what are the symptoms of TR?
Fatigue 􏰀 Hepatic pain on exertion 􏰀 Ascites, oedema
41
what are the signs of TR?
RV heave increased JVP pulsatile hepatomegaly jaundice
42
what are the symptoms of tricuspid stenosis ?
Fatigue 􏰀 Ascites 􏰀 Oedema
43
what are the management options for TR?
Medical: diuretics, ACEi, digoxin | 􏰀 Surgical: valve replacement
44
what are the management options for TS?
Medical: diuretics Surgical: repair, replacement
45
what murmur is heard with pulmonary regurg?
Graham-Steell murmur
46
what cause pulmonary regurg?
pulmonary hypertension
47
state some cause of pulmonary stenosis
Usually congenital: e.g. Turner’s, Fallot’s 􏰀 Rheumatic fever 􏰀 Carcinoid syndrome
48
what are the symptoms of PS?
Dyspnoea, fatigue 􏰀 Ascites 􏰀 Oedema
49
what valve disease is Carvallo’s sign seen?
TR | - left lower sternal edge in inspiration
50
what murmur is heard with PS?
Ejection (systolic murmur) click, soft P2 | heard at upper left sternal edge which radiates to left shoulder
51
what murmur is heard with PR?
Decrescendo EDM @ ULSE
52
how is PS diagnosed ?
catheterisation
53
what is the treatment for PS?
Mx: valvuloplasty or valvotomy
54
what bacteria cause IE?
``` S. viridans (>35%) 􏰀 S. bovis 􏰀 S. aureus 􏰀 S. epidermidis 􏰀 Enterococci 􏰀 Pseudomonas ```
55
what culture negative organisms cause IE?
``` Haemophilus Actinobacillus Cardiobacterium Eikenella Kingella Coxiella Chlamydia ```
56
what are the RFs for IE?
``` Prosthetic valves 􏰀 Degen. valvulopathy 􏰀 VSD, PDA, CoA (congenital heart disease) 􏰀 Rheumatic fever IVDU (tricuspid valve) ```
57
what valve IE is IVDU associated with?
tricuspid
58
state some clinical signs of IE?
``` roth spots janeway lesions oslers nodes splenomegaly micro haematuria vasculitis splinter haemorrhages ```
59
what are roth spots ?
boat-shaped retinal haemorrhages ̄c pale centre
60
what are janeway lesions
painless palmer macules
61
what are Oslers nodes ?
painful, purple papules on finger pulps
62
what criteria is used for IE?
Dukes criteria
63
what are the 2 major criteria for IE?
+ blood culture endocardium involved - pos ECHO, new valvular regurg
64
what are the 5 minor criteria for IE?
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
what is required for diagnosis of IE?
Dukes criteria: 2 major 1 major + 3 minor 􏰀 All 5 minor
66
what investigations should be done for IE?
Bloods - FBC, ESR, CRP, culture, serology, + IgG RF urine (micro haematuria) ECG (AV block) ECHO (TOE more sensitive than TTE)
67
what is the empirical treatment for subacute and acute IE?
Acute severe: Fuclox + gent IV 􏰁 Subacute: Benpen + gent IV
68
what is the treatment for staph IE?
Staphs: fluclox ± rifampicin IV
69
what is the treatment for enterococci IE?
Enterococci: amoxicillin + gent IV
70
what is the treatment for streps IE?
Streps: benpen + gent IV
71
what is the treatment for fungi IE?
􏰀 Fungi: flucytosine IV + fluconazole PO.
72
what should surgery be considered for IE?
Heart failure 􏰀 Emboli 􏰀 Valve obstruction 􏰀 Prosthetic valve

Y4 Cardio (10 decks)

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