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Cardio > Valvular disease > Flashcards

Valvular disease Flashcards

1
Q

What is a tapping apex beat a sign of?

A

Mitral Stenosis

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2
Q

What is a parasternal heave a sign of?

A

Right ventricular overload e.g. cor pulmonale/ pulmonary hypertension

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3
Q

What is a cardiac murmur?

A

audible turbulence of blood flow either innocent or pathological

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4
Q

What are the descriptors of a murmur?

A 
Systole or diastole?
What type of murmur?
Where is it loudest?
Where does it radiate to?
What grade of murmur?
(Influenced by respiration?)
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5
Q

What does the first heart sound signal?

A

The start of systole

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6
Q

What does the second heart sound signal?

A

The start of diastole

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7
Q

What murmur will commonly radiate to the carotids?

A

Aortic stenosis

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8
Q

What murmur will commonly radiate to the axilla?

A

Mitral regurgitation

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9
Q

What are the grades of murmurs?

A 
I. Very quiet 
II. Quiet - easy to hear
III. Loud
IV. Loud with a thrill
V. Very loud with a thrill
VI. Loud  - audible without a 				stethoscope
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10
Q

What murmurs are louder with inspiration?

A

Right-sided murmurs

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11
Q

What are the 5 common murmurs?

A 
Innocent Murmur
Mitral Regurgitation
Aortic Stenosis
Aortic Regurgitation
Mitral Stenosis
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12
Q

What is an innocent (functional) murmur?

A

A soft (<3/6) early systolic murmur. Diastolic murmurs are always pathological but listen carefully to systolic to see if it is innocent

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13
Q

What is valve stenosis?

A

The valves don’t open properly

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14
Q

What is valve regurgitation?

A

The valves don’t close properly

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15
Q

What is mixed valve disease?

A

The valves don’t open or close properly

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16
Q

What are the cardiac investigations which can be carried out?

A

Non-invasive - Echo

Invasive - cardiac catheterisation

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17
Q

What are the causes of aortic stenosis?

A

Degenerative (age related)
Congenital - bicuspid valve instead of tricuspid
Rheumatic

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18
Q

What are the symptoms of aortic stenosis?

A

Breathlessness
chest pain
Dizziness/ syncope

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19
Q

What are the clinical signs of aortic stenosis?

A

Low volume pulse
Forceful displaced apex
Ejection systolic murmur that can radiate to the carotids

20
Q

How do you treat aortic stenosis?

A

Conventional valve replacement
Trans catheter aortic valve replacement (TAVI)
Balloon Aortic valvotomy (BAV)

21
Q

What are the general history signals that it may be valvular disease?

A

Chest pain
Breathlessness
Collapse/ dizzy spells
Exertional symptoms are characteristic

22
Q

What are the complications of aortic stenosis?

A

Left ventricular hypertrophy

23
Q

What are the descriptors of cardiac chest pain?

A

Gripping
Squeezing
Heavy
Crushing

24
Q

What are the characteristics of cardiac breathlessness?

A

Related to activity (usually)
Often associated with ankle swelling
Orthopnoea
Paroxysmal Nocturnal Dyspnoea (PND)

25
Q

What are the Classes in the New York Heart Association Functional Classification (NYHA) - (for breathlessness due to heart problems - heart failure of valvular disease)?

A

Class I - No limitation
Class II - Slight limitation of ordinary activity
Class III - Marked limitation of less than ordinary activity
Class IV - Severe limitation of minimal activity or at rest

26
Q

What are the factors to consider in mechanical valves?

A

They last longer - potentially for life
There is a mechanical click of the second heart sound
Patient needs to be on lifelong warfarin - high risk especially as they get older
Given to younger patients

27
Q

What are the factors to consider in Bio-prosthetic valves?

A

They don’t need to take warfarin
They only last 10 years
They are generally given to older patients

28
Q

When is TAVI offered?

A

To patients who are not suitable for conventional surgery
Done through the groin
Stroke risk is a bit higher than conventional surgery

29
Q

What is currently preferred aortic valve replacement or TAVI?

A

AVR - there is more long term evidence

30
Q

What are the causes of mitral regurgiation?

A 
Leaflet 
- Prolapse
- Rheumatic
- Myxomatous (floppy) (congential)
- Endocarditis
Chordae rupture (degenerative)
- Prolapse/flail leaflet
Papillary muscles rupture (infarct where the chords attach to the muscle ischemic mitral regurgitation)
Annular dilatation 
- Functional (due to cardiac failure)
31
Q

What are the symptoms of mitral regurgitation?

A

Breathlessness
Peripheral Oedema
Fatigue

32
Q

What are the clinical signs of mitral regurgitation?

A

Displaced apex beat

Pansystolic murmur in the axilla (throughout systole)

33
Q

What are the complications of Mitral regurgitation?

A

Left ventricular failure

Pulmonary hypertension

34
Q

What is the medical treatment of mitral regurgitation?

A

Diuretics and heart failure medication if needed (ACE inhibitors)

35
Q

What is the surgical treatment of mitral regurgitation?

A

repair - when prolapse of the valve
replacement - when there is degenerative disease of the valve
(only conventional surgery - repair will always be

36
Q

What is a mitral clip?

A

a percutaneous technique were the leaflets are pulled together with a clip - not that popular

37
Q

What causes mitral stenosis?

A

Rheumatic disease or congenital but very rare

38
Q

What are the symptoms of mitral stenosis?

A

Breathlessness
Fatigue
Palpitations (AF)

39
Q

What are the clinical signs of mitral stenosis?

A

Malar flush
Tapping apex beat
Mid-diastolic rumbling murmur localised to apex - turning the patient on their left helps to hear it

40
Q

Medical treatment of mitral stenosis?

A

treat the AF diuretics

41
Q

Surgical treatment of mitral stenosis?

A

Valve replacement and balloon valvuloplasty

42
Q

What are the causes of aortic regurgitation?

A 
The leaflets can be affected by 
- endocarditis
- connective tissue diseases
- rheumatic
Annulus affected by 
- marfans
- aortic dissection
43
Q

Symptoms of aortic regurgitation?

A

Breathlessness

44
Q

Clinical signs of aortic regurgitation?

A

Collapsing pulse
Wide pulse pressure
Displaced apex beat
Early diastolic murmur left sternal edge

45
Q

What are the medications given for aortic regurgitation?

A

ACE inhibitors - to preserve heart function

46
Q

What is cardiomegaly?

A

An enlarged heart

47
Q

What are the potential surgical interventions for aortic regurgitation?

A

valve replacement - only conventional is an option

Given in patients who are symptomatic and have LV dilatation

Cardio (36 decks)

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