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Cardio > Valvular Disease > Flashcards

Valvular Disease Flashcards

1
Q

What does a clinical diagnosis in cardiology include?

A

Physical examination- murmurs and signs of heart failure
History - restriction and functional capacity
Investigations-
non-invasive,= echo
invasive = Cardiac catherization

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2
Q

What type of symptoms are characteristic of valvular disease?

A

Exertional symptoms

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3
Q

Clinical history for valvular heart disease?

A

Chest pain
Breathlessness
Collapse/Dizzy spells

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4
Q

Cardiac breathlessness and valvular disease?

A

Usually related to activity
Often associated with ankle activity
Orthopnoea - SOB lying down
PND- attack of severe SOB and ocughing that wakes someone up

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5
Q

Functional classification of Valvular disease?

A

Class 1- No limitation
Class 2- Slight limitation of ordinary activity
Class 3- Marked limitation of less than ordinary activity
Class 4- Severe limitation of minimal activity or at rest

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6
Q

What is involved in a cardiology clinical exam?

A
  • General appearance
  • Arterial pulse- radial, carotid
  • Venous pulse- JVP
  • Palpation- apex, parasternal heave
  • Auscultation- Heart sounds and murmurs
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7
Q

3 signs of right heart failure?

A

Raised JVP
Pitting oedema
Hepatic congestion

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8
Q

Describe the apex beat in mitral stenosis?

A

Tapping

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9
Q

When is the apex beat displaced and diffuse?

A

Left ventricular dilation (volume overload)

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10
Q

Describe the apex beat in left ventricular hypertrophy?>

A

Heaving
Maybe displaced
Pressure overload

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11
Q

How to find the parasternal heave and what situation would it be present in?

A

Hand to the left of sternum

Right ventricular overload- cor pulmonale, pulmonary hypertension

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12
Q

What is a cardiac murmur?

A

Audible turbulence of blood flow

Can be either innocent or pathological

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13
Q

Process and points for describing 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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14
Q

Process and points for describing 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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15
Q

What happens in the first heart sound?

A

Mitral and tricuspid valve shut

Start of systole

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16
Q

What happen sin 2nd heart sound?

A

Pulmonary and aortic valve shut

Start of diastole

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17
Q

Phonogram of murmurs showing

  • Normal
  • Aortic stenosis
  • Mitral regurgitation
  • Aortic regurgitation
  • Mitral stenosis
  • Patient ductus arteriosus
A
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18
Q

Types of systolic murmurs?

A

Pansystolic

Ejection systolic

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19
Q

Types of diastolic murmur?

A

Early diastolic murmur

Mid diastolic

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20
Q

Pansystolic murmur diagram?

A

*

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21
Q

Ejection systolic murmur diagram?

A

**

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22
Q

Early diastolic murmur diagram?

A

**

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23
Q

Mid diastolic murmur diagram?

A
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24
Q

What condition does a murmur radiate to the carotids?

A

Aortic stenosis

25
Q

Where does a mitral regurgitation murmur radiate to?

A

Axilla

26
Q

Grading of murmurs?

A 
1= Very quiet 
2= Quiet- easy to hear 
3= Loud 
4= Loud with a thrill 
5= Very loud with a thrill 
6= Loud- audible without stethoscope
27
Q

Which murmurs are louder with respiration?

A

Right sided murmurs

28
Q

What murmur has a 2nd heart sound splitting?

A

Aortic stenosis

29
Q

Third heart sound splitting?

A

Aortic regurgitation

30
Q

What heart sound is split in mitral stenosis?

A

4th heart sound

31
Q

When is an innocent murmur present?

A

Tricuspid regurgitation

32
Q

When is there a pericardial rub?

A

Mitral regurgitation

33
Q

What additional heart sounds occurs in a continuous murmur?

A

Systolic clicks

34
Q

Describe an innocent/functional murmur?

A

Soft
Position dependent
Often early systolic (diastolic murmurs are always pathological)

35
Q

What is valvular stenosis?

A

Valves which do not open properly

36
Q

What is valve regurgitation?

A

Valves which do not close properly

37
Q

What is mixed valve disease

A

Valves which neither open nor close properly

38
Q

Categories of aortic stenosis?

A

Degenerative
Congenital
Rheumatic

39
Q

Symptoms of aortic stenosis?

A

Breathlessness
Chest pain
Dizziness/syncope

40
Q

Signs of aortic stenosis?

A

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

41
Q

Aortic stenosis ECG?

A
42
Q

Treatment of aortic stenosis?

A

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

43
Q

Describe mechanical heart valves eg who would receive, drugs the would have, how long they last

A

Longevity
Younger patients
Warfarin

44
Q

Describe bio-prosthetic valves?

A

Lasts 10 years
No warfarin
Older patients

45
Q

AVR vs TAMI
Trans catheter aortic valve replacement
Aortic valve replacement

A

AVR=

  • Still preferred
  • Long term outcomes
  • No contra-indications
  • CAGB aswell

TAMI=

  • Co-morbidity
  • Previous sternotomy
46
Q

Causes of mitral regurgitation?

A

Leaflets- prolapsing, rheumatic,myxomatous (floppy) or endocarditis
Chordae rupture - prolapse/ flail leaflet
Papillary muscle rupture - ischaemic
Annular dilation

47
Q

Symptoms of mitral regurgitation?

A

Breathlessness
Peripheral oedema
Fatigue

48
Q

Signs of mitral regurgitation?

A

Displaced apex

Pansystolic murmur

49
Q

Treatment for mitral regurgitation?

A

Medication - diuretics and ACEI
Surgery - Repair- (prolapse), replacement (degenerative)
Percutaneous - Clips in infancy

50
Q

Main cause of mitral stenosis?

A

Rheumatic

51
Q

Symptoms of mitral stenosis?

A

Breathlessness
Fatigue
Palpitations (AF)

52
Q

Signs of mitral stenosis?

A

Malar Flush
Tapping apex beat
Mid diastolic rumbling diastolic murmur localized to apex

53
Q

Treatment of mitral stenosis?

A

Medication - Diuretics and treat AF
Balloon valvuloplasty
Surgery valve replacement

54
Q

Causes of aortic regurgitation?

A

Leaflets- endocarditis, connective tissue diseases, rheumatic
Annulas- marfans, aortic dissection

55
Q

Symptoms of aortic regurgitation?

A

Breathlessness

56
Q

Signs of aortic regurgitation?

A

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

57
Q

Treatment for aortic regurgitation?

A 
Medication= ACE inhibitors 
Surfery= valve replacement, Symptoms and LV dilatation
58
Q

Most common valve lessions?

A

aortic stenosis, mitral regurgitation, mitral stenosis and aortic regurgitation

Cardio (36 decks)

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