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Y3 MedEd > Valvular disease > Flashcards

Valvular disease Flashcards

1
Q

When should you repeat BP readings and what should you do if that criteria remains

A

Repeat measurements if difference in readings between arms in >15mmHg
If the difference in readings between arms remains more than 15 mmHg on the second measurement, measure subsequent blood pressures in the arm with the higher reading

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2
Q

Define malignant hypertension

A

BP ≥ 200/130 mmHg

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3
Q

What are the 3 stages of hypertension

A

Stage 1 Hypertension: 140/90 to 159/99 mmHg
Stage 2 Hypertension: 160/100 to 179/119 mmHg
Stage 3 Hypertension: sBP ≥ 180 mmHg or dBP ≥ 120 mmHg

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4
Q

Who should you offer ABPM to

A

People with clinic blood pressure of 140/90 mmHg or higher

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5
Q

What do you do to confirm hypertension (2 criteria)

A

clinic blood pressure of 140/90 mmHg or higher and

ABPM daytime average or HBPM average of 135/85 mmHg or higher

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6
Q

What are the investigations for target organ damage (8)

A 
Proteinuria – estimation of albumin:creatinine ratio (ACR) + test haematuria 
Glycated haemoglobin (HbA1C)
Electrolytes 
Creatinine 
eGFR 
Total cholesterol and HDL cholesterol 
Fundi (hypertensive retinopathy) 
12-lead ECG
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7
Q

Endocrine causes of hypertension (8)

A

Diabetes, hyperthyroidism, Cushing’s, Conn’s, hyperparathyroidism, phaeochromocytoma, Congenital Adrenal Hyperplasia, Acromegaly

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8
Q

Renal causes of hypertension (5)

A

Renal artery stenosis
Chronic glomerulonephritis, pyelonephritis
Polycystic kidney disease
Renal failure

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9
Q

Cardio causes of hypertension (2)

A

Coarctation of the aortaIncreased intravascular volume

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10
Q

Drugs that cause hypertension (3)

A

Sympathomimetics, corticosteroids, oral contraceptives

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11
Q

Pregnancy cause of hypertension

A

Pre-eclampsia

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12
Q

Causes of hypertension due to raised instravascular volume (3)

A

heart failure, liver failure, nephrotic syndrome

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13
Q

What abnormal heart sounds can you hear in hypertension (2)

A

may hear loud S2, S4

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14
Q

Mx of hypertension (think of the populations, also there is 4 stages)

A 
HT diabetes or under 55 and not black
ACEi or ARB
then
ACEi or ARB and CCB or thiazide-like diuretic
then
all all
Age 55 or black without diabetes
CCB
then
CCB + ARB/ACEi or thiazide-like diuretic
then all 4

Stage 4 os confirm resistant hypertension, seek help, or add spironolactone/alpha/beta blocker

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15
Q

Example of CCB (2)

A

Amlodipine

Verapamil

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16
Q

Common S.E. of ACEi (3)

A

Cough
High potassium
Increased creatinine

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17
Q

Common S.E. of CCBs (1)

A

Oedema

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18
Q

Common S.E. of BB (1)

A

Dizziness

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19
Q

Common S.E. of diuretics (3)

A

Dry mouth
Thirst
Low potassium levels

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20
Q

Common S.E. of alpha-blockers (1)

A

Dizziness

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21
Q

BP targets (clinic and home, for the two demographics)

A

<80 years
Clinic <140/90 mmHg
Home <135/85 mmHg

> 80 years
Clinic <150/90 mmHg
Home <145/85 mmHg

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22
Q

What is losartan

A

An AT2R antagonist

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23
Q

What causes the second heart sound

A

Thefirst heart sound(S1) is caused by the closing of theatrioventricular valves(thetricuspidandmitral valves) at the start of thesystolic contractionof theventricles

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24
Q

What causes normal physiological splitting of S2

A

inspiration lowers intrathoracic pressure, increasing the compliance of the pulmonary vascular bed, and augmenting right heart filling. Right ventricular systole is lengthened as a result, causing the pulmonic valve to close after the aortic valve, resulting in splitting of the second sound at 3LICS or 4LICS.

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25
Q

What causes paradoxical splitting of S2 (2)

A

results from delayed onset or prolongation of left ventricular systole (Prolong LV emptying, AS, LBBB)

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26
Q

What causes normal, wide splitting of S1 (3)

A

Normal wide splitting S1 – RBBB, LV pacing, ectopic beats

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27
Q

What cause widened splitting of S2 (2)

A

prolong PV emptying – pulmonay stenosis, RBBB

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28
Q

What cause fixed splitting of S2

A

ASD

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29
Q

What is the cadence of the third heart sound

A

Kentucky

30
Q

What is the cause of the third heart sound physically

A

S3 produced during passive rapid left ventricular filling when blood strikes a compliant left ventricle.

31
Q

What does a third heart sound indicate

A

In older patients it can indicated heart failure, as theventriclesandchordaeare stiff and weak so they reach their limit much faster than normal

32
Q

What is the cadence of the fourth heart sound

A

Tennessee

33
Q

What is the cause of the fourth heart sound physically

A

Results from a forceful atrial contraction during presystole that ejects blood into a hypertrophied ventricle which cannot expand further

34
Q

What does a fourth heart indicate (3)

A

HTN, aortic stenosis, hypertrophic cardiomyopathy

35
Q

Which pathology is accentuated on auscultation with the patient on the LHS

A

Mitral stenosis

36
Q

Which pathology is accentuated on auscultation with the patient leaning forward

A

Aortic regurgitation

37
Q

What is crescendo-decrescendo murmur also known as

A

Ejection systolic

38
Q

What is ejection systolic murmur also known as

A

Crescendo-descrescendo

39
Q

Clinical signs of aortic stenosis (4)

A

Crescendo decrescendo systolic murmur
(radiate to carotids)
Heaving apex beat
Slow rising pulse

40
Q

What does a narrow pulse pressure indicate

A

Aortic stenosis

41
Q

What is seen on an ECG of aortic stenosis

A

Evidence of LVH

42
Q

Where does mitral regurgitation radiate to

A

Left axilla

43
Q

What does a mitral regurgitation murmur sound like

A

High pitched ‘whistling’ mumur

44
Q

Mitral regurgitation - what during the heart beat is the abnormal heart sound?

A

Pan-systolic

45
Q

What is mitral regurgitation associated with (4)

A

IHD
Idiopathic weaknening of valve with age
Connective tissue disorder e.g. EDS, MS

46
Q

What does a mitral stenosis murmur sound like

A

Low pitched rumbling

47
Q

When during the heart beat is the abnormal heart sound in mitral stenosis

A

Mid-diastolic

48
Q

What heart sounds change in mitral stenosis

A

Loud S1

Mid diastolic low pitched rumbling murmur

49
Q

What pathology causes a loud S1/opening snap

A

Mitral stenosis

50
Q

What is mitral stenosis associated with (3)

A

Often associated with Atrial Fibrilation
Malar flush = Red cheeks
Associated with rheumatic fever

51
Q

Signs of aortic regurgitation (4)

A

Watson’s water hammer pulse, also known asCorrigan’s pulseorcollapsing pulse
Quincke’s sign
De Musset’s Sign
Becker’s sign

52
Q

What murmur is heard in aortic regurgitation, describe it and what is its name

A

Austin Flint

Mid-diastolic rumbling murmur

53
Q

What is an Austin Flint murmur

A

Mid diastolic rumbling murmur of aortic regurgitation

54
Q

What is Carvallos sign

A

Of tricuspid regurgitation, pansystolic murmur heard louder on inspiration

55
Q

Clinical feature of tricuspid regurgitation

A

Elevated JVP with giant V waves

56
Q

5 manifestations of rheumatic fever

A

Arthritis, Carditis(Carey Coombs murmur -mid-diastolic murmur due to mitral vasculitis, pericarditis, pericardial effusion or rub, etc), Sydenham’sChorea(+/-slurred speech), SC nodules, Erythema marginatum

57
Q

What is a Graham Steel murmur associated with

A

Pulmonary regurgitation

58
Q

How to differentiate AR and MS?

A

Wide PP in AR

59
Q

Buzzwords - which valvular pathology:

narrow PP

A

Aortic stenosis – exertional syncope, SOB, angina

60
Q

Buzzwords - which valvular pathology:

soft 2nd heart sound

A

Aortic stenosis – exertional syncope, SOB, angina

61
Q

Buzzwords - which valvular pathology:

heaving apex beat

A

Aortic stenosis – exertional syncope, SOB, angina

62
Q

Buzzwords - which valvular pathology:

blowing pansystolic murmur at apex

A

Mitral regurgitation

63
Q

Buzzwords - which valvular pathology:

soft 1st heart sound

A

Mitral regurgitation

64
Q

Buzzwords - which valvular pathology:

wide PP

A

Aortic regurgitation

65
Q

Buzzwords - which valvular pathology:

end diastolic murmur at left sternal edge

A

Aortic regurgitation

66
Q

Buzzwords - which valvular pathology:

murmur best heard leaning forward at expiration

A

Aortic regurgitation

67
Q

Buzzwords - which valvular pathology:

rumbling mid-diastolic murmur at apex

A

Mitral stenosis

68
Q

Buzzwords - which valvular pathology:

pansystolic murmur at left lower sternal edfe

A

Tricuspid regurgitation

69
Q

Buzzwords - which valvular pathology:

IVDU

A

Tricuspid regurgitation

70
Q

Buzzwords - which valvular pathology:

increased JVP

A

Tricuspid regurgitation

71
Q

Buzzwords - which valvular pathology:

tapping apex beat

A

Mitral stenosis

Y3 MedEd (34 decks)

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