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CARDIOLOGY > Valvular Disease > Flashcards

Valvular Disease Flashcards

1
Q

What group of symptoms are typical of patients with valvular heart disease?

A

Exertional symptoms

  • chest pain
  • breathlessness
  • collapse and dizzy spells
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2
Q

How do patients often describe chest pain which is originating from their heart?

A

Gripping – Squeezing – Heavy - Crushing

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3
Q

What other signs may indicate that a person’s breathlessness is due to a cardiac cause?

A
  • Related to activity (usually)
  • Often associated with ankle swelling
  • Orthopnoea (breathless when lying down)
  • Paroxysmal Nocturnal Dyspnoea (PND)
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4
Q

What signs on examination would point towards failure of the Right side of the Heart?

A
  • Raised JVP
  • Pitting oedema
  • Hepatic congestion
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5
Q

Where is the apex beat usually located?

A

Left 5th intercostal space

mid-clavicular line

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6
Q

How does the apex beat differ in disease?

A
  • Tapping apex in mitral stenosis
  • Displaced and diffuse in left ventricular dilatation
  • Heaving and may be displaced in left ventricular hypertrophy
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7
Q

What is a parasternal heave and what condition may cause this?

A
  • heave felt on examination when hand is positioned to left of sternum
  • caused by RV overload
    => cor pulmonale/pulmonary hypertension
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8
Q

What is a cardiac murmur?

A
  • Audible turbulence of blood flow

- Can be Innocent OR pathological

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9
Q

What makes each of the 2 heart sounds, and what do these heart sounds signify?

A

1st Heart sound

  • Mitral and tricuspid valve closing
  • Start of SYSTOLE

2nd Heart sound

  • Aortic and pulmonary valves closing
  • Start of DIASTOLE
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10
Q

What pathological murmurs are heard during SYSTOLE (i.e. between heart sounds 1 and 2)?

A 
Aortic stenosis (ejection SYSTOLIC murmur)
Mitral Regurgitation (Pansystolic)
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11
Q

Which pathological murmurs are heard during DIASTOLE (after the 2nd heart sound)?

A
  • Aortic regurg.

- Mitral Stenosis (occurs right before 1st heart sound starts again => opening snap)

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12
Q

Where can murmurs radiate to?

A

Carotids (aortic stenosis)

Axilla (mitral regurgitation)

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13
Q

How is the volume of a murmur graded?

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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14
Q

Right-sided heart murmurs are louder on inspiration. TRUE/FALSE?

A

TRUE

=> tricuspid and pulmonary valve murmurs

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15
Q

Describe the characteristics of an innocent or functional murmur

A
  • Quiet (<3 on grading)
  • Position dependent
  • Often early systolic
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16
Q

Diastolic murmurs are ALWAYS pathological. TRUE/FALSE?

A

TRUE

17
Q

What are the main reasons that valves do not work properly?

A

VALVE STENOSIS
- Valves do not open properly

VALVE REGURGITATION
- Valves do not close properly

MIXED VALVE DISEASE
- Valves neither open nor close properly

18
Q

What are the main causes of aortic stenosis?

A
  • Degenerative (age related)
  • Congenital (E.g bicuspid valve)
  • Rheumatic disease
19
Q

What are the main symptoms of aortic stenosis?

A
  • chest pain
  • breathlessness
  • dizziness/syncope
20
Q

What signs can present with aortic stenosis?

A
  • Low volume pulse
  • Forceful displaced apex
  • Ejection systolic murmur that can radiate to the carotids
21
Q

How is aortic stenosis treated?

A
  • Conventional valve replacement
  • Trans catheter aortic valve replacement (TAVI)
  • Balloon Aortic valvotomy (BAV)
22
Q

What are the two types of valves that can be used for replacement in aortic stenosis, and who is suitable for each?

A

Mechanical valve

  • lasts longer
  • need warfarin coverage
  • used for younger patients (congenital bicuspid valve)

Bio-prosthetic Valve

  • No warfarin needed
  • Only last around 10 years
  • Given to older patients
23
Q

Aortic valve replacement is still preferred over TAVI. TRUE/FALSE?

A

TRUE

  • no contraindications to the procedure
  • long term outcomes are better
24
Q

What parts of the mitral valve can become damaged to cause mitral regurgitation?

A
  • Leaflets
  • Chordae rupture (degenerative => become floppy)
  • Papillary muscles rupture (ischaemia)
  • Annular dilatation
25
Q

What can cause problems with the mitral valve LEAFLETS and lead to mitral regurgitation?

A
  • Prolapse
  • Rheumatic disease
  • Myxomatous (floppy)
  • Endocarditis
26
Q

What are the main symptoms of mitral regurgitation?

A
  • Breathlessness
  • Peripheral oedema
  • Fatigue
27
Q

What signs on examination indicate a diagnosis of mitral regurgitation?

A
  • Displaced apex beat

- Pansystolic murmur radiating to axilla

28
Q

What sign does mitral regurgitation cause on CXR?

A

Cardiomegaly

29
Q

How is mitral regurgitation treated?

A
  • Diuretics
  • ACEi (Similar to heart failure)

Surgical:

  • Repair – prolapse
  • Replacement - degenerative

Percutaneous:
- Clips in infancy

30
Q

Mitral stenosis is mainly caused by what disease?

A

Rheumatic fever

31
Q

What are the main symptoms of mitral stenosis?

A
  • Breathlessness
  • Fatigue
  • Palpitations (AF)
32
Q

What signs of mitral stenosis may be apparent on examination?

A
  • Malar flush
  • Tapping apex beat
  • Mid diastolic rumbling murmur localised to apex
33
Q

What CXR sign may indicate a diagnosis of mitral stenosis?

A

straight left heart border

34
Q

How can mitral stenosis be treated?

A
  • Diuretics and treat AF

Surgery:

  • Valve replacement
  • Balloon Valvuloplasty
35
Q

What may cause aortic regurgitation?

A

Leaflets

  • Endocarditis
  • CT disease
  • Rheumatic

Annulus (part of fibrous skeleton of heart)

  • Marfans
  • Aortic dissection
36
Q

What is the main symptom of aortic regurgitation?

A

breathlessness

37
Q

WHat signs may be noticed on examination of a patient with aortic regurgitation?

A
  • Collapsing pulse
  • Wide pulse pressure
  • Displaced apex
  • Early diastolic murmur left sternal edge
38
Q

What sign may aortic regurgitation cause on a CXR?

A

Cardiomegaly

39
Q

How is aortic regurgitation treated?

A
  • ACE inhibitors

Surgery:

  • only given to symptomatic patients with LV dilatation
  • Valve replacement

CARDIOLOGY (14 decks)

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