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CR3 > Valvular Disease & Endocarditis > Flashcards

Valvular Disease & Endocarditis Flashcards

1
Q

What produces the first heart sound?

A
  • closure of the mitral valve before ventricular contraction
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2
Q

What produces the second heart sound?

A
  • closure of the aortic valve before ventricular relaxation
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3
Q

What is the third heart sound?

A
  • sloshing in

- blood coming into contact with a compliant/dilated ventricle

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4
Q

When to dilated ventricles occur?

A
  • mitral regurg

- HF with dilated cardiomyopathy

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5
Q

What is the 4th heart sound?

A
  • a stiff wall
  • blood pushing against non-compliant ventricle during atrial contraction (ventricular diastole)
  • LVH
  • Post MI fibrosis
  • failure of relaxation = diastolic HF
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6
Q

Define stenosis

A
  • pathological narrowing of a valve diameter
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7
Q

What causes stenosis?

A
  • increased pressure = hypertrophy = dilation = failure
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8
Q

Define regurgiatation

A

pathological reverse flow of blood when valves should be closed

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9
Q

What causes regurgitation?

A

increased volumes = dilation = failure

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10
Q

Diastolic valvular pathologies

A 
LHS
- mitral stenosis
- aortic regurg
RHS
- tricuspid stenosis
- pulmonary regurg
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11
Q

Systolic valvular pathologies

A 
LHS
- aortic stenosis
- mitral regurg
RHS
- pulmonary stenosis
- tricuspid regurg
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12
Q

Causes of valve disease

A
  • degeneration = calcification/old age
  • infection = rheumatic fever, infective endocarditis
  • abnormal valve
  • abnormal surrounding myocardium = ischaemia, hypertrophy, dilatation
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13
Q

Mitral Regurg Causes

A
  • myocardium dilatation
  • ischaemic (post MI, ruptured chorea-tendonae)
  • rheumatic fever
  • infective endocarditis
  • mitral valve prolapse
  • calcification (elderly)
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14
Q

Effects of mitral regurg

A
  • LA enlargement
  • LVH = SV and ejection fraction reduction
  • LV failure
  • AF
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15
Q

Symptoms of mitral regurg

A

Exertional dyspnoea
palpitation
ankle swelling (CHF)

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16
Q

Signs of mitral regurg

A

Pulse = irregularly irregular
Apex = thrusting, displaced
Soft S1 HS
Pan systolic systolic murmur

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17
Q

Mitral regurg Ix

A

AF ECG

CXR Pulmonary Congestion

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18
Q

Causes of aortic stenosis

A
  • senile calcification
  • bicuspid aortic valve congenital
  • rheumatic (rare)
19
Q

Pathophys of aortic stenosis

A
  • increased afterload
  • concentric hypertrophy of LV to maintain SV
  • decreased myocardial compliance in diastole = diastolic dysfunction
  • reduced coronary blood flow, increased myocardial workload
  • reduction in size of LV
  • pulmonary venous hypertension
20
Q

Symptoms of aortic stenosis

A
  • chest pain = myocardial ischaemia
  • breathlessness
  • syncope
21
Q

Signs of aortic stenosis

A
  • pulse slow rising
  • displaced apex
  • quiet S1 if severe
  • ejection systolic murmur
22
Q

Aortic stenosis Ix

A

ECG LVH

CXR cardiac enlargement, calcification of aortic ring

23
Q

Acute causes of aortic regurg

A
  • infective endocarditis

- dissection of aortic root (ascending aorta)

24
Q

Chronic causes of aortic regurg

A
  • degeneration
  • rheumatic fever
  • infective endocarditis
  • degeneration of bicuspid valve
  • spondyloarthropathy (ANK SPON)
  • aortitis (vasculitis)
25
Q

Aortic regurg Pathophys

A
  • volume overload of LV
    ACUTE
  • rapid increase in LV pressure
  • pulmonary oedema and decreased CO
    CHRONIC
  • LV dilatation until decompensated = LV impairment, HF
  • increased SV and low diastolic pressures
26
Q

Symptoms of Aortic regurg

A
  • breathlessness
  • palpitations
  • RHF signs
  • cardiovasc collapse as loss of CO if acute
27
Q

Signs of aortic regurg

A
  • de musset sign
  • corrigans sign
  • muellers sign
  • quincke sign
  • water hammer/collapsing pulse
  • traube’s sign
  • bilateral inspiratory crackles
  • early diastolic murmur = blowing high pitched
  • Austin flint murmur = late diastolic
28
Q

Aortic regurg Ix

A

ECG LVH

CXR = aortic root prominence

29
Q

Causes of mitral stenosis

A
  • Rhemutaic heart disease!!

- congenital (rare)

30
Q

What does mitral stenosis mimic?

A
  • atria myxoma

- atrial thrombus

31
Q

Mitral Stenosis Pathophys

A
  • high pressure in LA
  • increased LA size
  • pulmonary hypertension and R. HF
  • AF
  • associated regurg
32
Q

Symptoms of mitral stenosis

A
  • breathlessness
  • palpitations
  • ankle swelling
33
Q

Signs of mitral stenosis

A
  • mitral facies
  • irreg pulse
  • CHF signs
  • Loud S1
  • low pitched diastolic murmur crescendo
34
Q

Mitral stenosis Ix

A
  • ECG P mitrale

- CXR enlarged LA = double margin

35
Q

Echo of mitral valve disease - what to look at?

A
  • valve appearance
  • LA size
  • LV size and function
  • Doppler to asses stenosis and regurg
  • estimate pulmonary pressures
  • R. heart size and function
36
Q

Echo of aortic valve disease - what to look at?

A
  • valve appearance
  • valve gradient
  • valve area
  • severity of AR based on colour flow and CW doppler
  • LV size and function
37
Q

When to treat aortic stenosis?

A
  • when symptomatic

- OR when certain severity parameters met on Echo

38
Q

When to treat mitral regurg?

A
  • before patient becomes symptomatic

- to prevent irreversible changes in cardiac function

39
Q

Intervention for valvular disease

A
  • repair
  • replace = tissue or metallic
  • balloon valvuloplasty
  • transcatheter aortic valve implantation
40
Q

How to repair a valve?

A
  • annuloplasty ring

- through the groin

41
Q

RF for valve disease

A
  • pathological valve
  • replacement
  • structural heart disease
42
Q

Dukes criteria major?

A
  • typical organism on blood culture or positive serology + positive echo
43
Q

Dukes criteria minor?

A
  • predisposing factors
  • fever
  • vascular phenomena clubbing, splinter haemorrhage
  • splenomegaly
  • immunological phenomena
  • suggestive echo
  • suggestive microbiology
44
Q

Peripheral signs of endocarditis

A

Look at slide 50 Qreview

  • nodes
  • clubbing

CR3 (30 decks)

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