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5th year countdown > Valvular Disease + Infective Endocarditis > Flashcards

Valvular Disease + Infective Endocarditis Flashcards

1
Q

Ejection type of systolic murmur

A

Aortic stenosis

Pulmonary stenosis

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2
Q

Pansystolic murmur

A

Mitral regard
Tricuspid regurgitation
Ventricular septal defect

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3
Q

Diastolic decrescendo

A

Aortic regurgitation

Pulmonary regurgitation

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4
Q

Mid-to-late

A

Mild mitral or tricuspid stenosis

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5
Q

What is the scoring system for murmurs

A

1-6

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6
Q

What is a thrill

A

palpable murmur

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7
Q

What is a heave

A

pumping of heart against hand

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8
Q

Causes of aortic stenosis

A 
Degernation 
Bicuspid valvue (congenital)
Post inflammatory (rheumatic fever)
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9
Q

Affects of AS on heart

A

LV hypertrophy, ↓CO

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10
Q

What other cardiac disease does AS put u at risk off?

A

AF, HF, MI

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11
Q

CF of AS

A 
SOB on exertion +- chest pain
Syncope
Fatigue 
Palpitation 
Narrow pulse pressure (distance between SBP + DBP)
Thrill 
Slow rising pulse - volume increases with pulsation 
S4
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12
Q

Investigation AS

A

ECGLVH - on ECG
ECHO - hypotrophy LV muscle, valve area < 1cm2
CXR - signs HF, dilatation of aorta
Cardiac catheterisation (pressure gradients)

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13
Q

Differentials for AS

A 
Aortic sclerosis -  thick valve normal output
Subacute endocarditis (always rule out with new murmur)
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14
Q

Mgmt for AS

A

Conservative
AV Replacement (fit young patients)
Transcatheter AV implantation (elderly or comorbities)

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15
Q

Mitral regurgitation causes

A

Degenerative
Infective endocarditis/RF
Pupillary muscle rupture

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16
Q

Risk for MR

A

AF, pulmonary hypertension, VTE
Acute: rapid pulmonary oedema
Chronic: LV dilatation +- failure

17
Q

CF of MR, what does it sound like on auscultation

A

SOB +- cough
Fatigue
Palpitations
shhhhhh dub

18
Q

Differentials MR

A

VSD

19
Q

Mgmt for chronic and acute MR

A

Chronic: surgical valve repair or replacement
Acute: Diuretics (acute p oedema - OMFG), may require +ve inotropes (adrenaline), intra-aortic ballon pump.

20
Q

Aortic regurgitation

A 
Bicuspid valve
Collagen disorders (marfans
21
Q

CF of AR

A

Fatigue
Dyspnoea, orthopnea, PND
syncope

Widened pulse pressure
Collapsing pulse
early diastolic murmur - aortic region, louder leaning forward in exportation
Lung basal crackles

22
Q

Mgmt of AR

A

Surfical AVR

ECHO

23
Q

Mitral Stenosis

A

Degeration

Rheumatic fever

24
Q

CF of MS

A

Dyspnoea, orthopnea, PND
Palpitations
Haemoptysis

Malar flush
Raised JVP
RV heave
Mid diastolic rumbling murmur + opening snap
Loudest at apex - LL
Heptomegaly, ascite, oedema

Inv
CXR: HF
ECG: RVH, p mitrale

25
Q

Inv of MS

A

Inv
CXR: HF
ECG: RVH, p mitrale
ECHO: TOE to assess atrial appendage for thrombus

26
Q

Mgmt of MS

A

SOB: Diytetics
AF: Anticoagulant, BB
Valvulotomy
MVR

27
Q

RF for infective endocarditis

A

Valve disease/replacement
IVDU
Previous IE/Congential HD
Poor oral hygiene

28
Q

Risk on which valves

A

Mitral > Aortic > Tricuspid > pulmonary

29
Q

Organism

A 
S aura (IVDU, prosthetic) 
Strep viridian's
30
Q

CF of IE

A

Fever/rigors
Weight loss
Fatigue

Osler nodes, Janeway lesions, splinter haemorrhage, roth spot
Heart murmur

31
Q

INV of IE

A

Baseline ECG - PR prolongation (root abscess)
3 x blood cultures in 24 hours
TTE (60% sensitive) - trans thoracic ECHO
TOE

32
Q

Criteria of IE

A

Duke criteria
Major criteria:
BC for IE, Echo +ve, new valvular regurg, pros ethic valve
Minor: Fever, vasculitis/stroke/pv episodi

33
Q

Mgmt of IE

A

IV antibiotics 4-6 weeks - PICC line due to vein irritation from antics
Surgery - valve replacements

34
Q

complications of IE

A 
Aortic root abscess
Septic emboli - pulmonary, cerebral, renal
Sepsis
HF
Arrythmia 
MI
35
Q

ticking + central sternotomy scar

A

valve replacement

36
Q

OSCE

A

Describe systolic/di where loudest, radiating to, consistent with, investigation

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