Valvular Disease + Infective Endocarditis Flashcards
Ejection type of systolic murmur
Aortic stenosis
Pulmonary stenosis
Pansystolic murmur
Mitral regard
Tricuspid regurgitation
Ventricular septal defect
Diastolic decrescendo
Aortic regurgitation
Pulmonary regurgitation
Mid-to-late
Mild mitral or tricuspid stenosis
What is the scoring system for murmurs
1-6
What is a thrill
palpable murmur
What is a heave
pumping of heart against hand
Causes of aortic stenosis
Degernation Bicuspid valvue (congenital) Post inflammatory (rheumatic fever)
Affects of AS on heart
LV hypertrophy, ↓CO
What other cardiac disease does AS put u at risk off?
AF, HF, MI
CF of AS
SOB on exertion +- chest pain Syncope Fatigue Palpitation Narrow pulse pressure (distance between SBP + DBP) Thrill Slow rising pulse - volume increases with pulsation S4
Investigation AS
ECGLVH - on ECG
ECHO - hypotrophy LV muscle, valve area < 1cm2
CXR - signs HF, dilatation of aorta
Cardiac catheterisation (pressure gradients)
Differentials for AS
Aortic sclerosis - thick valve normal output Subacute endocarditis (always rule out with new murmur)
Mgmt for AS
Conservative
AV Replacement (fit young patients)
Transcatheter AV implantation (elderly or comorbities)
Mitral regurgitation causes
Degenerative
Infective endocarditis/RF
Pupillary muscle rupture
Risk for MR
AF, pulmonary hypertension, VTE
Acute: rapid pulmonary oedema
Chronic: LV dilatation +- failure
CF of MR, what does it sound like on auscultation
SOB +- cough
Fatigue
Palpitations
shhhhhh dub
Differentials MR
VSD
Mgmt for chronic and acute MR
Chronic: surgical valve repair or replacement
Acute: Diuretics (acute p oedema - OMFG), may require +ve inotropes (adrenaline), intra-aortic ballon pump.
Aortic regurgitation
Bicuspid valve Collagen disorders (marfans
CF of AR
Fatigue
Dyspnoea, orthopnea, PND
syncope
Widened pulse pressure
Collapsing pulse
early diastolic murmur - aortic region, louder leaning forward in exportation
Lung basal crackles
Mgmt of AR
Surfical AVR
ECHO
Mitral Stenosis
Degeration
Rheumatic fever
CF of MS
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
Inv of MS
Inv
CXR: HF
ECG: RVH, p mitrale
ECHO: TOE to assess atrial appendage for thrombus
Mgmt of MS
SOB: Diytetics
AF: Anticoagulant, BB
Valvulotomy
MVR
RF for infective endocarditis
Valve disease/replacement
IVDU
Previous IE/Congential HD
Poor oral hygiene
Risk on which valves
Mitral > Aortic > Tricuspid > pulmonary
Organism
S aura (IVDU, prosthetic) Strep viridian's
CF of IE
Fever/rigors
Weight loss
Fatigue
Osler nodes, Janeway lesions, splinter haemorrhage, roth spot
Heart murmur
INV of IE
Baseline ECG - PR prolongation (root abscess)
3 x blood cultures in 24 hours
TTE (60% sensitive) - trans thoracic ECHO
TOE
Criteria of IE
Duke criteria
Major criteria:
BC for IE, Echo +ve, new valvular regurg, pros ethic valve
Minor: Fever, vasculitis/stroke/pv episodi
Mgmt of IE
IV antibiotics 4-6 weeks - PICC line due to vein irritation from antics
Surgery - valve replacements
complications of IE
Aortic root abscess Septic emboli - pulmonary, cerebral, renal Sepsis HF Arrythmia MI
ticking + central sternotomy scar
valve replacement
OSCE
Describe systolic/di where loudest, radiating to, consistent with, investigation
