Valvular Disease + Infective Endocarditis

Question 1

Ejection type of systolic murmur

Answer 1

Aortic stenosis

Pulmonary stenosis

Question 2

Pansystolic murmur

Answer 2

Mitral regard
Tricuspid regurgitation
Ventricular septal defect

Question 3

Diastolic decrescendo

Answer 3

Aortic regurgitation

Pulmonary regurgitation

Question 4

Mid-to-late

Answer 4

Mild mitral or tricuspid stenosis

Question 5

What is the scoring system for murmurs

Answer 5

1-6

Question 6

What is a thrill

Answer 6

palpable murmur

Question 7

What is a heave

Answer 7

pumping of heart against hand

Question 8

Causes of aortic stenosis

Answer 8

Degernation 
Bicuspid valvue (congenital)
Post inflammatory (rheumatic fever)

Question 9

Affects of AS on heart

Answer 9

LV hypertrophy, ↓CO

Question 10

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

Answer 10

AF, HF, MI

Question 11

CF of AS

Answer 11

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

Question 12

Investigation AS

Answer 12

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

Question 13

Differentials for AS

Answer 13

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

Question 14

Mgmt for AS

Answer 14

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

Question 15

Mitral regurgitation causes

Answer 15

Degenerative
Infective endocarditis/RF
Pupillary muscle rupture

Question 16

Risk for MR

Answer 16

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

Question 17

CF of MR, what does it sound like on auscultation

Answer 17

SOB +- cough
Fatigue
Palpitations
shhhhhh dub

Question 18

Differentials MR

Answer 18

VSD

Question 19

Mgmt for chronic and acute MR

Answer 19

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

Question 20

Aortic regurgitation

Answer 20

Bicuspid valve
Collagen disorders (marfans

Question 21

CF of AR

Answer 21

Fatigue
Dyspnoea, orthopnea, PND
syncope

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

Question 22

Mgmt of AR

Answer 22

Surfical AVR

ECHO

Question 23

Mitral Stenosis

Answer 23

Degeration

Rheumatic fever

Question 24

CF of MS

Answer 24

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

Question 25

Inv of MS

Answer 25

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

Question 26

Mgmt of MS

Answer 26

SOB: Diytetics AF: Anticoagulant, BB Valvulotomy MVR

Question 27

RF for infective endocarditis

Answer 27

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

Question 28

Risk on which valves

Answer 28

Mitral > Aortic > Tricuspid > pulmonary

Question 29

Organism

Answer 29

``` S aura (IVDU, prosthetic) Strep viridian's ```

Question 30

CF of IE

Answer 30

Fever/rigors Weight loss Fatigue Osler nodes, Janeway lesions, splinter haemorrhage, roth spot Heart murmur

Question 31

INV of IE

Answer 31

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

Question 32

Criteria of IE

Answer 32

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

Question 33

Mgmt of IE

Answer 33

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

Question 34

complications of IE

Answer 34

``` Aortic root abscess Septic emboli - pulmonary, cerebral, renal Sepsis HF Arrythmia MI ```

Question 35

ticking + central sternotomy scar

Answer 35

valve replacement

Question 36

OSCE

Answer 36

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