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Valvular Heart Disease Flashcards

1
Q

what type of symptoms are characteristic of cardiac/ valvular heart disease

A

exertional symptoms

  • chest pain
  • breathlessness/ SOB
  • collapse/ dizzy spells
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2
Q

what is a stabbing chest pain more likely to be

A

pleuritic

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3
Q

describe cardiac chest pain

A

gripping, squeezing, heavy, crushing

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4
Q

why is ankle swelling common associated with breathlessness

A

if Ls of heart fails and there is a back pressure in lungs the RS of the heart will failure leading to ankle oedema

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5
Q

what is orthopnoea and why does it happen

A

breathlessness when lying flat

effect of gravity increases pressure in the lung worsening SOB

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6
Q

what is PND and how does it happen

A

paroxysmal nocturnal dyspnoea- when patient wakes struggling to breath in the middle of the night

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7
Q

what does the new york heart association of functional classification describe

A

gradient based on activity 1= no limitation 4= severe limitation

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8
Q

what are the signs of right heart failure

A

raised JVP, pitting oedema, hepatic congestion (because of back pressure in systemic system)

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9
Q

what are the signs of left heart failure

A

basal crepitations, pulmonary oedema, SOB

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10
Q

what does the JVP estimate

A

right arterial pressure

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11
Q

where does pitting oedema occur

A

ankles and sacrum (in bed ridden patients)

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12
Q

where is the apex beat normally

A

5th intercostal space/ mid clavicular line

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13
Q

what can cause a tapping apex beat

A

mitral stenosis

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14
Q

what can cause a displaced and diffuse apex beat

A

left ventricular dilatation (volume overload)

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15
Q

what is a diffuse apex beat

A

when the apex beat can be felt equally with four or more fingers or in more than one intercostal space

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16
Q

what can cause left ventricular hypertrophy

A

hypertension and aortic stenosis

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17
Q

what is felt at the apex beat in left ventricular hypertrophy

A

heaving and maybe displaced

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18
Q

where do you feel for a parasternal heave

A

hand left of sternum

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19
Q

what can cause a parasternal heave

A

right ventricular overload e.g. cor pulmonale/ pulmonary hypertension

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20
Q

what is a cardiac murmur

A

audible turbulence of blood flow

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21
Q

what is an innocent murmur

A

increased flow causing turbulence in right ventricular outflow tract

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22
Q

what causes a pathological murmur

A

structural cardiac abnormalities

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23
Q

where do you auscultate the aortic valve

A

2nd- 3rd right intercostal space

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24
Q

where do you auscultate the pulmonary valve

A

2nd-3rd left intercostal space

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25
where do you auscultate the tricuspid valve
left sternal border
26
where do you auscultate the mitral valve
apex
27
what creates the first heart sound
mitral and tricuspid valve closing
28
what does the first sound signify in the heart cycle
start of systole
29
what creates the second heart sound
aortic and pulmonary valves closing
30
what does the second sound signify in the heart cycle
start of diastole
31
what murmur is a diamond shape in a phenocardiogram
mitral stenosis
32
describe a pansystolic murmur
same volume throughout systole
33
describe an ejection systolic murmur
crescendo decrescendo-rises slowly then falls quickly- late peaking
34
what type of murmur coincides with the pulse
systolic murmurs
35
what are the characteristics of an innocent murmur
soft mid systolic, heard in pulmonary area, localised, no radiation, no other symptoms
36
what causes the physiological splitting of the 2nd heart sound
inspiration causes a drop in intrathoracic pressure resulting in increased venous return to RHS of the heart. this increased volume prolongs RV ejection time hence the pulmonary component of the second heart sound may be delayed behind the aortic during inspiration
37
in splitting of 2nd heart sound which is louder
first (aortic) louder than second (pulmonary)
38
where is the splitting of the 2nd heart sound best heart
pulmonary area- in the second intercostal space at the sternal border
39
what causes a third heart sound and when is it heard
caused by acceleration and deceleration of blood flow during early passive filling of the ventricle an low frequency early diastolic sound, occurs immediately after 2nd hs
40
where is a third heart sound best heard
at the apex with the bell
41
what does a 3rd heart sound mean
can be physiological or pathological (usually LV systolic dysfunction)
42
describe the 4th heart sound and when it is heard
low frequency lat diastolic filling sound occurs shortly before 1st heart sound
43
what causes the 4th heart sound
atrial contraction causing rapid flow into a stiff/ less compliant ventricle
44
when conditions can cause a 4th heart sound
myocardial ischaemia, hypertension, aortic stenosis
45
where are 4th heart sounds best heard
at the apex with the bell of the stethoscope
46
can diastolic murmurs be physiological
no always pathological
47
what murmur radiates to the neck (carotids)
aortic stenosis
48
what murmur radiates to the axilla
mitral regurgitation
49
describe mitral stenosis murmur
mid diastolic, rumbling, crescendo decrescendo
50
what are the two types of diastolic murmur
early and mid
51
what does the grading of murmurs describe
loudness I-very quite VI- audible without a stethoscope
52
what is a IV murmur
loud with a thrill
53
what is a V murmur
very loud with a thrill
54
how are right sided murmurs different from left sided murmurs
right sided murmurs are louder with inspiration
55
what causes valve stenosis
valves that do not open properly
56
what causes valve regurgitation
valves which do not close properly
57
what is mixed valve disease
when the valves neither open or close properly
58
what can cause aortic stenosis
degenerative (age related, most important), congenital (presents earlier- bicuspid aortic valve), rheumatic
59
what are the symptoms of aortic stenosis
breathlessness, chest pain (mimicking angina), dizziness/ syncope (CO insufficient)
60
what are the clinical signs of aortic stenosis
low volume pulse, forceful displaced apex, ejection systolic murmur that radiates to the carotids
61
how is aortic stenosis shown on an ECG
tall r waves- LVH signs
62
how is aortic stenosis treated
valve replacement: open heart surgery (preferred), trans catheter balloon aortic valvotomy medication will NOT help
63
what types of prosthetic heart valves are there
mechanical (lasts longer but needs warfarin bio-prosthetic (no warfarin)
64
what can cause mitral regurgitation
leaflets - prolapse - rheumatic - myxomatous (floppy) - endocarditis ``` chordae rupture (degenerative) -prolapse/ fail leaflet ``` papillary muscle rupture -ischaemic annular dilatation -functional
65
what are the symptoms of mitral regurgitation
breathlessness (back pressure in lungs), peripheral oedema, fatigue (heart failure, lack of tissue perfusion)
66
what are the clinical signs of mitral regurgitation
displaced apex, pansystolic murmur (radiating to the axilla)
67
where is mitral regurgitation best heard
mitral area
68
how is mitral regurgitation treated
medications- diuretics and ACE inhibitors (for heart failure) surgical- repair (prolapse), replacement (degenerative) percutaneous clips in infancy
69
what causes mitral stenosis
rheumatic (main cause), congenital (main cause)
70
what are the symptoms of mitral stenosis
breathlessness (back pressure in the lungs), fatigue, palpitations (AF)
71
what are the clinical signs of mitral stenosis
malar flush, tapping apex beat, mid diastolic rumbling murmur localised to apex
72
how is mitral stenosis best heard
with bell of stethoscope with patient in left lateral position
73
how does mitral stenosis cause AF
The pressure buildup of mitral valve stenosis results in enlargement of your heart's upper left chamber which leads to AF
74
what can be seen on a CXR of a patient with mitral regurgitation
cardiomegaly
75
what can be seen on a CXR of a patient with mitral stenosis
straight left heart border
76
how is mitral stenosis treated
medications- diuretics and treatment for AF surgery- valve replacement balloon valvuloplasty
77
briefly describe the process of balloon valvuloplasty in mitral stenosis
balloon passed through the mitral valve and the blown up
78
what can cause aortic regurgitation
leaflets; - endocarditis - connective tissue disease - rheumatic annulus (dilation of the proximal aorta) - marfans - aortic dissection
79
what are the symptoms of aortic regurgitation
breathlessness (congestion of the lungs)
80
what are the clinical signs of aortic regurgitation
collapsing pulse, wide pulse pressure (large end diastolic volume), displaced apex, early diastolic murmur at left sternal edge
81
what can be seen on a CXR of a patient with aortic regurgitation
cardiomegaly
82
how is mitral regurgitation treated
medication- ace inhibitors surgery- valve replacement, treat symptoms and LV dilatation

SD2 (12 decks)

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