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SD2 > Valvular Heart Disease > Flashcards

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
Q

where do you auscultate the tricuspid valve

A

left sternal border

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26
Q

where do you auscultate the mitral valve

A

apex

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27
Q

what creates the first heart sound

A

mitral and tricuspid valve closing

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28
Q

what does the first sound signify in the heart cycle

A

start of systole

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29
Q

what creates the second heart sound

A

aortic and pulmonary valves closing

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30
Q

what does the second sound signify in the heart cycle

A

start of diastole

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31
Q

what murmur is a diamond shape in a phenocardiogram

A

mitral stenosis

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32
Q

describe a pansystolic murmur

A

same volume throughout systole

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33
Q

describe an ejection systolic murmur

A

crescendo decrescendo-rises slowly then falls quickly- late peaking

34
Q

what type of murmur coincides with the pulse

A

systolic murmurs

35
Q

what are the characteristics of an innocent murmur

A

soft mid systolic, heard in pulmonary area, localised, no radiation, no other symptoms

36
Q

what causes the physiological splitting of the 2nd heart sound

A

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
Q

in splitting of 2nd heart sound which is louder

A

first (aortic) louder than second (pulmonary)

38
Q

where is the splitting of the 2nd heart sound best heart

A

pulmonary area- in the second intercostal space at the sternal border

39
Q

what causes a third heart sound and when is it heard

A

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
Q

where is a third heart sound best heard

A

at the apex with the bell

41
Q

what does a 3rd heart sound mean

A

can be physiological or pathological (usually LV systolic dysfunction)

42
Q

describe the 4th heart sound and when it is heard

A

low frequency lat diastolic filling sound

occurs shortly before 1st heart sound

43
Q

what causes the 4th heart sound

A

atrial contraction causing rapid flow into a stiff/ less compliant ventricle

44
Q

when conditions can cause a 4th heart sound

A

myocardial ischaemia, hypertension, aortic stenosis

45
Q

where are 4th heart sounds best heard

A

at the apex with the bell of the stethoscope

46
Q

can diastolic murmurs be physiological

A

no always pathological

47
Q

what murmur radiates to the neck (carotids)

A

aortic stenosis

48
Q

what murmur radiates to the axilla

A

mitral regurgitation

49
Q

describe mitral stenosis murmur

A

mid diastolic, rumbling, crescendo decrescendo

50
Q

what are the two types of diastolic murmur

A

early and mid

51
Q

what does the grading of murmurs describe

A

loudness
I-very quite
VI- audible without a stethoscope

52
Q

what is a IV murmur

A

loud with a thrill

53
Q

what is a V murmur

A

very loud with a thrill

54
Q

how are right sided murmurs different from left sided murmurs

A

right sided murmurs are louder with inspiration

55
Q

what causes valve stenosis

A

valves that do not open properly

56
Q

what causes valve regurgitation

A

valves which do not close properly

57
Q

what is mixed valve disease

A

when the valves neither open or close properly

58
Q

what can cause aortic stenosis

A

degenerative (age related, most important),
congenital (presents earlier- bicuspid aortic valve),
rheumatic

59
Q

what are the symptoms of aortic stenosis

A

breathlessness, chest pain (mimicking angina), dizziness/ syncope (CO insufficient)

60
Q

what are the clinical signs of aortic stenosis

A

low volume pulse, forceful displaced apex, ejection systolic murmur that radiates to the carotids

61
Q

how is aortic stenosis shown on an ECG

A

tall r waves- LVH signs

62
Q

how is aortic stenosis treated

A

valve replacement: open heart surgery (preferred), trans catheter

balloon aortic valvotomy

medication will NOT help

63
Q

what types of prosthetic heart valves are there

A

mechanical (lasts longer but needs warfarin

bio-prosthetic (no warfarin)

64
Q

what can cause mitral regurgitation

A

leaflets

  • prolapse
  • rheumatic
  • myxomatous (floppy)
  • endocarditis
chordae rupture (degenerative)
-prolapse/ fail leaflet

papillary muscle rupture
-ischaemic

annular dilatation
-functional

65
Q

what are the symptoms of mitral regurgitation

A

breathlessness (back pressure in lungs), peripheral oedema, fatigue (heart failure, lack of tissue perfusion)

66
Q

what are the clinical signs of mitral regurgitation

A

displaced apex, pansystolic murmur (radiating to the axilla)

67
Q

where is mitral regurgitation best heard

A

mitral area

68
Q

how is mitral regurgitation treated

A

medications- diuretics and ACE inhibitors (for heart failure)

surgical- repair (prolapse), replacement (degenerative)

percutaneous clips in infancy

69
Q

what causes mitral stenosis

A

rheumatic (main cause), congenital (main cause)

70
Q

what are the symptoms of mitral stenosis

A

breathlessness (back pressure in the lungs), fatigue, palpitations (AF)

71
Q

what are the clinical signs of mitral stenosis

A

malar flush, tapping apex beat, mid diastolic rumbling murmur localised to apex

72
Q

how is mitral stenosis best heard

A

with bell of stethoscope with patient in left lateral position

73
Q

how does mitral stenosis cause AF

A

The pressure buildup of mitral valve stenosis results in enlargement of your heart’s upper left chamber which leads to AF

74
Q

what can be seen on a CXR of a patient with mitral regurgitation

A

cardiomegaly

75
Q

what can be seen on a CXR of a patient with mitral stenosis

A

straight left heart border

76
Q

how is mitral stenosis treated

A

medications- diuretics and treatment for AF

surgery- valve replacement

balloon valvuloplasty

77
Q

briefly describe the process of balloon valvuloplasty in mitral stenosis

A

balloon passed through the mitral valve and the blown up

78
Q

what can cause aortic regurgitation

A

leaflets;

  • endocarditis
  • connective tissue disease
  • rheumatic

annulus (dilation of the proximal aorta)

  • marfans
  • aortic dissection
79
Q

what are the symptoms of aortic regurgitation

A

breathlessness (congestion of the lungs)

80
Q

what are the clinical signs of aortic regurgitation

A

collapsing pulse, wide pulse pressure (large end diastolic volume), displaced apex, early diastolic murmur at left sternal edge

81
Q

what can be seen on a CXR of a patient with aortic regurgitation

A

cardiomegaly

82
Q

how is mitral regurgitation treated

A

medication- ace inhibitors

surgery- valve replacement, treat symptoms and LV dilatation

SD2 (12 decks)

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