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Cardiorespiratory > Valvular heart disease > Flashcards

Valvular heart disease Flashcards

1
Q

Is the bell or diaphragm of stethoscope better at hearing high-pitched sounds?

A

Diaphragm - high pitched.
Bell - low pitched.

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2
Q

What causes a murmur to be heard?

A

Turbulent blood flow through valve.

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3
Q

What ECG changes can be seen in severe mitral stenosis?

A

P Mitrale

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4
Q

What is the most common complication of infective endocarditis?

A

Heart failure

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5
Q

Ankylosing spondylitis is associated with which murmur?

A

Aortic regurgitation

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6
Q

What are S1 and S2 heart sounds?

A

S1 - closing of tricuspid and mitral valves.
S2 - closing of pulmonary and aortic valves.

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7
Q

What is S3 heart sound?

A

Rapid ventricular filling, gallop rhythm. Can indicate HF in older patients.

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8
Q

What is S4 heart sound?

A

Atria contracting against a stiff or hypertrophic ventricle.

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9
Q

Where is the best area for listening to S1 and S2?

A

Erb’s point - 3rd intercostal space, left sternal border.

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10
Q

What cardiac changes world you see with stenosis and regurgitation?

A

Stenosis - hypertrophy.
Regurgitation - dilatation.

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11
Q

What is the most common valvular heart disease?

A

Aortic stenosis

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12
Q

How would you investigate valvular heart disease?

A

Echocardiogram

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13
Q

List the causes of aortic stenosis

A

Calcification, congenital bicuspid valve, rheumatic heart disease.

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14
Q

Describe the murmur for aortic stenosis

A

Ejection systolic, high-pitched murmur.

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15
Q

Where does an aortic stenosis murmur radiate to?

A

The carotids.

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16
Q

What symptoms might you expect for aortic stenosis?

A

Exertional syncope, angina, dyspnoea.

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17
Q

List the causes of aortic regurgitation

A

Idiopathic age-related degeneration, congenital bicuspid valve, CT disorders e.g. EDS, Marfan syndrome.

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18
Q

Describe the murmur for aortic regurgitation

A

Early diastolic soft murmur.

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19
Q

What is an Austin-Flint murmur?

A

Rumbling diastolic murmur heard at apex caused by backflow of blood through aortic valve and over mitral valve.

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20
Q

What type of pulse might you feel with aortic regurgitation?

A

Collapsing pulse - forcefully appearing and rapidly disappearing pulse felt over radial artery with patients arm held upright.

21
Q

What are the causes for mitral stenosis?

A

Rheumatic heart disease

22
Q

Describe the murmur for mitral stenosis

A

Mid-diastolic, low-pitched murmur.

23
Q

Which murmur is associated with a malar flush and why?

A

Mitral stenosis due to back pressure of blood into pulmonary system, increasing CO2 causing vasodilation.

24
Q

List the causes of mitral regurgitation

A

Idiopathic age-related degeneration, IHD (papillary muscle dysfunction), infective endocarditis, CT disorders e.g. EDS, Marfan syndrome.

25
Q

Describe the murmur for mitral regurgitation

A

Pansystolic, high-pitched murmur.

26
Q

Where does the murmur radiate to in mitral regurgitation?

A

Left axilla.

27
Q

Would you expect signs of HF and pulmonary oedema in mitral regurgitation?

A

Yes

28
Q

Describe the murmur for tricuspid regurgitation

A

Pansystolic murmur and split S2

29
Q

Describe the murmur for pulmonary stenosis

A

Ejection systolic murmur and split S2

30
Q

What are the causes of pulmonary stenosis?

A

Congenital: Noonan syndrome, Tetralogy of Fallot.

31
Q

What is the lifespan of a bioprosthetic valve?

A

10 years

32
Q

What is the lifespan of a mechanical valve?

A

20 years

33
Q

Which anticoagulant is required for mechanical valves?

A

Warfarin

34
Q

What is the target INR range for mechanical valves?

A

2.5-3.5

  • Aortic: 3.0
  • Mitral: 3.5
35
Q

List some complications from mechanical valves

A

Thrombus formation, infective endocarditis, haemolysis.

36
Q

What is the alternative to open heart surgery for an aortic valve replacement?

A

Transcatheter aortic valve implantation (TAVI).

37
Q

Describe the risk factors for infective endocarditis

A

IV drug use, valvular heart disease, congenital heart disease, hypertrophic cardiomyopathy, prosthetic heart valves, ICDs, dialysis, immunocompromised, Hx infective endocarditis, dentition.

38
Q

What is the most common causative organism for infective endocarditis?

A

Staphylococcus aureus

39
Q

Describe the clinical features of infective endocarditis

A

Fever, new/changing murmur, splinter haemorrhages, petechiae, Janeway lesions, Osler’s nodes, Roth spots.

40
Q

How many sets of blood cultures are needed for suspected infective endocarditis?

A

3

41
Q

What findings might be seen on an echocardiogram for infective endocarditis?

A

Vegetations on valves.

42
Q

What criteria is used to diagnose infective endocarditis?

A

Modified Duke criteria.

43
Q

What is the treatment for infective endocarditis?

A

IV antibiotics e.g. flucloxacillin, or surgery.

44
Q

Should nitrates be given to alleviate symptoms of aortic stenosis?

A

No nitrates are contraindicated.

45
Q

Name some common antibiotics used for the treatment of bacterial endocarditis

A

Benzylpenicillin, amoxicillin, gentamicin, vancomycin, flucloxacillin.

46
Q

What are the indications for surgery in infective endocarditis?

A

Severe congestive heart failure, infections resistant to antibiotic therapy, recurrent emboli after antibiotic therapy, severe valvular incompetence, and an aortic abscess.

47
Q

What is Quincke’s sign?

A
  • Pulsations are seen in the nail bed with each heartbeat when the nail bed is lightly compressed.
  • Sign of aortic regurgitation.
48
Q

List the CYP450 inducers and inhibitors of warfarin

A

Inducers - SCARS:

  • Smoking.
  • Chronic alcohol intake.
  • Antiepileptics: phenytoin, carbamazepine, phenobarbital.
  • Rifampicin.
  • St John’s wort.

Inhibitors - ASS-ZOLES:

  • Antibiotics: ciprofloxacin, erythromycin, isoniazid, clarithromycin.
  • SSRIs: fluoxetine, sertraline.
  • Sodium valproate.
  • Zoles: omeprazole, ketoconazole, fluconazole.

Cardiorespiratory (15 decks)

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