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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.

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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.
49
Q

Why is there angina with aortic stenosis?

A

Due to reduced blood flow through the coronary arteries during diastole, because the stenosed valve can’t properly close, obstructing flow through the coronary vessels. The hearts demand for oxygen therefore exceeds its supply.

50
Q

What are the most common valves affected in infective endocarditis?

A
  • Mitral valve - previously normal valves.
  • Tricuspid valve - IVDU.

Cardiorespiratory (15 decks)

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