Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MBBS 3: Internal Medicine > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

Describing murmurs?

A
  1. Timing
  2. Location
  3. Grade
  4. Character
  5. Shape
  6. Pitch
  7. Radiation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Timing of murmurs?

A

A murmur is either:
1. systolic
2. diastolic
3. continuous throughout systole and diastole.
- Remember that systole occurs between the S1 and S2 heart sounds, whereas diastole occurs between S2 and S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The 4 main listening posts on the chest for determing the location of murmurs?

A
  1. A = aortic valve post (right upper sternal border)
  2. P = pulmonic valve post (left upper sternal border)
  3. T = tricuspid valve post (left lower sternal border 4th ICS)
  4. M = mitral valve post (apex)
  5. E = ‘Erb’s point’ (left sternal border 3rd ICS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Aortic murmurs?

A

sytolic murmurs
1. aortic stenosis
2. aortic valve sclerosis
3. flow murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pulmonary valve murmur?

A

systolic murmur
1. flow murmur
2. pulmonic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Tricuspid valve murmurs?

A

systolic
1. tricuspid regurgitation
2. ventricular septal defect
diastolic
1. tricuspid stenosis
2. atrial septal defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Mitral valve murmurs?

A

systolic
1. mitral regurgitation
diastolic
1. mitral stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Erbs point murmurs?

A

diastolic
1. aortic regurgitation
2. pulmonic regurgitation
systolic
1. hypertrophic obstructive cardiomyopathy (HOCM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where to hear a PDA murmur?

A

left 1st rib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Grading systolic murmurs?

A

Grade 1
very faint , may only be heart by expert and not heard in all positions
Grade 2
soft and heard in all positions
Grade 3
moderately loud but no thrill
Grade 4
very loud with associated thrill
Grade 5
loud with the edge of stethoscope tilted against the chest
Grade 6
very loud and can be heard with the stethoscope just off the chest wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diastolic murmurs?

A

Grade 1
Very soft and can only be heard by exert or very quite room
Grade 2
Soft
Grade 3
Moderately loud
Grade 4
Loud or associated with a thrill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Character of the murmur?

A

Systolic murmurs can be classified as either
1. midsystolic (systolic ejection murmurs, or SEM),
- A midsystolic murmur begins just after the S1 heart sound and terminates just before the P2 heart sound: thus, S1 and S2 will be distinctly audible
2. holosystolic (pansystolic)
- begins with or immediately after the S1 heart sound and extends up to the S2
3. late systolic.
4. Mid-late systolic murmur
- begins significantly after S1 and may or may not extend up to the S2.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Shape of the murmur?

A
  • The shape of a murmur describes the change of intensity throughout the cardiac cycle.
  • Murmurs are either crescendo, decrescendo, crescendo-decrescendo or uniform
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pitch of a murmur?

A

A murmur will be high pitched if there is a large pressure gradient across the pathologic lesion or
- low: if the pressure gradient is low
- high: if the pressure gradient is high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Low pitched murmurs?

A

murmur of mitral stenosis
- is low pitched because there is a lower pressure gradient between the left atrium and the left ventricle during diastole.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

High pitched murmur?

A

murmur of aortic stenosis
- is high pitched because there is usually a large pressure gradient between the left ventricle and the aorta.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How to listen to pitch of the murmurs?

A

Remember high-pitched sounds are heard with the diaphragm of the stethoscope, whereas low-pitched sounds are heard with the bell.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Radiation of murmurs?

A

While murmurs are usually most intense at one specific listening post, they often radiate to other listening posts or areas of the body.
1. murmur of aortic stenosis frequently radiates to the carotid arteries
2. murmur of mitral regurgitation radiates to the left axillary region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Causes of mitral stenosis?

A
  1. Acquired is often from rheumatic heart disease
  2. Congenital causes are very rare
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Clinical presentation of mitral stenosis in history?

A
  1. SOB
  2. orthopnea
  3. PND
  4. hemoptysis
  5. abdominal swelling or limb swelling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Clinical presentation of MS in auscultation?

A

Loud S1
Opening snap
Low pitched late diastolic rumble which gets louder towards end of diastole
Palpable P2
Severe MS associated with softening of S1 or absent opening snap and a soft but long murmur, and a small pulse pressure

22
Q

Diagnosis and evaluation of MS?

A
  1. CXR
    - show an enlarged left atria or pulmonary edema or right chamber enlargement, pulmonary hemisiderosis
  2. Cardiac ECHO
    - Assess valve morphology and size
    - If valve are is less than 1cm then there is critical stenosis
    - Assess involvement of other valves
23
Q

Treatment of MS?

A
  1. If asymptomatic
    - No specific treatment
  2. If symptomatic
    - Percutaneous balloon valvotomy
    - If heavily calcified, advice for open surgery with valve replacement
  3. Pregnancy is contraindicated
    - Offer C/S very early in pregnancy
24
Q

Causes of mitral regurgitation?

A
  1. Myoxamatous (floppy) valve
  2. Ruptured chordae tendineae
  3. Previous endocarditis
  4. Papillary muscle dysfunction
  5. Rheumatic disease
  6. Functional
25
Clinical presentation of acute MR?
may present with acute pulmonary edema, low cardiac output, and an innocent murmur
26
Clinical presentation of chronic MR?
1. Hyperkinetic LV 2. Pansystolic murmur 3. Murmur often very loud and radiates to the axilla 4. Louder with expiration at the apex
27
Diagnosis and evaluation of MR?
1. CXR - Cardiomegaly, left atrial enlargement, pulmonary congestion, pulmonary artery enlargement 2. ECG - LAE 3. Cardiac ECHO - Distinguishes between functional and primary MR - Looks at valve morphology - Vegetations and perforations - Assess LV cavity size and functionality (EF)
28
Treatment of MR?
1. Medical management with diuretics especially with the functional MR 2. Surgery is often most beneficial treatment modality for most MR - MR begets MR 3. Mitral valve repair preferred over replacement
29
Causes of aortic stenosis?
1. Congenital unicuspidal valve 2. Congenital bicuspid valve 3. Calcified valve which often develops from age 30 to 40s 4. Degenerative calcific valve Starts with an aortic sclerosis at age 50-60s
30
Clinical presentation of AS?
1. Systolic ejection murmur - Crescendo-decrescendo murmur - Pick late in systole if severe 2. Slow rising carotid pulses - Parvus et tardus 3. Classic symptoms - Angina, SOB, and dizziness or syncope
31
Diagnosis and evaluation of AS?
1. ECG - LVH but may be normal 2. Cardiac ECHO - Shows morphology of the valve - Calculate gradient and valve area
32
Treatment of AS?
No proven medical therapy 1. Avoid nitrates as they can dangerously lower venous return 2. Surgery or percutaneous intervention are only proven treatments
33
Valvular Causes of aortic regurgitation?
1. Bicuspid aortic valve 2. Previous endocarditis 3. RHD
34
Aortic disease causes of aortic regurgitation?
1. Marfan syndrome 2. Syphillis 3. Aortic dissection
35
Clinical presentation of AR?
1. Abnormal pulses 2. Bounding pulses 3. Wide pulse pressure 4. Early diastolic murmur loudest at 5. Erb’s point and loudest in expiration
36
Diagnosis and evaluation of AR?
1. Lab - VDRL, TPHA 2. Cardiac ECHO - Distinguishes aortic valve vs aortic wall - Determines valve morphology - Detects vegetations or perforations - Assess associated valve lesions
37
Signs of AR?
Quincke’s sign capillary pulsation of the nail bed Corrigan sign prominent carotid pulsations Water hammer or collapsing pulse radial pulse disappears when the arm is lifted perpendicular to the body De Musset’s sign head nodding with each heart beat Hill’s sign increased blood pressure of more than 20mmHg in the legs compared to the arms Duroziez’s sign systolic and diastolic murmurs over the femoral artery on gradual compression of the artery Traube’s sign double sound over femoral artery when its compressed distally Maynes sign decrease in diastolic blood pressure of more than 15mmHg when arm is held above the head Rosenbach’s sign liver pulsation with each heart beat in the absence of severe TR Austin Flint Murmur short rumbling diastolic murmur due to the impinging regurgitant jet of blood on the anterior mitral valve leaflet Becker’s signs accentuated renal artery pulsations Gerhards sign pulsation of the spleen Landolfi’s signs alternating vasoconstriction and vasodilatation of the pulpits with each heart beat Lincoln sign exaggerated movement of the ankle when one leg is crossed over the other
38
Treatment of AR?
No proven medical therapy Surgery and percutaneous intervention only treatment modalities
39
Primary valve disease causes of tricuspid valve disease?
1. Rare 2. Mainly congenital
40
Acquired tricuspid valve disease?
1. Left heart disease 2. Pulmonary hypertension 3. Endocarditis 4. Pacemaker lead injury 5. Radiation 6. Trauma
41
Clinical presentation of tricuspid valve disease?
Signs of right heart disease 1. Peripheral edema 2. ascites 3. hepatomegally 4. raised JVP 5. right ventricular heave 6. right sided S3
42
43
Treatment of tricuspid valve disease?
Asymptomatic 1. Usually associated with mild to moderate TR 2. No treatment needed Symptomatic 1. Associated with severe TR 2. Treat medically with diuretics 3. Can consider TV repair or replacement
44
Causes of pulmonary valve stenosis?
Pulmonary valve stenosis are rare and often associated with other congenital abnormalities
45
Causes of pulmonary regurgitation?
1. Often previous pulmonary valve surgery 2. Pulmonary hypertension of any cause 3. Previous endocarditis
46
Treatment of pulmonary regurgitation?
Consider surgery if Symptoms related to PR like arrhythmias RV systolic EF less than 40% Progressive RV dilatation Poor exercise tolerance Severe PR in a patient who is undergoing other cardiac surgery
47
Purpose of antibiotic prophylaxis?
Goal is to prevent Infective endocarditis
48
Indications for prophylactive antibiotics?
1. Prosthetic valves(including bioprosthetics), or valve repair with additional prosthetic material 2. History of infective endocarditis 3. Congenital cyanotic heart disease 4. Unrepaired, or incompletely repaired or repaired with prosthetic material 5. Any valve disease in a transplanted heart
49
What procedures require prophylaxis?
1. Dental procedures that involve manipulation of the gingival tissue or periapical tooth region or mucosal perforation 2. Respiratory tract procedures that involve incision or biopsy 3. Procedures in patients with GIT or urinary tract infections 4. Procedures on infected skin
50
Prophylactic treatment for most dental or respiratory procedures?
Amoxicillin 2 gm iv given 30-60min before procedure
51
Alternative prophylactic treatment for penicillin allergic patients?
1. Cephalexin 500mg iv stat 2. azithromycin 500mg iv stat 3. clarithromycin 500mg iv stat or 4. Clindamycin 900mg iv stat

MBBS 3: Internal Medicine (72 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions