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1st Year Medicine > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What is the New York heart association functional classification of valvular disease?

A

Class 1 - no limitation.
Class 2 - slight limitation but ordinary activity.
Class 3 - marked limitation - less than ordinary activity.
Class 4 - severe limitation - minimal activity at rest.

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2
Q

What clinical examination must we do for valvular disease?

A 
General appearance.
Arterial pulses.
Venous pulses e.g. JVP.
Palpation for heaves and thrills.
Auscultation.
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3
Q

What part of the wave is prominent in raised JVP and what heart sound does it correlate with?

A

CV, S2.

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4
Q

What are the four auscultation areas in order?

A

Aortic, pulmonary, tricuspid and mitral.

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5
Q

What 7 things must we say when describing murmurs?

A 
Systole or diastole.
What type of murmur.
Where is it loudest.
Does it radiate?
What grade?
Influenced by respiration.
What type of systolic.
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6
Q

What are the grades of a murmur?

A 
I - very quiet
II - quiet but easy to hear
III - loud
IV - loud with thrill
V - loud audible without a stethoscope
VI - loud and audible from a distance.
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7
Q

What types of systolic murmur do we get and what are the differences?

A

Pan systolic. Sustained sound all the way between S1 and S2

Ejection systolic - sound sweeps and falls between s1 and s2.

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8
Q

What types of diastolic murmur do we get?

A

Early and mid.

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9
Q

How can we differentiate a right sided murmur from the left?

A

Right sided are louder on inspiration.

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10
Q

What is valve stenosis?

A

When the valve doesn’t open properly.

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11
Q

What is valve regurgitation?

A

Valves that don’t close properly.

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12
Q

What is mixed valve disease?

A

Valves don’t open or close properly.

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13
Q

What is a non invasive investigation for valvular disease?

A

Echo.

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14
Q

What is an invasive investigation for valvular disease?

A

Cardiac catheterisation.

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15
Q

What causes aortic stenosis?

A

Congenitally bicuspid valve. Age related degeneration and rheumatic.

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16
Q

What is congenitally bicuspid valve?

A

Two leaflets fuse early during development.

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17
Q

What are the symptoms of aortic stenosis?

A

Breathlessness, chest pain and dizziness/syncope.

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18
Q

What are signs of aortic stenosis?

A

Low pulse volume, slow rising pulse, forceful apex. Ejection systolic murmur maximal in the aortic area and radiating to the carotids. Aortic thrill.

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19
Q

With What presentation should we automatically think aortic stenosis?

A

Any elderly presenting with exertion all dyspnoea and chest pain.

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20
Q

What are the standard investigations for murmurs?

A

ECG, CXR and Echo.

21
Q

What sound is usually normal in aortic stenosis?

A

S1.

22
Q

What is the classic triad of presentation with aortic stenosis?

A

Angina, syncope and HF.

23
Q

What is the treatment for aortic stenosis?

A

Valve replacement.
Balloon valvuloplasty.
TAVI - trans aortic valve implantation.

24
Q

What are the two different types of heart valves and the differences between the two?

A

Mechanical - good longevity but requires warfarin.

Biological - poor longevity but don’t require warfarin.

25
Q

Where are TAVI’s done? is the patient anaesthetised? how long do they take? what is the recovery time?

A

Cath room, patient sedated, takes less than an hour, recovery time is one to two days.

26
Q

What is the procedure for a TAVI?

A

Cath in groin and threaded up to valve. Fluoroscopy used to guide the tip. Valve mounted on self expanding stent and deployed. New bp valve pushes diseased valve out the way and anchors itself.

27
Q

What are some causes of mitral regurgitation?

A

Rheumatic heart disease, myxomatous degeneration, endocarditis, chordal rupture, papillary muscle ischaemia or infarction and any cause of LVH.

28
Q

What are the symptoms of mitral regurgitation?

A

Breathlessness, ankle swelling, fatigue and palpitations.

29
Q

What are the signs of mitral regurg?

A

Displaced apex beat.
Pan systolic murmur maximal at the apex beat and radiating to the axilla.
AF, right ventricular heave, loud P2, soft S1, split S2.

30
Q

What does an increasing severity of mitral regurg murmur mean?

A

Increased severity = bigger left ventricle.

31
Q

What are the drug treatments of mitral regurgitation?

A

Diuretics, ACE inhibitors, digoxin and warfarin.

32
Q

What is the surgery for mitral regurg?

A

Valve repair or replacement.

33
Q

What causes mitral stenosis?

A

Rheumatic heart disease, but past history may be absent in half of people. Rarely is congenital.

34
Q

What is myxomatous degeneration?

A

Floppy mitral valve syndrome.

35
Q

What cause rheumatic heart disease?

A

Rheumatic fever, causes fibrosis of heart valves.

36
Q

What are the symptoms of mitral stenosis?

A

Breathlessness, tiredness, cheapest pain and palpitations.

37
Q

What are the signs of mitral stenosis?

A

Malar flush, tapping apex beat, mid systolic murmur localised to the apex. Later stages show cachexia and RHF.
Also shows low volume pulse, loud S1, opening snap.
Rumbling mid diastolic best heard with patient on the left side.

38
Q

Why do we get a malar flush?

A

Due to decreased cardiac output.

39
Q

What can we occasionally see on X-ray with mitral stenosis?

A

Straight vertical left sided heart border.

40
Q

What is the drug treatment for mitral stenosis?

A

Diuretics, beta blockers, digoxin and warfarin.

41
Q

What is the surgery for mitral stenosis?

A

Valve replacement.

42
Q

When is a mitral valve balloon valvuloplasty suitable for mitral stenosis?

A

Only suitable for pliable competent valve.

43
Q

What causes aortic regurgitation?

A

Infective endocarditis, rheumatic heart disease, marfans, acute aortic dissection.

44
Q

What are the symptoms of aortic regurgitation?

A

Breathlessness chest pain dizziness.

Paroxysmal nocturnal dyspnoea, palpitations, angina and syncope.

45
Q

What are the signs of aortic regurgitation?

A

High volume collapsing pulse, displaced apex beat, high pitched early diastolic murmur at lower left sternal edge.

46
Q

When is aortic regurgitation heard best?

A

Sitting forward on expiration.

47
Q

What is the treatment of aortic stenosis?

A

Ace inhibitors , ARB’s and diuretics

Valve replacement.

48
Q

If you have mitral regurg what will you also have?

A

Afib.

49
Q

What is cardiac chest pain like?

A

Gripping, squeezing, heavy and crushing.

1st Year Medicine (64 decks)

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