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Cardioresp - Phase II > Valvular heart disease > Flashcards

Valvular heart disease Flashcards

1
Q

What are the causes of Mitral Stenosis?

A 
Rheumatic fever
Calcification due to old age
Infective endocarditis
SLE
RA
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2
Q

How can Mitral Stenosis cause RHF?

A

Higher LA pressure causes Pulmonary HTN causing RVH and tricuspid regurgitation leading to RHF

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3
Q

What are the signs of Mitral Stenosis?

A

60-70% have AF
Malar flush
Palpitations - tapping apex beat due to palpable 1st heart sound

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4
Q

Describe the murmur heard in Mitral Stenosis

A

Mid diastolic murmur
Heard best with the bell of the stethoscope at the apex with the patient lying on their left side
Loud S1
Opening snap (High pitched sound just after S2)

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5
Q

What would you see on CXR in a patient with Mitral Stenosis?

A

Enlarged LA
Signs of pulmonary oedema (Batwing pulmonary opacities, Peri-bronchial cuffing, Kerley B lines, Pleural effusion, upper lobe diversion of pulmonary vasculature)

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6
Q

What are the causes of Mitral Regurgitation?

A 
Prolapsing mitral valve
Rheumatic fever
Papillary muscle rupture post MI
Cardiomyopathy
Connective tissue disease (Marfans, Ehlers Danlos)
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7
Q

What are the signs of Mitral Regurgitation?

A

Malar flush
Displaced apex beat
Palpable thrill

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8
Q

Describe the murmur heard with Mitral Regurgitation?

A

A pansystolic murmur heard with the diaphragm radiating to the axilla
No gap between murmur and S2

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9
Q

What would you see on CXR in a patient with Mitral Regurgitation?

A

Cardiomegaly

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10
Q

What would you see on ECG in a patient with Mitral Regurgitation?

A 
Bifid P waves
LV hypertrophy (S wave in V1 + R wave in V5 or V6 >35mm - 3.5 large squares)
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11
Q

What are the 3 abnormalities that cause a Pansystolic murmur?

A

Tricuspid regurgitation
Ventral septal defect
Mitral regurgitation

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12
Q

What is the triad of symptoms for Aortic Stenosis?

A

Dyspnoea
Angina
Syncope

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13
Q

What are some of the causes of Aortic Stenosis?

A

Age related calcification
Rheumatic fever
Bicuspid Aortic valve

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14
Q

What are some of the signs of Aortic Stenosis?

A

Slow rising pulse
Low volume
Narrow pulse pressure
Forceful apex beat

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15
Q

What would you hear on auscultation?

A

An ejection systolic murmur heard loudest over the Aortic region radiating to the Carotids (Both sides)
Audible gap between murmur and S2, unless very severe disease

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16
Q

What would you see on CXR?

A

Post stenotic dilatation of the ascending Aorta

17
Q

What would you see on ECG?

A

LV strain pattern - depressed ST segment, T wave inversion in leads oriented towards the LV
Signs of LV hypertrophy

18
Q

What are the signs of LV hypertrophy on ECG?

A

Increased R wave amplitude in left sided ECG leads, increased S wave depth in the right sided leads and delayed repolarisation in the lateral leads

19
Q

What are the causes of Aortic Regurgitation?

A

Rheumatic fever
Bicuspid valve
Infective endocarditis
Marfan’s syndrome

20
Q

Why is there LVH in patients Aortic regurgitation?

A

Regurgitation of the Aortic valve allows blood from the Aorta back into the LV during diastole, therefore the volume needed to be pumped out during systole is larger causing an increased pressure to be needed so LVH occurs

21
Q

What are the signs of Aortic regurgitation?

A 
Bounding collapsing pulse with a wide pulse pressure
Pistol shot femorals
Quincke's sign
De Musset's sign
Displaced apex beat
22
Q

When can the pulse pressure increase physiologically?

A

Post exercise due to an increase in SV and decrease in total peripheral resistance
Pregnancy

23
Q

What can cause an increase in pulse pressure?

A

Aortic regurgitation
Atherosclerosis
Thyrotoxicosis
Arterovenous fistula

24
Q

What is Quincke’s sign?

A

Capillary pulsation in the nail beds seen in Aortic Regurgitation

25
Q

What is De Musset’s sign?

A

Head nodding with each heartbeat seen in Aortic Regurgitation

26
Q

What are Pistol shot femorals?

A

A sharp bang can be heard on auscultation of the femoral arteries in time with each heartbeat

27
Q

What would you hear on auscultation in a patient with Aortic regurgitation?

A

A high pitched early diastolic murmur best heard left sternal edge 4th ICS with the patient leaning forward holding their breath in expiration.

28
Q

What would the ECG of someone with Aortic regurgitation show?

A

Signs of LV hypertrophy

Cardioresp - Phase II (18 decks)

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