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Clinical > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

Characteristic symptoms of valvular heart disease?

A

EXERTIONAL symptoms are characteristic; at rest, valve issues can be asymptomatic:
Breathlessness
Chest pain
Collapse/dizzy spells

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2
Q

Describe cardiac related breathlessness

A

Usually related to exertion and is often associated with ankle swelling

Patients describe orthopnoea and PND - ask how many pillows they sleep with?
Patients describe sitting up as relieving symptoms - this relieves venous congestion (effect of gravity)

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3
Q

Which type of heart failure are orthopnoea and PND associated with?

A

Left-sided heart failure (has effects on lungs)

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4
Q

New York Heart Association Functional Classification (NYHA)?

A

Class I - no limitation (but do have heart disease)

Class II - slight limitation of ordinary activity, on marked exertion

Class III - marked limitation of less than ordinary activity, e.g: on minimal activity

Class IV - severe limitation of minimal activity or symptoms at rest

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5
Q

Signs of right-sided heart failure?

A

Raised JVP

Ankle/sacral pitting oedema - venous congestion changes hydrostatic pressure in capillaries

Hepatic congestion - liver is vulnerable to circulatory disturbances so right-sided heart failure causes this

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6
Q

Apex beat in mitral stenosis?

A

Tapping apex

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7
Q

Apex beat in left ventricular dilatation?

A

There is volume overload and a displaced and diffuse apex

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8
Q

Apex beat in left ventricular hypertrophy?

A

There is pressure overload and a displaced and heaving apex

Sometimes, the apex is be displaced. Heaves may be felt though

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9
Q

When do parasternal heaves occur?

A

Thrusting feeling

When there is right ventricular overload due to COR PULMONALE (right-sided heart failure secondary to pulmonary hypertension and lung disease)

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10
Q

What is a cardiac murmur?

A

Audible turbulence of blood flow

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11
Q

Types of cardiac murmurs?

A

Innocent and pathological

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12
Q

Important information when describing murmurs?

A

Systolic or diastolic murmur?

What type of murmur?

Where is it loudest?

Where does it radiate to?

What grade of murmur?

Is the murmur influenced by breathing?

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13
Q

Differentiating between systolic and diastolic murmurs?

A

Feel carotids:
Systolic murmurs occur after S1 and are in time with the pulse

Diastolic murmurs occur after S2 and will not be in time with the pulse

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14
Q

Types of systolic murmurs?

A

Pansystolic - heard at a constant volume throughout systole

Ejection systolic - increase in volume towards S2 before dropping off

ADD PICTURE

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15
Q

Types of diastolic murmurs?

A

Early diastolic - decrease in volume towards S1

Mid-diastolic (rumbling) - variable volume towards S1 (increase, decrease, increase in volume)

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16
Q

Where do murmurs commonly radiate to?

A

Carotids (aortic stenosis)

Axilla (mitral regurgitation)

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17
Q

Grading system of murmurs?

A 
I - very quiet
II - quiet but easy to heart
III - loud
IV - loud with a thrill
V - very loud with a thrill
VI - loud and audible without a stethoscope
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18
Q

How does inspiration affects murmurs?

A

Right-sided murmurs tend to be louder with inspiration

19
Q

When are systolic clicks heard?

A

Mitral valve prolapse (two valve flaps do not close evenly)

20
Q

When is a continuous murmur heard?

A

Ventricular-septal defect (can occur post-MI)

21
Q

When is a pericardial rub heard?

A

Heard throughout the cycle and indicates pericarditis (swelling of pericardial sac)

22
Q

Features of innocent (functional) murmurs?

A

Soft (less than 3/6 severity)

Position-dependent (these murmurs tend to be influenced by venous return so position changes are important)

Often early systolic murmurs (diastolic murmurs are never innocent)

No thrills are felt

23
Q

What is valve stenosis?

A

Valves which do not open properly, e.g: aortic stenosis (most common valve lesion)

24
Q

What is valve regurgitation?

A

Valves which do not close properly

25
Q

What is mixed valve disease?

A

Valves which neither open properly nor close properly - mixture of stenosis and regurgitation

26
Q

Causes of aortic stenosis?

A

Degenerative (age-related) due to calcification

Congenital, e.g: a common abnormality is the aortic bicuspid valve (should have 3 cusps)

Rheumatic

27
Q

3 symptoms of aortic stenosis?

A

Breathlessness

Chest pain - coronary arteries are above aortic valve so coronary perfusion is affected

Dizziness/syncope

28
Q

3 signs on examination of aortic stenosis?

A

Low volume pulse - not enough blood being pumped into systemic circulation

Forceful displaced apex - left ventricular hypertrophy (tall QRS complexes on ECG)

Ejection systolic murmur that can radiate to carotids

29
Q

Treatment of aortic stenosis?

A

Conventional valve replacement - very successful; mostly normal life span if there is no left ventricular hypertrophy

Trans-catheter aortic valve replacement (TAVI) - crush valve with stent-balloon

Balloon aortic valvotomy (BAV) -

30
Q

Types of prosthetic heart valves and facts?

A

Mechanical - longevity is an advantage and tend to be used in younger patients; will be on life-long warfarin

Bio-prosthetic - normally last 10 years and tend to be used in older patients; no warfarin is required

31
Q

Valve replacement vs TAVI?

A

Valve replacement is still preferred due to good long-term outcomes, there are no contra-indications and a CABG can be done at the same time (all patients will have a coronary angiograph beforehand)

TAVI - tends to be used in those with co-morbidites and if they have had a previous sternotomy

32
Q

Causes of mitral regurgitation, separated into broad categories?

A 
Leaflets:
Prolapse (can be congenital or due to chordae rupture)
Rheumatic (immune complex deposition)
Myxomatous (floppy leaflets)
Endocarditis

Chordae rupture (tends to be degenerative and age-related) - prolapse/flail leaflet

Papillary muscle rupture - ischaemic

Annular (ring attached mitral valve) dilatation - functional (there is poor leaflet apposition)

33
Q

Symptoms of mitral regurgitation?

A

Breathlessness
Pulmonary oedema
Fatigue

34
Q

Examination signs of mitral regurgitation?

A

Displaced apex

Pansystolic murmur that radiate to the axilla

Cardiomegaly on CXR

35
Q

Treatment of mitral regurgitation using medication, surgery, etc?

A

Medications - diuretics (for functional mitral regurgitation with heart failure); also, ACEIs

Surgical:
Repair - only an option for mitral valve prolapse
Replacement

Percutaneous - clips in infancy are showing encourgaing results so far

36
Q

Causes of mitral stenosis?

A

Essentially, RHEUMATIC is the main cause

Rare causes include congenital

37
Q

Symptoms of mitral stenosis?

A

Breathlessness

Fatigue

Palpitation (AF) - many patients with mitral stenosis will get AF due to left atrial hypertrophy

38
Q

Examination signs of mitral stenosis?

A

Malar flush - sign of advanced disease

Tapping apex beat

Mid-diastolic rumbling; a diastolic murmur that is LOCALISED at the apex

Straight left heart border on CXR

39
Q

Treatment of mitral stenosis with medication, surgery, etc?

A

Medication - diuretics and treat AF

Surgery - valve replacement

Balloon valvuloplasty

40
Q

Causes of aortic regurgitation?

A

Leaflets:
Endocarditis
Connective tissue diseases
Rheumatic

Annulus:
Marfans (disease of connective tissue)
Aortic dissection

41
Q

Symptoms of aortic regurgitation?

A

Breathlessness

42
Q

Examination signs of aortic regurgitation?

A

Collapsing pulse

Displaced apex

Early diastolic murmur at the left sternal edge (tricuspid area) - best heart with patient sitting up and holding an exhalation

Cardiomegaly on CXR

43
Q

Treatment of aortic regurgitation with medication, surgery, etc?

A

Medications - ACEIs (for dilated left ventricle)

Surgery - to deal with symptoms and LV dilatation; options include valve replacement

Clinical (54 decks)

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