Valvular Heart Disease

Question 1

Valvular heart diseases are usually only symptomatic ____

Answer 1

on exertion

Question 2

Tapping apex beat seen in ___

Answer 2

mitral stenosis

Question 3

displaced and DIFFUSE apex beat seen in ___

Answer 3

LV dilatation - volume overload

Question 4

displaced and HEAVING apex beat seen in ___

Answer 4

LV hypertrophy - pressure overload

Question 5

L Parasternal heave is cause by ___

Answer 5

RV overload eg. cor pulmonale / pulmonary hypertension

Question 6

6 checkpoints to describe murmurs =

Answer 6

syst/diastolic?
Type?
Where is it loudest?
Radiate?
Grade?
Influenced by respiration?

Question 7

___ murmurs are influenced by respiration

Answer 7

RHS

Question 8

Murmur that radiates to the carotids

Answer 8

aortic stenosis

Question 9

Murmur that radiates to the axilla

Answer 9

mitral regurgitation

Question 10

Grade 1, 2 + 3 murmur =

Answer 10

very quiet
quiet
loud
ALL = NO THRILL

Question 11

First grade of murmur with a thrill

Answer 11

4 - loud with thrill

5 = v loud w thrill

Question 12

Grade of murmur heard without a stethoscope

Answer 12

6

Question 13

Continuous murmur is seen in ___

Answer 13

VSD

Question 14

Main cause of aortic stenosis

Answer 14

degenerative - calcification with age

Question 15

Causes of aortic stenosis

Answer 15

degenerative
congenital bicuspid valve
rheumatic

Question 16

Aortic stenosis causes a ___ overload

Symptoms =

Answer 16

Pressure

SOB chest pain syncope

Question 17

causes a slow rising weak pulse

Answer 17

aortic stenosis

Question 18

Ejection systolic murmur that radiates to carotids

Answer 18

aortic stenosis

Question 19

Murmur that is associated with a heaving displaced apex

Answer 19

aortic stenosis

Question 20

Treatment for symptomatic aortic stenosis

Answer 20

conventional valve replacement
TAVI
BAV - palliative in elderly

Question 21

Young patients are given ____ valves for aortic stenosis due to their longevity.
They need long-term ___

Answer 21

mechanical valves

warfarin - anti-coagulation

Question 22

elderly patients are given ____ valves for aortic stenosis
Last for ___ and so may need replacement
Warfarin?

Answer 22

bio-prosthetic
10yrs
no need for warfarin

Question 23

Arterial valve replacement/TAVI is preferred method for valve replacement

Answer 23

AVR

Question 24

TAVI is used over AVR if:

Answer 24

have co-morbidity and won’t survive general anaesthesia
OR
if had previous sternotomy

Question 25

AVR means can get ___ at the same time

Answer 25

CABG

Question 26

Causes of mitral regurgitation

Answer 26

leaflets - myxomatous, endocarditis (prolapse, rheumatic) chordae rupture - degenerative papillary muscle rupture - ischaemic annular dilatation of LV

Question 27

Symptoms of mitral regurgitation

Answer 27

SOB peripheral oedema fatigue

Question 28

Pansystolic murmur radiating to the axilla | displaced apex

Answer 28

mitral regurgitation

Question 29

Pharmacological treatment for mitral regurgitation

Answer 29

diuretics | HF medication - ACEI, digoxin, warfarin

Question 30

Surgical treatment for mitral regurgitation

Answer 30

valve repair - for prolapse | replacement - for degenerative

Question 31

Causes of mitral stenosis

Answer 31

rheumatic mainly | congenital

Question 32

Rheumatic usually affects ___ valve

Answer 32

mitral

Question 33

Malar flush is seen in ___

Answer 33

mitral stenosis

Question 34

mid-diastolic rumbling murmur localised to apex

Answer 34

mitral stenosis

Question 35

Mitral stenosis causes ____ on CXR

Answer 35

straight L heart border

Question 36

symptoms of mitral stenosis

Answer 36

SOB, fatigue, palpitations (AF), malar flush

Question 37

Pharmacological treatment of mitral stenosis

Answer 37

diuretics | drugs for AF - β-blocker, digoxin, warfarin

Question 38

Surgical treatment of mitral stenosis

Answer 38

valve replacement | balloon valvuloplasty

Question 39

Causes of aortic regurgitation

Answer 39

leaflets (endocarditis, connective tissue, rheumatic) | annulus (Marfans, aortic dissection)

Question 40

Collapsing pulse is seen in ___

Answer 40

aortic regurgitation

Question 41

Signs and symptoms of aortic regurgitation

Answer 41

SOB, collapsing pulse, displaced apex, early diastolic murmur left sternal edge

Question 42

Pharmacological treatment for aortic regurgitation

Answer 42

ACEI

Question 43

Surgery for aortic regurgitation

Answer 43

surgery if symptomatic and LV dilatation | valve replacement

Question 44

Early diastolic murmur loudest at left sternal edge

Answer 44

aortic regurgitation

Question 45

Commonest coagulase staph= | causes ___ endocarditis

Answer 45

Staph edidermidis | Prosthetic valve

Question 46

Predisposing factors for endocarditis (4)

Answer 46

IV line PWID prosthetic valve abnormal valve - rheumatic, calcified etc.

Question 47

Endocarditis usually affects the ____ of the heart

Answer 47

LHS - mitral and aortic valves

Question 48

emboli from endocarditis may develop to become

Answer 48

abscesses | haemorrhages

Question 49

Most common organism in endocarditis

Answer 49

Staph aureus

Question 50

Bartonella ; Coxiella Burnetti ; Chlamydia ; Legionella ; mycoplasma ; brucella ; gram -ves ; fungi =

Answer 50

atypical causes of endocarditis

Question 51

4 most common org.s of endocarditis

Answer 51

Staph aureus > Viridans strep > enterococci > staph epidermidis

Question 52

Signs and symptoms seen in endocarditis

Answer 52

``` fever, malaise, wt loss, SOB new/changed murmur, clubbing, splenomegaly Splinter haemorrhages Roth spots Janeway lesions + Osler's nodes Microscopic haematuria ```

Question 53

Infect prosthetic valves and present early as infected when inserted=

Answer 53

S.aureus/epidermidis

Question 54

RHS (tricuspid) endocarditis is more effective in ___ | org. is usually

Answer 54

PWIDs | Staph aureus

Question 55

In ___ endocarditis get a "pneumonia"

Answer 55

RHS - PWIDs | as emboli to lungs

Question 56

Treatment for native valve endocarditis =

Answer 56

amoxacillin and gentamycin IV - synergistic effect

Question 57

Treatment for prosthetic valve endocarditis =

Answer 57

vancomycin and gentamycin IV | rifampicin PO

Question 58

Treatment for PWID endocarditis =

Answer 58

flucloxacillin IV | if penicillin allergic give vancomycin

Question 59

MSSA Staph aureus endocarditis treatment =

Answer 59

flucloxacillin IV

Question 60

MRSA staph aureus endocarditis treatment =

Answer 60

vancomycin IV and | Rifampicin PO

Question 61

Treatment for viridans strep endocarditis =

Answer 61

benzyloenicllin and gentamycin IV

Question 62

Treatment for enterococci endocarditis =

Answer 62

amoxicillin/vancomycin IV AND gentamycin IV

Question 63

Treatment for Staph edidermidis endocarditis =

Answer 63

``` vancomycin IV + Gentamycin IV + Rifampicin PO (same as prosthetic valve endocarditis treatment) ```

Question 64

Give antibiotics IV for ____ in endocarditis

Answer 64

4-6 weeks

Question 65

Whilst on IV antibiotics for endocarditis monitor:

Answer 65

cardiac function temperature serum CRP if failing => surgery early

Question 66

Organism cause of Q fever

Answer 66

Coxiella burnetti

Question 67

Organism cause of Rheumatic fever =

Answer 67

Group A Strep (pyogenes)

Question 68

Painful, raised, red-purple lesions on fingers/toes

Answer 68

Osler's nodes

Question 69

Non-tender, small, erythematous lesions on the palms/soles

Answer 69

Janeway lesions

Question 70

Connective tissue disorders most commonly affect the ___ valve

Answer 70

mitral

Question 71

Rheumatic fever is more common in ____yos

Answer 71

5-15 yos

Question 72

pulsatile hepatomegaly is caused by ___

Answer 72

tricuspid regurgitation

Question 73

Murmur accentuated by leaning forward and holding full expiration

Answer 73

aortic regurgitation - L parasternal edge w. diaphragm

Question 74

Murmur accentuated by lying on LHS listening with bell

Answer 74

mitral stenosis