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JazCardio > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

Valvular heart diseases are usually only symptomatic ____

A

on exertion

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2
Q

Tapping apex beat seen in ___

A

mitral stenosis

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3
Q

displaced and DIFFUSE apex beat seen in ___

A

LV dilatation - volume overload

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4
Q

displaced and HEAVING apex beat seen in ___

A

LV hypertrophy - pressure overload

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5
Q

L Parasternal heave is cause by ___

A

RV overload eg. cor pulmonale / pulmonary hypertension

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6
Q

6 checkpoints to describe murmurs =

A 
syst/diastolic?
Type?
Where is it loudest?
Radiate?
Grade?
Influenced by respiration?
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7
Q

___ murmurs are influenced by respiration

A

RHS

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8
Q

Murmur that radiates to the carotids

A

aortic stenosis

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9
Q

Murmur that radiates to the axilla

A

mitral regurgitation

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10
Q

Grade 1, 2 + 3 murmur =

A

very quiet
quiet
loud
ALL = NO THRILL

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11
Q

First grade of murmur with a thrill

A

4 - loud with thrill

5 = v loud w thrill

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12
Q

Grade of murmur heard without a stethoscope

A

6

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13
Q

Continuous murmur is seen in ___

A

VSD

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14
Q

Main cause of aortic stenosis

A

degenerative - calcification with age

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15
Q

Causes of aortic stenosis

A

degenerative
congenital bicuspid valve
rheumatic

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16
Q

Aortic stenosis causes a ___ overload

Symptoms =

A

Pressure

SOB chest pain syncope

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17
Q

causes a slow rising weak pulse

A

aortic stenosis

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18
Q

Ejection systolic murmur that radiates to carotids

A

aortic stenosis

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19
Q

Murmur that is associated with a heaving displaced apex

A

aortic stenosis

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20
Q

Treatment for symptomatic aortic stenosis

A

conventional valve replacement
TAVI
BAV - palliative in elderly

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21
Q

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

A

mechanical valves

warfarin - anti-coagulation

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22
Q

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

A

bio-prosthetic
10yrs
no need for warfarin

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23
Q

Arterial valve replacement/TAVI is preferred method for valve replacement

A

AVR

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24
Q

TAVI is used over AVR if:

A

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

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25
Q

AVR means can get ___ at the same time

A

CABG

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26
Q

Causes of mitral regurgitation

A

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

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27
Q

Symptoms of mitral regurgitation

A

SOB
peripheral oedema
fatigue

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28
Q

Pansystolic murmur radiating to the axilla

displaced apex

A

mitral regurgitation

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29
Q

Pharmacological treatment for mitral regurgitation

A

diuretics

HF medication - ACEI, digoxin, warfarin

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30
Q

Surgical treatment for mitral regurgitation

A

valve repair - for prolapse

replacement - for degenerative

31
Q

Causes of mitral stenosis

A

rheumatic mainly

congenital

32
Q

Rheumatic usually affects ___ valve

A

mitral

33
Q

Malar flush is seen in ___

A

mitral stenosis

34
Q

mid-diastolic rumbling murmur localised to apex

A

mitral stenosis

35
Q

Mitral stenosis causes ____ on CXR

A

straight L heart border

36
Q

symptoms of mitral stenosis

A

SOB, fatigue, palpitations (AF), malar flush

37
Q

Pharmacological treatment of mitral stenosis

A

diuretics

drugs for AF - β-blocker, digoxin, warfarin

38
Q

Surgical treatment of mitral stenosis

A

valve replacement

balloon valvuloplasty

39
Q

Causes of aortic regurgitation

A

leaflets (endocarditis, connective tissue, rheumatic)

annulus (Marfans, aortic dissection)

40
Q

Collapsing pulse is seen in ___

A

aortic regurgitation

41
Q

Signs and symptoms of aortic regurgitation

A

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

42
Q

Pharmacological treatment for aortic regurgitation

A

ACEI

43
Q

Surgery for aortic regurgitation

A

surgery if symptomatic and LV dilatation

valve replacement

44
Q

Early diastolic murmur loudest at left sternal edge

A

aortic regurgitation

45
Q

Commonest coagulase staph=

causes ___ endocarditis

A

Staph edidermidis

Prosthetic valve

46
Q

Predisposing factors for endocarditis (4)

A

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

47
Q

Endocarditis usually affects the ____ of the heart

A

LHS - mitral and aortic valves

48
Q

emboli from endocarditis may develop to become

A

abscesses

haemorrhages

49
Q

Most common organism in endocarditis

A

Staph aureus

50
Q

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

A

atypical causes of endocarditis

51
Q

4 most common org.s of endocarditis

A

Staph aureus > Viridans strep > enterococci > staph epidermidis

52
Q

Signs and symptoms seen in endocarditis

A 
fever, malaise, wt loss, SOB
new/changed murmur, clubbing, splenomegaly
Splinter haemorrhages
Roth spots
Janeway lesions + Osler's nodes
Microscopic haematuria
53
Q

Infect prosthetic valves and present early as infected when inserted=

A

S.aureus/epidermidis

54
Q

RHS (tricuspid) endocarditis is more effective in ___

org. is usually

A

PWIDs

Staph aureus

55
Q

In ___ endocarditis get a “pneumonia”

A

RHS - PWIDs

as emboli to lungs

56
Q

Treatment for native valve endocarditis =

A

amoxacillin and gentamycin IV - synergistic effect

57
Q

Treatment for prosthetic valve endocarditis =

A

vancomycin and gentamycin IV

rifampicin PO

58
Q

Treatment for PWID endocarditis =

A

flucloxacillin IV

if penicillin allergic give vancomycin

59
Q

MSSA Staph aureus endocarditis treatment =

A

flucloxacillin IV

60
Q

MRSA staph aureus endocarditis treatment =

A

vancomycin IV and

Rifampicin PO

61
Q

Treatment for viridans strep endocarditis =

A

benzyloenicllin and gentamycin IV

62
Q

Treatment for enterococci endocarditis =

A

amoxicillin/vancomycin IV
AND
gentamycin IV

63
Q

Treatment for Staph edidermidis endocarditis =

A 
vancomycin IV
\+
Gentamycin IV
\+
Rifampicin PO
(same as prosthetic valve endocarditis treatment)
64
Q

Give antibiotics IV for ____ in endocarditis

A

4-6 weeks

65
Q

Whilst on IV antibiotics for endocarditis monitor:

A

cardiac function
temperature
serum CRP
if failing => surgery early

66
Q

Organism cause of Q fever

A

Coxiella burnetti

67
Q

Organism cause of Rheumatic fever =

A

Group A Strep (pyogenes)

68
Q

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

A

Osler’s nodes

69
Q

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

A

Janeway lesions

70
Q

Connective tissue disorders most commonly affect the ___ valve

A

mitral

71
Q

Rheumatic fever is more common in ____yos

A

5-15 yos

72
Q

pulsatile hepatomegaly is caused by ___

A

tricuspid regurgitation

73
Q

Murmur accentuated by leaning forward and holding full expiration

A

aortic regurgitation - L parasternal edge w. diaphragm

74
Q

Murmur accentuated by lying on LHS listening with bell

A

mitral stenosis

JazCardio (15 decks)

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