Valvular Heart Disease Flashcards
Valvular heart diseases are usually only symptomatic ____
on exertion
Tapping apex beat seen in ___
mitral stenosis
displaced and DIFFUSE apex beat seen in ___
LV dilatation - volume overload
displaced and HEAVING apex beat seen in ___
LV hypertrophy - pressure overload
L Parasternal heave is cause by ___
RV overload eg. cor pulmonale / pulmonary hypertension
6 checkpoints to describe murmurs =
syst/diastolic? Type? Where is it loudest? Radiate? Grade? Influenced by respiration?
___ murmurs are influenced by respiration
RHS
Murmur that radiates to the carotids
aortic stenosis
Murmur that radiates to the axilla
mitral regurgitation
Grade 1, 2 + 3 murmur =
very quiet
quiet
loud
ALL = NO THRILL
First grade of murmur with a thrill
4 - loud with thrill
5 = v loud w thrill
Grade of murmur heard without a stethoscope
6
Continuous murmur is seen in ___
VSD
Main cause of aortic stenosis
degenerative - calcification with age
Causes of aortic stenosis
degenerative
congenital bicuspid valve
rheumatic
Aortic stenosis causes a ___ overload
Symptoms =
Pressure
SOB chest pain syncope
causes a slow rising weak pulse
aortic stenosis
Ejection systolic murmur that radiates to carotids
aortic stenosis
Murmur that is associated with a heaving displaced apex
aortic stenosis
Treatment for symptomatic aortic stenosis
conventional valve replacement
TAVI
BAV - palliative in elderly
Young patients are given ____ valves for aortic stenosis due to their longevity.
They need long-term ___
mechanical valves
warfarin - anti-coagulation
elderly patients are given ____ valves for aortic stenosis
Last for ___ and so may need replacement
Warfarin?
bio-prosthetic
10yrs
no need for warfarin
Arterial valve replacement/TAVI is preferred method for valve replacement
AVR
TAVI is used over AVR if:
have co-morbidity and won’t survive general anaesthesia
OR
if had previous sternotomy
AVR means can get ___ at the same time
CABG
Causes of mitral regurgitation
leaflets - myxomatous, endocarditis (prolapse, rheumatic)
chordae rupture - degenerative
papillary muscle rupture - ischaemic
annular dilatation of LV
Symptoms of mitral regurgitation
SOB
peripheral oedema
fatigue
Pansystolic murmur radiating to the axilla
displaced apex
mitral regurgitation
Pharmacological treatment for mitral regurgitation
diuretics
HF medication - ACEI, digoxin, warfarin
Surgical treatment for mitral regurgitation
valve repair - for prolapse
replacement - for degenerative
Causes of mitral stenosis
rheumatic mainly
congenital
Rheumatic usually affects ___ valve
mitral
Malar flush is seen in ___
mitral stenosis
mid-diastolic rumbling murmur localised to apex
mitral stenosis
Mitral stenosis causes ____ on CXR
straight L heart border
symptoms of mitral stenosis
SOB, fatigue, palpitations (AF), malar flush
Pharmacological treatment of mitral stenosis
diuretics
drugs for AF - β-blocker, digoxin, warfarin
Surgical treatment of mitral stenosis
valve replacement
balloon valvuloplasty
Causes of aortic regurgitation
leaflets (endocarditis, connective tissue, rheumatic)
annulus (Marfans, aortic dissection)
Collapsing pulse is seen in ___
aortic regurgitation
Signs and symptoms of aortic regurgitation
SOB, collapsing pulse, displaced apex, early diastolic murmur left sternal edge
Pharmacological treatment for aortic regurgitation
ACEI
Surgery for aortic regurgitation
surgery if symptomatic and LV dilatation
valve replacement
Early diastolic murmur loudest at left sternal edge
aortic regurgitation
Commonest coagulase staph=
causes ___ endocarditis
Staph edidermidis
Prosthetic valve
Predisposing factors for endocarditis (4)
IV line
PWID
prosthetic valve
abnormal valve - rheumatic, calcified etc.
Endocarditis usually affects the ____ of the heart
LHS - mitral and aortic valves
emboli from endocarditis may develop to become
abscesses
haemorrhages
Most common organism in endocarditis
Staph aureus
Bartonella ; Coxiella Burnetti ; Chlamydia ; Legionella ; mycoplasma ; brucella ; gram -ves ; fungi
atypical causes of endocarditis
4 most common org.s of endocarditis
Staph aureus > Viridans strep > enterococci > staph epidermidis
Signs and symptoms seen in endocarditis
fever, malaise, wt loss, SOB new/changed murmur, clubbing, splenomegaly Splinter haemorrhages Roth spots Janeway lesions + Osler's nodes Microscopic haematuria
Infect prosthetic valves and present early as infected when inserted=
S.aureus/epidermidis
RHS (tricuspid) endocarditis is more effective in ___
org. is usually
PWIDs
Staph aureus
In ___ endocarditis get a “pneumonia”
RHS - PWIDs
as emboli to lungs
Treatment for native valve endocarditis =
amoxacillin and gentamycin IV - synergistic effect
Treatment for prosthetic valve endocarditis =
vancomycin and gentamycin IV
rifampicin PO
Treatment for PWID endocarditis =
flucloxacillin IV
if penicillin allergic give vancomycin
MSSA Staph aureus endocarditis treatment =
flucloxacillin IV
MRSA staph aureus endocarditis treatment =
vancomycin IV and
Rifampicin PO
Treatment for viridans strep endocarditis =
benzyloenicllin and gentamycin IV
Treatment for enterococci endocarditis =
amoxicillin/vancomycin IV
AND
gentamycin IV
Treatment for Staph edidermidis endocarditis =
vancomycin IV \+ Gentamycin IV \+ Rifampicin PO (same as prosthetic valve endocarditis treatment)
Give antibiotics IV for ____ in endocarditis
4-6 weeks
Whilst on IV antibiotics for endocarditis monitor:
cardiac function
temperature
serum CRP
if failing => surgery early
Organism cause of Q fever
Coxiella burnetti
Organism cause of Rheumatic fever =
Group A Strep (pyogenes)
Painful, raised, red-purple lesions on fingers/toes
Osler’s nodes
Non-tender, small, erythematous lesions on the palms/soles
Janeway lesions
Connective tissue disorders most commonly affect the ___ valve
mitral
Rheumatic fever is more common in ____yos
5-15 yos
pulsatile hepatomegaly is caused by ___
tricuspid regurgitation
Murmur accentuated by leaning forward and holding full expiration
aortic regurgitation - L parasternal edge w. diaphragm
Murmur accentuated by lying on LHS listening with bell
mitral stenosis
