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1st Year - Cardiology > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What type of symptoms are characteristic of valvular heart disease?

A

Exertional symptoms (patients with even severe valve disease don’t tend to experience symptoms at rest)

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2
Q

What 4 features of breathlessness suggest cardiac breathlessness?

A

Related to activity (usually)Often associated with ankle swellingOrthopnoeaParoxysmal nocturnal dyspnoea

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3
Q

What is a classification system used to assess the extent of heart failure’s affect on a patients functional status?

A

New York Heart Association Functional classification

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4
Q

Classes of New York Heart Association Functional classification?

A

Class I = no limitationClass II = Slight limitation of ordinary activityClass III = marked limitation of less than ordinary activityClass IV = severe limitation of minimal activity or at rest

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5
Q

Signs of right heart failure? (3)

A

Raised JVPPitting oedema (ankles and sacrum (more severe heart failure if in sacrum also))Hepatic congestion

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6
Q

Does right heart failure have a peripheral or central effect?

A

Peripheral

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7
Q

Tapping apex beat?

A

Mitral stenosis (thrusting displaced palpable (but more so than normal) apex beat

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8
Q

Apex beat in left ventricular dilation?

A

Displaced and diffuse (volume overload)

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9
Q

Apex beat in left ventricular hypertrophy?

A

Displaced and heaving (pressure overload)

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10
Q

What causes a parasternal heave over the left parasternal edge?

A

Right ventricular hypertrophy (due to right ventricular overload e.g. cor pulmonale/ pulmonary hypertension)

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11
Q

What is a cardiac murmur?

A

Audible turbulence of blood flow (can be innocent or pathological)

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12
Q

How to describe murmurs? (6)

A

Timing? - systolic or diastolicType of murmur? - ejection systolic or pan systolic/ early or mid diastolicWhere is it loudest?Where does it radiate to?What grade of murmur?Does respiration influence it?

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13
Q

What murmur radiates to the carotid?

A

Aortic stenosis

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14
Q

What murmur radiates to the axilla?

A

Mitral regurgitation

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15
Q

What causes the first heart sound?

A

Mitral and tricuspid valve closing (start of systole)

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16
Q

What causes the second heart sound?

A

Aortic and pulmonary valves closing (start of diastole)

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17
Q

Pansystolic murmur?

A

Mitral regurgitation

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18
Q

Ejection systolic murmur?

A

Aortic stenosis

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19
Q

Early diastolic murmur?

A

Aortic regurgitation

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20
Q

Mid diastolic murmur?

A

Mitral stenosis

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21
Q

Grading of murmurs?

A

I - very quiet (dispute of whether it is there or not)II - quiet - easy to hearIII - loudIV - loud with a thrillV - very loud with a thrillVI - loud - audible without a stethoscope

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22
Q

Are right or left sided murmurs louder with inspiration?

A

Right-sided murmurs

23
Q

What are the 12 common murmurs?

A

2nd sound splittingThird soundFourth soundSystolic clicksInnocent murmurMitral regurgitationAortic stenosisAortic regurgitation*Mitral stenosisContinuous murmurTricuspid regurgitationPericardial rub

24
Q

What is the most common cause of a continuous heart murmur?

A

Septal defect

25
Q

What is another name for an innocent murmur?

A

Functional murmur

26
Q

What are 2 features of an innocent murmur?

A

Soft (less than 3/6 severity)Position dependent

27
Q

Are innocent murmurs systolic or diastolic?

A

Always systolic (diastolic murmurs are always pathological)

28
Q

What are the 3 types of valvular heart disease and what causes each?

A

Valve stenosis - valves which do not open properlyValve regurgitation - valves which do not close properlyMixed valve disease - valves which neither open properly nor close properly

29
Q

What type of symptoms will left heart failure cause?

A

Pulmonary symptoms and signs

30
Q

What is the most common valve lesion?

A

Aortic stenosis

31
Q

Causes of aortic stenosis?

A

Degenerative (age related - most commonly (calcification of the aortic valve))Congenital (e.g. bicuspid valve)Rheumatic

32
Q

Symptoms of aortic stenosis? (3)

A

BreathlessnessChest painDizziness/ syncope

33
Q

Signs of aortic stenosis? (4)

A

Low volume pulseforceful displaced apexejection systolic murmur that can radiate to the carotidsSlow rising pulse

34
Q

What change can aortic stenosis eventually lead to on an ECG?

A

Large QRS complexes due to left ventricular hypertrophy

35
Q

Treatment of aortic stenosis?

A

Only treated if symptomaticTreated with a valve replacement (3 different options)

36
Q

Types of valve replacements possible for aortic stenosis?

A

Conventional valve replacementTrans catheter aortic valve implantation (TAVI) - used if patients have co-morbiditiesBalloon aortic valvotomy (BAV) - used for patients who are very frail

37
Q

2 types of prosthetic heart valves?

A

MechanicalBio-prostehtic

38
Q

Advantage and disadvantage of a mechanical heart valve?

A

Advantage = longevityDisadvantage = require warfare to prevent valvular thrombosis(tends to be given to younger patients)

39
Q

Advantage and disadvantage of bio-prosthetic heart valve?

A

No warfarinTends to cause problems after about 10 yeas and require replacement

40
Q

Comparison of aortic valve replacement and TAVI?

A

AVR = preferred, can do CABG at the same time and has long term better outcomesTAVI = preferred if the patient has co-orbidities that would make a general anaesthetic difficult

41
Q

Causes of mitral regurgitation?

A

Leaflet problem (e.g. prolapse, rheumatic, myxomatous (weakening), endocarditis)Chordae rupture (degenerative) - prolapse/ frail leafletPapillary muscles rupture (ischaemic)Annular dilation (functional)(the mitral valve is very complex meaning there are lots of reasons for mitral regurgitation)

42
Q

Symptoms of mitral regurgitation?

A

If severe, symptoms of left heart failureBreathlessnessOedemaFatigue

43
Q

Signs of mitral regurgitation?

A

Displaced apexPansystolic murmur radiating to the axilla

44
Q

Treatment of mitral regurgitation?

A

Depends on the cause:Medication = diuretics and drug treatment for heart failure if presentSurgical = repair for prolapse, replace for degenerative

45
Q

What causes mitral stenosis?

A

Rheumatic is the main causeRarely congenital

46
Q

Symptoms of mitral stenosis?

A

BreathlessnessFatiguePalpitations (AF - as the left atrium tried to force blood through the aurifice, the right atrium get bigger and therefore there is a higher chance of AF)

47
Q

Signs of mitral stenosis?

A

Malar flushTapping apex beatMid diastolic rumbling localised to the apex

48
Q

Treatment of mitral stenosis?

A

Medication = diuretics and treat AFSurgery = valve replacementBallon valvuloplasty = fragile patients

49
Q

Causes of aortic regurgitation?

A

Leaflets (endocarditis, connective tissue diseases, rheumatic)Annulus (marfans, aortic dissection)

50
Q

Symptoms of aortic regurgitation?

A

Breathlessness

51
Q

Signs of aortic regurgitation? (3)

A

Collapsing pulseDisplaced apexEarly diastolic murmur left sternal edge

52
Q

What is another name for a collapsing pulse?

A

Water hammer pulse (blood gets forcefully pushed through and then sucked back slightly)

53
Q

What causes cardiomegaly in aortic regurgitation?

A

Large volume of blood in the left ventricle

54
Q

Treatment of aortic regurgitation?:

A

Medication = ACEISurgery = valve replacement when symptoms and LV dilation

1st Year - Cardiology (25 decks)

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