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CARD - 1 > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What are three common aetiologies of mitral stenosis?

A

RHEUMATIC FEVER, RHEUMATIC FEVER, RHEUMATIC FEVER

Rarer causes - mucopolysaccharidoses, carcinoid and endocardial fibroelastosis

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2
Q

What are the features of mitral stenosis?

A 
Mid-late diastolic murmur (best heard in expiration)
Loud S1, opening snap
Low volume pulse
Malar flush 
AF
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3
Q

What are features of severe MS?

A

Length of murmur increases

Opening snap becomes closer to S2

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4
Q

What might you see on CXR in MS?

A

Left atrial enlargement

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5
Q

What is mitral regurgitation?

A

When blood leaks back through the mitral valve on systole

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6
Q

What is the most common valve disease?

A

Aortic stenosis

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7
Q

What is the second most common valve disease?

A

Mitral regurg

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8
Q

Where is the mitral valve located?

A

Between the L atrium and ventricle

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9
Q

What can MR lead to?

A

Less efficient heart as less blood is pumped through the body with each contraction

NOTE: it is common in otherwise healthy patients to a trivial degree and does not req. treatment

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10
Q

As the degree of regurg in MR becomes more severe what happens?

A

Bodys O2 demands may exceed what the heart can supply –> myocardium thickens

Can lead to patient becoming fatigued as thicker myometrium is less efficient and –> irreversible heart failure

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11
Q

What are RFs for mitral regurgitation?

A 
Female sex
Low BMI
Age
Renal dysfunction
Prior MI
Prior mitral stenosis or valve prolpase
Collagen disorders, e.g. Marfans, EDS
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12
Q

How can rheumatic fever cause mitral regurg?

A

Causes inflammation of the valves

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13
Q

How can MR occur post-CAD/MI?

A

If papillary muscles/chordae tendinae are affected by cardiac insult, mitral valve disease may ensue

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14
Q

What is mitral valve prolapse?

A

Leaflets of mitral valve are deformed so valve doesn’t close properly and allows for backflow

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15
Q

How can IE lead to mitral regurg?

A

Vegetations colonising the valve prevent it closing properly

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16
Q

What are causes of mitral regurg?

A 
CAD/MI
Mitral valve prolapse
IE
Rheumatic fever
Congenital
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17
Q

What are symptoms of MR?

A

Usually asymptomatic

May have symptoms due to failure of left ventricle, arrhythmias, pulmonary hypertension (SoB, fatigue, oedema)

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18
Q

What are signs of MR?

A

Pansystolic blowing murmur
Heard best at apex and radiates to axila
S1 quiet (due to incomplete closure of valve)
Severe MR may cause widely split S2

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19
Q

What might you see on ECG with MR?

A

Broad P wave (indicative of atrial enlargement)

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20
Q

What might you see on CXR in MR?

A

Cardiomegaly (with enlarged left atrium and ventricle)

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21
Q

What investigation is crucial to the diagnosis of MR?

A

Echocardiography

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22
Q

How is MR managed?

A

Medical mx in acute cases - nitrates, diuretics, positive inotropes, intra-aortic balloon pump
If in HF - ACEi + beta blockers + spironolactone
Acute, severe regurg –> surgery (repair > replacement in degenerative regurg)
If cannot repair - mechanical/pig valve

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23
Q

What things is mitral valve prolapse associated with?

A 
PDA, ASD
Cardiomyopathy
Turner's
Marfan's, Fragile X
Osteogenesis imperfecta
Pseudoxanthoma elasticum
Wolf-Parkinson White syndrome
Long QT syndrome
EDS
PCKD
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24
Q

What are features of mitral valve prolapse?

A

Atypical chest pain/palpitations
Mid-systolic click (occurs later if patient squatting)
Late systolic murmur (longer if pt standing)

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25
Q

What are complications of mitral valve prolapse?

A

MR
Arrhythmias (incl. long QT)
Emboli
Sudden death

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26
Q

What is responsible for the first heart sound?

A

Closure of the mitral and tricuspid valves

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27
Q

What is responsible for the second heart sound?

A

Closure of aortic and pulmonary valves

28
Q

What does splitting of S2 during inspiration indicate?

A

This is normal

29
Q

When might you get a soft S1?

A

MR

30
Q

When might you get a loud S1?

A

MS

31
Q

When might you get a soft S1?

A

Aortic stenosis

32
Q

What causes a third heart sound?

A

Diastolic filling of the ventricle

Considered normal up to 30y (up to 50y in women)

Heart in LV failure, pericarditis, MR

33
Q

When might a fourth heart sound be heard?

A

AS, HOCM, HTN

34
Q

What causes a fourth heart sound?

A

Atrial contraction against a stiff ventricle

35
Q

What does a fourth heart sound coincide with on ECG?

A

The P wave

36
Q

Where should you auscultate to hear the pulmonary valve?

A

L 2nd intercostal space, upper border of sternum

37
Q

Where should you auscultate to hear the aortic valve?

A

R 2nd intercostal space, upper border of sternum

38
Q

Where should you auscultate to hear the mitral valve?

A

Left fifth intercostal space, medial to midclav line

39
Q

Where should you auscultate to hear the tricuspid valve?

A

Left 4th intercostal space, lower left sternal border

40
Q

What part of the stethoscope is best at picking up high pitched noises?

A

Diaphragm

41
Q

What part of the stethoscope is best at picking up low pitched noises?

A

Bell

42
Q

What clinical features may be present in aortic stenosis?

A

Chest pain
SoB
Syncope

43
Q

What murmur is classically seen in aortic stenosis?

A

Ejection systolic murmur

44
Q

What decreases the murmur in aortic stenosis?

A

Valsalva manoeuvre

45
Q

What are features of severe aortic stenosis?

A 
Narrow pulse pressure
Slow rising pulse
Delayed ESM
Soft/absent S2
S4
Thrill
LV hypertrophy/failure
46
Q

What are causes of aortic stenosis?

A

Degenerative calcification (most common in pts >65)
Bicuspid aortic valve (most common in <65)
William’s syndrome (supravalvular aortic stenosis)
Post-rheumatic disease
Subvalvular - HOCM

47
Q

How do you manage asymptomatic aortic stenosis?

A

Observe pt

Unless valvular gradient >40mmHg + features like LV systolic dysfunction

48
Q

How do you manage symptomatic aortic stenosis?

A

Valve replacement

49
Q

What treatment may be given to those with critical aortic stenosis who are not fit for valve replacement?

A

Balloon valvuloplasty

50
Q

What is the murmur of AR like?

A

Early diastolic

51
Q

What increases the intensity of the AR murmur?

A

Handgrip manoeuvre

52
Q

What are other features of AR?

A 
Collapsing pulse
Wide pulse pressure
Quincke sign (nailbed pulsation) 
De Musset's sign (head bobbing) 
Mid-diastolic Austin-Flint murmur in severe AR
53
Q

What causes an Austin flint murmur?

A

Partial closure of the anterior mitral valve cusps caused by the regurg streams

54
Q

What are causes of AR?

A 
Valve dx:
Rheumatic fever
IE
Connective tissue dx, e.g. RA/SLE
Bicuspid aortic valve
Aortic root dx:
Aortic dissection
Spondyloarthopathies, e.g. AS
Syphillis
Marfans, EDS
55
Q

What are signs of tricuspid regurg?

A

Pansystolic murmur
Promiment/giant V waves on JVP
Pulsatile hepatomegaly
Left parasternal heave

56
Q

What are causes of TR?

A

R ventricular infarction (damage to papillary muscles)
Pulmonary HTN (e.g. COPD)
Rheumatic heart disease
IE
Ebstein’s anomaly (leaflets in ventricle)
Carcinoid syndrome

57
Q

How does pulmonary hypertension cause tricuspid regurg?

A

It causes increased right ventricular pressure which dilates the tricuspid valve

58
Q

What most commonly causes tricsupid valve stenosis?

A

Rheumatic fever (inflammation –> valve fuses)

59
Q

What murmur do you get with tricuspid stenosis?

A

Mid-diastolic

60
Q

What conditions cause an ejection systolic murmur?

A

Aortic stenosis
Pulmonary stenosis
ASD, ToF

61
Q

What conditions cause a holosystolic murmur?

A

Mitral/tricuspid regurg (high pitched and blowing)

VSD (harsh in nature)

62
Q

What conditions cause a late systolic murmur?

A

Mitral valve prolapse

Coarcation of aorta

63
Q

What conditions cause an early diastolic murmur?

A

AR (high pitched, blowing)

Graham-Steel (pulmonary regurg, high pitched and blowing)

64
Q

What conditions cause a mid-late diastolic murmur?

A

MS (rumbling)

Austin-Flint (severe AR, rumbling)

65
Q

What condition causes a continuous machine like murmur?

A

PDA

CARD - 1 (28 decks)

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