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The Cardiovascular System > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What is orthopnoea?

A

Breathlessness when lying flat

(ask how many pillows the patient sleeps with)

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2
Q

What is paroxysmal nocturnal dyspnoea

A

Breathlessness occuring at night

Leads the patient to sit on edge of bed or open window to catch breath

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3
Q

What is the New York Association Functional Classification?

A

A system used to classify the severity of heart failure using increasing classes of severity:

  1. Class I - no limitiation
  2. Class II - Slight limitation of ordinary activity
  3. Class III - marked limitation of less than ordinary activity
  4. Class IV - severe limitation of minimal activity or at rest
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4
Q

Heart failure can either be ______ or ______ sided

A

Left or right

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5
Q

What effect does left sided heart failure have?

A

Back pressure on lungs because heart inefficiently moves blood from the lungs to systemic circulation

This leads to pulmonary oedema

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6
Q

What effect does right sided heart failure have?

A

There is back pressure in the peripheral circulation cause by inefficiencies of the right heart to take in blood from the systemic circulation

This causes peipheral oedema

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7
Q

What are the signs of right sided heart failure?

A
  • Raised JVP
  • Pitting oedema - ankles and even up to sacrum
  • Hepatic congestion
  • Parasternal heave - RVH and overload - commonyl seen in cor pulmonale and pulmonary hypertension
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8
Q

What are the signs of left heart failure?

A

Displaced apex beat

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9
Q

What is used to confirm any diagnosis of heart failure?

A

Echocardiogram

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10
Q

What is a heart murmur?

A

Audible turbulent blood flow that ca be either innocent or pathological

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11
Q

Where are the 4 areas of auscultation?

A
  1. Parasternal - 2nd intercostal space (right)
  2. Parasternal - 2nd intercostal space (left)
  3. Parasternal - 4th intercostal space (left)
  4. Mid-clavicular line - 5th intercostal space (left)
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12
Q

When will a systolic heart murmur be heard?

A

Between the first (S1) and second (S2) heart sounds

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13
Q

When will a diastolic heart murmur be heard?

A

Out with the first and second heart sounds

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14
Q

What is the first heart sound (S1)?

A

Mitral and tricuspid valves closing - start of systole

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15
Q

What is the second heart sound (S2)?

A

The closing of the pulmonary and aortic valves - start of diastole

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16
Q

What are the two main types of systolic murmur?

A
  1. Pansystolic
  2. Ejection systolic
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17
Q

What is a pansystolic murmur?

A

The sound remains constant between S1 and S1

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18
Q

What is an ejection systolic murmur?

A

There is increasing sound throughout systole

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19
Q

What are the two main types of diastolic murmur?

A
  1. Early diastolic
  2. Mid diastolic

There may also be late diastolic murmurs

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20
Q

What is an early diastolic murmur?

A

A murmum with decreasing sound after S2

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21
Q

What is a mid-diastolic murmur?

A

Increasing sound from S2 to S1 in crescendo configuration

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22
Q

If a murmur radiates to the carotids what type of murmur is it?

A

Ejection systolic

Due to aortic stenosis

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23
Q

If the murmur radiates to the axilla what is the likely cause of the murmur?

A

Mitral regurgitation

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24
Q

Which murmurs are increased during inspiration?

A

Right sided

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25
Q

Why do right sided murmurs icrease with inspiration?

A

There is increased blood flow (respiratory pump)

Hence, murmurs are more audible

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26
Q

Which murmurs are always pathological?

A

Diastolic

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27
Q

What is valve stenosis?

A

Valves cannot open properly

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28
Q

Why does valve regurgitation occur?

A

Valves do not close properly

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29
Q

What is mixed valve disease?

A

Valves neither open nor close properly

30
Q

What is an invasive procedure for murmur investigation?

A

Cardiac catheterisation

31
Q

What can cause aortic stenosis?

A

Calcification and cholesterol deposition in heart valves

32
Q

What are the risk factors for aortic stenosis?

A
  • Age
  • Genetics
  • Diet
  • Obesity
33
Q

What is a congenital condition that can lead to aortic stenosis?

A

Bicuspid aortic valve

34
Q

Over time, what morpholical change will likey occur in the heart with an aortic stenosis?

A

Left ventricular hypertrophy

35
Q

What are the symptoms of aortic stenosis?

A
  • Breathlessness
  • Chest pain
  • Dizziness/syncope
36
Q

What are the signs of aortic stenosis?

A
  • Low volume pulse
  • Forceful displaced apex (due to LVH)
  • Ejection systolic murmur that can radiate to carotids
37
Q

How will aortic stenosis often present on an ECG?

A

Large QRS complex due to ventricular hypertrophy

38
Q

What is the treatment for aortic stenosis?

A

Sternotomy - conventional valve replacement

Trans catheter aortic valve replacement 9TAVI) - used when surgery is not suitable, replacement vave is insterted via femoral artery or directly into the heart (transapical)and is deployed over the native valve

Balloon aortic valvotomy (BAV) - can crack through calcification, may lead to regurgiation and is onyl palliative to prolong life

39
Q

Why are mechanical valves good for yound patients?

A

They will last a lifetime

40
Q

When a mechanical valve is inserted, what drug must be administered and why?

A

Warfarin

To prevent coagulation and thrombosis over new valve

41
Q

In what type of patient will a bio prosthetic valve be used?

A

Older patients as the valves do not generally last as long

42
Q

In which instances may TAVI be preferred over aortic valve replacement?

A

Good for patients with co-morbidities or those who cannot undergo surgery

43
Q

What is annular dilatation?

A

The valves are pulled apart

This can cause reguritation

44
Q

What is the annulus?

A

The base of the heart valve that supports the valves

45
Q

What may be some problems with heart valves themselves?

A
  • Endocarditis
  • Prolapse
  • Rheumatic
  • Myxomatous (floppy)
46
Q

What may cause mitral regurgitation?

A
  • Annular dilatation
  • Prolapse of valves
  • Chordae rupture - degenerative condition
  • Papillary muscle rupture - due to ischaemia
47
Q

What are the main symptoms of mitral reguritation?

A
  • Breathlessness
  • Peripheral oedema
  • Fatigue
48
Q

What are the signs of mitral regurgitation?

A
  • Displaced apex
  • Pansystolic murmur - axilla
49
Q

Of the two, which has a better prognosis, aortic stenosis or mitral regurgitation?

A

Aortic stenosis

50
Q

What is cardiomegaly?

A

An enlarged heart

51
Q

What is the treatment for mitral regurgitation?

A
  • Medication for heart failure - diuretics, ACEI
  • Surgical repair of prolapse or replacement for degenerative
  • Percuatanous - clips can be used in infacy to stop progression and degeneration
52
Q

What may be the causes of mitrl stenosis?

A

Rheumatic disease

Congential defect - rare

53
Q

In mitral stenosis it is common to see left atrial __________

A

Hypertrophy

54
Q

What are the symptoms of mitral stenosis?

A
  • Breathlessness
  • Fatigue
  • Palpitations (AF)
55
Q

What are the signs of mitral stenosis?

A
  • Malar flush
  • Tapping apex beat
  • Mid diastolic rumbling murmur localised to apex
56
Q

On a CXR, what may be a tell-tale sign of mitral stenosis?

A

Straight left heart border due to enlarged pulmonary artery

57
Q

What is the treatment for mitral stenosis?

A
  • High thrombotic risk - diuretics and treatment for AF
  • Surgery - valve replacement
  • Balloon valvuloplasty
58
Q

What is aortic regurgitation caused by?

A

Failure of valves to close properly

59
Q

What can cause failure of valves to close in aortic regurgitation?

A

Leaflets

  • Endocarditis
  • Connective tissue diseases
  • Rheumatic

Annulus

  • Marfans - genetic disorder increasing risk of mitral valve prolapse and aortic aneurysm
  • Aortic dissection
60
Q

What is the main symptom of aortic regurgitation?

A

Breathlessness

61
Q

What are the signs of aortic regurgitation?

A
  • Collapsing pulse - blood rushes back to ehart due to low pressure (through aortic valve)
  • Displaced apex
  • Early diastolic murmur at the left sternal edge
62
Q

When is aortic regurgitation more easily heard?

A

When sitting forward breathing out and holding

63
Q

Aortic regurgitation leads to a large ___, larger ______ ________ which causes diastolic pressure to be ______ resulting in a _____ pulse presssure

A

EDV

Stroke volume

Lower

Wide

64
Q

Volume overload in the heart often leads to what?

A

Cardiomegaly

65
Q

What is the treatment for aortic regurgitation?

A
  • Medication - ACEI, Beta blockers
  • Surgery - based on symptoms and LV dilatation - valve replacement
66
Q

Right sided vavular heart problems are usually what?

A

Rare and congenital

67
Q

What is the most common cause of right sided heart failure?

A

Left sided heart failure

68
Q

Why are calcium channel blockers not used in heart failure?

A

They will have a negative ionotropic effect, weakening heart force further causing deterioration of the condition

69
Q

LVF can cause what?

A

Backpressure on lungs and peripheral oedema

70
Q

RVF can cause what?

A

Back pressure on body, causing peripheral oedema

The Cardiovascular System (24 decks)

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