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Cardiovascular > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What symptoms are characteristic of valvular heart disease?

A

Chest pain
Breathlessness
Collapse/dizzy spells

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2
Q

What are the different types of cardiac breathlessness?

A

Related to activity (usually)
Often associated with ankle swelling
Orthopnoea
Paroxysmal Nocturnal Dyspnoea (PND)

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3
Q

What is the new york heart associated functional classification (NYHA) of breathlessness?

A

Class 1 - no limitation
Class 2 - slight limitation of ordinary activity
Class 3 - Marked limitation of less than ordinary activity
Class 4 - Severe limitation of minimal activity or at rest

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4
Q

What should be examined in a cardiology clinical exam?

A 
General appearance 
Arterial pulse - radial, carotid
Venous pulse - JVP 
Inspection - scars, pacemakers, audible murmurs or beats 
Palpation - apex, heave, thrills 
Auscultation - heart sounds and murmurs
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5
Q

What are the signs of right sided heart failure?

A

Raised JVP
Pitting oedema
Hepatic congestion

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6
Q

Where is the apex beat usualyl found?

A

5th intercostal space in the mid-clavicular line

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7
Q

What can cause the apex to tap?

A

Mitral stenosis

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8
Q

What can cause a displaced apex beat?

A

Left ventricular dilatation (volume overload)

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9
Q

What can cause a heaving apex beat?

A

Heaving with a displaced apex beat can be caused in ventricular hypertrophy (pressure overload)

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10
Q

What can cause a parasternal heave?

A

Right ventricular overload - cor pulmonale/pulmonary hypertension

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11
Q

What is a murmur?

A

Audible turbulence of blood flow

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12
Q

What are the 2 types of murmur?

A

Innocent and pathological

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13
Q

How are murmurs described?

A 
Systole or diastole?
What type?
Where is it loudest?
Where does it radiate?
What is the grade of murmur?
Is it influenced by respiration?
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14
Q

What causes the 1st heart sound?

A

Mitral and tricuspid valve closing which indicates the start of systole

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15
Q

What causes the 2nd heart sound?

A

Aortic and pulmonary valves closing which indicates the start of diastole

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16
Q

What are the 2 types of systolic murmur?

A

Pansystolic

Ejection systolic

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17
Q

What are the 2 types of diastolic murmur?

A

Early diastolic

Mid diastolic

18
Q

Where does aortic stenosis radiate to?

A

Carotids

19
Q

Where does mitral regurgitation radiate to?

A

Axilla

20
Q

What are the 2 systolic murmurs?

A

Aortic and pulmonary stenosis

Mitral and tricuspid regurgitation

21
Q

What are the grades of murmur?

A 
1 - very quiet 
2 - quiet but easy to hear 
3 - loud
4- loud with a thrill
5 - very loud with a thrill
6 - Audible without a stethoscope
22
Q

How does respiration influence murmurs?

A

Right sided murmurs are louder with inspiration

23
Q

What does an innocent murmur sound like?

A

Soft, is position dependent and often early systolic (diastolic murmurs are ALWAYS pathological)

24
Q

How can aortic stenosis occur?

A

Degenerative (age related)
Congenital (bicuspid valve)
Rheumatic fever

25
Q

What are the symptoms of aortic stenosis?

A

Breathlessness
Chest pain
Dizziness/syncope

26
Q

What are the clinical signs of aortic stenosis?

A

Low volume pulse
Forceful displaced apex
Ejection systolic murmur that can radiate to the carotids

27
Q

How is aortic stenosis treated?

A

Valve replacement
Transcatheter aortic valve replacement (TAVI)
Balloon aortic valvotomy (BAV)

28
Q

What are the pros and cons of a mechanical valve?

A

Pros - longevity

Cons - life-long warfarin so indicated in younger patients

29
Q

What are the pros and cons of a bio-prosthetic valve?

A

Pros - no warfarin

Cons - 10 years roughly lasting so indicated in older patients

30
Q

What can cause mitral regurgitation?

A 
Leaflets (prolapse, rheumatic, myxomatous (floppy), endocarditis) 
Chordae rupture (degenerative) 
Papillary muscle rupture (ischaemic)
Annular dilatation (functional)
31
Q

What are the symptoms of mitral regurgitation?

A

Breathlessness
Peripheral oedema
Fatigue

32
Q

What are the clinical signs of mitral regurgitation?

A

Displaced apex

Pansystolic murmur that radiates to the axilla

33
Q

How can mitral regurgitation be treated?

A

Medication - diuretics and heart failure drugs (ACEI, beta blockers)
Surgical (repair for prolapse, replacement for degenerative causes)
Percutaenous

34
Q

What can cause mitral stenosis?

A

Rheumatic is main cause

Congenital rare

35
Q

What are the symptoms of mitral stenosis?

A

Breathlessness
Fatigue
Palpitations (AF)

36
Q

What are the clinical signs of mitral stenosis?

A

Malar flush
Tapping apex beath
Mid diastolic rumbling diastolic murmur localised to the apex

37
Q

How can mitral stenosis be treated?

A

Diuretics and treat AF (beta-blockers, flecainide, amiodarone)
Surgery - valve replacement
Balloon valvuloplasty

38
Q

What can cause aortic regurgitation?

A

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

39
Q

What are the symptoms of aortic regurgitation?

A

Breathlessness

40
Q

What are the clinical signs of aortic regurgitation?

A

Collapsing pulse
Wide pulse pressure
Displaced apex
Early diastolic murmur at the left sternal edge

41
Q

What is the treatment for aortic regurgitation?

A

ACEI
Surgery - to treat symptoms and LV dilatation
Valve replacement

Cardiovascular (27 decks)

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