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Cardiovascular > Valvular heart disease > Flashcards

Valvular heart disease Flashcards

1
Q

What can cause: A raised JVP?

A

Right heart failure

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2
Q

What can cause: Pitting oedema?

A

Right heart failure

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3
Q

What can cause: a displaced apex beat?

A

Left ventricular hypertrophy or Left heart failure

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4
Q

What can cause: hepatic congestion?

A

Right heart failure

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5
Q

What can cause: a tapping apex beat?

A

Mitral senosis

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6
Q

What can cause: Left parasernal heave?

A

Right ventricular hypertrophy, right ventricular overload=>COr pulmonale, Pulmonary stenosis, pulmonary hypertension

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7
Q

What can cause:Apex heave?

A

Left ventricular hypertrophy, mitral stenosis

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8
Q

What is a cardiac murmur?

A

Audible turbulence of blood flow

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9
Q

What causes a pathological and innocent murmur?

A 
Pathological= structural cardiac abnormalities
Innocent = Increased flow across a velve (always systolic)
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10
Q

Which murmor radiates to the neck?

A

Aortic stenosis

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11
Q

Which murmur radiates to the axilla?

A

Mitral regurgitation

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12
Q

Why do right sided murmurs sound louder on inspiration?

A

Increased venous return

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13
Q

How is a murmur graded?

A 
1-6
1 = questionable murmur
2-3 = definite murmor - no thrill
4-5 = Definite murmor with thrill
6 = murmor audible without a stethoscope
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14
Q

What are the systolic murmurs?

A

Mitral regurgitation

Aortic stenosis

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15
Q

What are the diastolic murmurs?

A

Mitral stenosis

Aortic regurgitation

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16
Q

What causes pathological S3?

A

Left ventricular systolic dysfunction

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17
Q

What causes S4?

A

Decreased Left ventricular compliance due to ischemia, hypertension or aortic stenosis

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18
Q

What causes systolic clicks?

A

Mitral valve collapse

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19
Q

What is the innocent murmur?

A

Systolic flow murmur in the right ventricular outflow tract- pulmonary area

20
Q

What is mixed valve disease?

A

Valves which neither open or close effectively

21
Q

What is valve stenosis?

A

Valves which do not open properly

22
Q

What is valve regurgitation?

A

Valves which do not close properly

23
Q

What are the common consequences of valve disease?

A

Heart failure

24
Q

What are the investigations for valvular heart disease?

A

Echocardiograph is the gold standard for diagnosis
CXR and ECG are cheap and useful
Cardiocatherterisation is invasive

25
What are the causes of aortic stenosis?
Degenerative (age) calcification of the valve Congenital bicuspid valve (aortic valve usually has 3 leaflets) Rheumatic: cross reaction from a strep throat infection infrequently effects the aortic valve.
26
What are the symptoms of aortic stenosis?
Breathless, chest pain, diziness and syncope. The chest pain mimics angina pain but coronary arteries are clear. Aortic stenosis leads to LVH => mismatch supply and demand for oxygen => ischemic pain
27
What are the signs of aortic stenosis?
Low volume pulse, slow rising pulse, displaced apex beat. | Ejection systolic murmur that can radiate to carotids
28
What is the treatment for aortic stenosis?
Surgery- medication will not help Open heart surgery and conventional valve replacement- most common Transcatheter aortic valve replacement (TAVI) Balloon aortic valvotomy BAV (palliative)
29
What are the advantages and disadvantages of mechanical prosthetic heart valves?
+ longevity - anticoagulation for life => Younger patients
30
What are the advantaes and disadvantages of bioprothetic tissue valves?
+ no anticoagulation - Only last for 10 ish years => older patients
31
What are the advantages of conventional aortic valve replacement with open heart surgery?
Improved long term outcomes Really good in a well patietn Allows CABG at the same time
32
When would a TAVI (transcatheter aortic valve replacement) be preferred?
Patient with comorbiditeis | Patients with a previous sternotomy
33
What are the causes of mitral regurgitation?
Leaflets: Prolapse, Rheumatic, endocarditis, myxomatous (floppy) Chordae rupture: Degenerative, prolapse Papillary muscle rupture: Ischemic Annular dilation: when the heart dilates, the valve is pulled apart
34
What are the symptoms of mitral regurgitation?
Breathless, peripheral oedema, fatigue (poor tissue oxygenation)
35
WHat are the signs of mitral regurgitation?
Displaced apex beat Pan systolic murmur which can radiate to the axilla CXR- cardiomegaly
36
What is the treatments for mitral regurgitation?
Medication and monitor with echo Heart failure: Diuretics, ACE inhibitors, Beta blockers, spirilactone Surgical: repair if prolapsed and replacement if degenerative ?Percutaneous clips in infancy have shown promising results
37
What are the causes for mitral stenosis?
``` Rheumatic fever (most common cause takes years to develop) Congenital- rare ```
38
What are the symptoms of Mitral stenosis?
Breathless, fatigue and AF
39
What are the signs of mitral stenosis?
Malar flush, Tapping apex beat Mid diastolic rumbling murmor localised to apex beat (left lateral position with bell of stethoscope) ECG may show AF CXR may show a straight left heart boarder
40
What is the treatment for Mitral stenosis?
``` Medications = diuretics and treat AF Surgery = valve replacement Balloon valvuloplasty (if surgery is conraindicated) ```
41
What are the causes of aortic regurgitation?
Leaflets: endocarditis, connective tissue disease, rheumatic Annulus (dilation of the proximal aorta): Marfan's syndrome, aortic dissection
42
What are the symptoms of aortic regurgitation?
Breathless
43
What are the signs of aortic regurgitation?
Collapsing pulse, wide pusle pressure, displaced apex beat Early diastolic murmur at the left parasternal edge CXR: cardiomegaly?
44
Why doe aortic regurgitation cause a wide pulse pressure?
Aortic valve will leak blood into ventricle which will decrease diastolic BP. This will increase EDV and SV which will increase systolic BP
45
What is the treatment for aortic regurgitation?
``` Medication = ace inhibitors Surgery = surgery timing is important. Monitor using echo and then its a valve replacement ```

Cardiovascular (24 decks)

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