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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
Q

What are the causes of aortic stenosis?

A

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
Q

What are the symptoms of aortic stenosis?

A

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
Q

What are the signs of aortic stenosis?

A

Low volume pulse, slow rising pulse, displaced apex beat.

Ejection systolic murmur that can radiate to carotids

28
Q

What is the treatment for aortic stenosis?

A

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
Q

What are the advantages and disadvantages of mechanical prosthetic heart valves?

A

+ longevity
- anticoagulation for life
=> Younger patients

30
Q

What are the advantaes and disadvantages of bioprothetic tissue valves?

A

+ no anticoagulation
- Only last for 10 ish years
=> older patients

31
Q

What are the advantages of conventional aortic valve replacement with open heart surgery?

A

Improved long term outcomes
Really good in a well patietn
Allows CABG at the same time

32
Q

When would a TAVI (transcatheter aortic valve replacement) be preferred?

A

Patient with comorbiditeis

Patients with a previous sternotomy

33
Q

What are the causes of mitral regurgitation?

A

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
Q

What are the symptoms of mitral regurgitation?

A

Breathless, peripheral oedema, fatigue (poor tissue oxygenation)

35
Q

WHat are the signs of mitral regurgitation?

A

Displaced apex beat
Pan systolic murmur which can radiate to the axilla
CXR- cardiomegaly

36
Q

What is the treatments for mitral regurgitation?

A

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
Q

What are the causes for mitral stenosis?

A 
Rheumatic fever (most common cause takes years to develop)
Congenital- rare
38
Q

What are the symptoms of Mitral stenosis?

A

Breathless, fatigue and AF

39
Q

What are the signs of mitral stenosis?

A

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
Q

What is the treatment for Mitral stenosis?

A 
Medications = diuretics and treat AF
Surgery = valve replacement 
Balloon valvuloplasty (if surgery is conraindicated)
41
Q

What are the causes of aortic regurgitation?

A

Leaflets: endocarditis, connective tissue disease, rheumatic
Annulus (dilation of the proximal aorta): Marfan’s syndrome, aortic dissection

42
Q

What are the symptoms of aortic regurgitation?

A

Breathless

43
Q

What are the signs of aortic regurgitation?

A

Collapsing pulse, wide pusle pressure, displaced apex beat
Early diastolic murmur at the left parasternal edge
CXR: cardiomegaly?

44
Q

Why doe aortic regurgitation cause a wide pulse pressure?

A

Aortic valve will leak blood into ventricle which will decrease diastolic BP.
This will increase EDV and SV which will increase systolic BP

45
Q

What is the treatment for aortic regurgitation?

A 
Medication = ace inhibitors
Surgery = surgery timing is important. Monitor using echo and then its a valve replacement

Cardiovascular (24 decks)

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