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Cardiovascular > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What is mitral regurgitation?

A

Backflow though the mitral valve during systole

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2
Q

What are causes of mitral regurgitation?

A 
Functional - LV dilatation
Annular calcifcation
Rheumatic fever
Infective endocarditis
Ruptured cord tendinae
Papillary muscle dysfunction/rupture (post MI)
CT disorders
Cardiomyopathy
Congenital
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3
Q

What are symptoms of mitral regurgitation

A

Dyspnoea, fatigue, palpitations, symptoms of cause (fever etc)

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4
Q

What are signs of mitral regurgitation?

A

Pansystolic murmur at apex
Radiates to axilla

AF
Displaced hyperdynamic apex due to dilated LV

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5
Q

How do you manage mitral regurgitation?

A

Control rate if AF fast
Anticoagulate if AF, history of embolism, prosthetic heart valve, mitral stenosis.
Diuretics
Surgery

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6
Q

What is mitral prolapse? Symptoms and signs?

A

Inversion of mitral valve

Mid-systolic click or late systolic murmur

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7
Q

What is mitral stenosis? Causes?

A 
Narrowing of the mitral valve
Rheumatic fever
Congenital
Prothetic valve
Tumour
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8
Q

What are signs of mitral stenosis?

A 
Mid diastolic murmur (rumbling) heard best in expiration with patient on left side (ROLL)
Opening snap
Malar flush on cheeks due to reduced CO
Low volume pulse
AF
Tapping, non-displaced apex beat
RV heave
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9
Q

How do patients with mitral stenosis present?

A

Pulmonary hypertension causes dyspneaa, haemoptysis, chronic bronchitis, pressure from large left atrium on local structures:
Hoarseness (RLN)
Dysphagia (oesophagus)
Bronchial obstruction
Fatigue, palpitations, chest pain, systemic emboli, IE

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10
Q

How is mitral stenosis managed?

A 
Rate control if in AF
Anticoagulate with warfarin
Diuretics to reduce preload and pulmonary congestion
Balloon valvuloplasty
Valve replacement
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11
Q

What is aortic stenosis? Causes?

A 
Narrowing of aortic valve
Degenerative calcification
Bicuspid aortic valve
William's syndrome (supravalvular aortic stenosis
Rheumatic heart disease
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12
Q

How does AS present?

A

Chest pain
Exertional Dyspnoea
Syncope

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13
Q

What are signs of AS?

A

Ejection systolic murmur at left steal edge, aortic area and radiates to carotids
Slow rising pulse with narrow pulse pressure - parvus et tardus carotid upstroke - diminished and delayed
Soft absent S2
S4
LV heave
Aortic thrill
Non-displaced apex beat

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14
Q

What are Ddx for AS?

A

Hypertrophic obstructive cardiomyopathy

Aortic sclerosis - senile degeneration of valve (no carotid radiation and normal pulse)

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15
Q

How is AS managed?

A

If symptomatic Valve replacement

TAVI transcatheter aortic valve implantation if not fit for surgery with critical aortic stenosis

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16
Q

What is aortic regurgitation?causes?

A

Backflow through aortic valve
Valve disease: rheumatic fever, IE, CT disease - SLE, bicuspid aortic valve
Aortic root disease: aortic dissection, spondyloarthropathies, hypertension, syphilis, Marfan’s/ED

17
Q

Symptoms of AR?

A

Exertional dyspnoea
Orthopnoea - breathlessness lying flat so use lots of pillow
Paroxysmal nocturnal dyspnoea - night breathlessness

18
Q

Signs of AR?

A

Early diastolic murmur (high pitched, heard best in expiration with patient sat forward)
Collapsing (water hammer) pulse
Wide pulse pressure

dIsplaced apex beat
Corrigan’s signs - carotid pulsation
de Musset’s sign - head nodding with each heart beat
Quincke’s sign - capillary pulsation in nail beds

Severe - Austin flint murmur - mid diastolic

19
Q

Management of AR?

A

Reduce systolic hypertension - ACEi
Echo every 6-12 months
Severe AR with enlarged ascending aorta, increased symptoms, enlarging LB or refractory IE –> surgery valve replacement

20
Q

What is the diagnostic test for all valvular heart disease?

A

Echocardiography

21
Q

What does a continuous machine-like murmur indicate?

A

Patent ductus arteriosus

22
Q

What does an ejection systolic murmur indicate?

A

Aortic stenosis
Radiates to carotids
slow rising pulse - narrow pulse pressure

23
Q

What does a holosystolic/pansystolic murmur indicate?

A

Mitral regurgitation

radiates to axilla

24
Q

What does a late systolic murmur indicate?

A

Mitral valve prolapse

+ mid-systolic click

25
Q

What does an early diastolic murmur indicate?

A

Aortic regurgitation
Best heard on expiration with patient sat forward
Collapsing pulse - wide pulse pressure

26
Q

What does a mid-late diastolic murmur indicate?

A

Mitral stenosis

On expiration, Patient roll on left hand side

Cardiovascular (16 decks)

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