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Cardiovascular (Annie) > Valvular Heart disease > Flashcards

Valvular Heart disease Flashcards

1
Q

when are symptoms of valvular heart disease shown?

A

on exertion

= exertional symptoms

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2
Q

what are symptoms of valvular heart disease?

A

1) chest pain
- gripping
- squeeing
- heavy
- crushing
2) breathlessness
3) collapse
4) dizzy spells
= exertional symptoms

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3
Q

what 4 things is cardiac breathlessness associated with?

A

1) related to activity
2) associated with ankle swelling
3) orthopnoea (SOB when lying flat)
4) paroxysmal Nocturnal dyspnoea (PND) = waking from sleep unable to breathe

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4
Q

what is used for functional classification?

A

Class I = no limitation
Class II = slight limitation on ordinary activity
Class III = mark limitation of less than ordinary activity
Class IV = severe limitation of minimal activity

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5
Q

what are 3 signs of right heart failure?

A

1) raised JVP
2) pitting oedema
- ankles or sacrum
3) hepatic congestion

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6
Q

what would the apex beat be in mitral stenosis?

A

= tapping apex

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7
Q

when would the apex beat be displaced and diffused?

A

= In left ventricular dilation (volume overload)

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8
Q

when would the apex beat be heaving and displaced?

A

= in left ventricular hypertrophy (pressure overload)

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9
Q

where would you find a parasternal heave?

A

= hand of left sternum

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10
Q

what would a parasternal heave show?

A

= right ventricular overload

- cor pulmonale/pulmonary hypertension

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11
Q

what is a cardiac murmur?

A

= audible turbulence of blood flow

- can be innocent & pathological

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12
Q

what 6 questions should you cover when describing cardiac murmurs?

A

1) systole or diastole?
2) what type of murmur?
3) where is it loudest?
4) where does it radiate to?
5) what grade of murmur?
6) (influenced by respiration)?

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13
Q

how would you know if the murmur is in systole or diastole?

A

1st heart sound
= start of systole
= mitral & tricuspid closing

2nd heart sound
= start of diastole
= aortic & pulmonary closing

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14
Q

when is aortic stenosis heard?

A

systole

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15
Q

when is mitral regurgitation usually heard?

A

systole

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16
Q

when is aortic regurgitation usually heard?

A

diastole

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17
Q

when is mitral stenosis usually heart?

A

diastole

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18
Q

what are the 2 types of systolic and diastolic murmur?

A

Systolic

1) pan systolic
2) ejection systolic

Diastolic

1) early diastolic
2) mid diastolic

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19
Q

what 2 areas might the murmurs radiate to?

A

1) carotids (aortic stenosis)

2) axilla (mitral regurgitation)

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20
Q

describe the grading of murmurs?

A

1) very quiet
2) quiet
3) Loud
4) loud with a thrill
5) very loud with a thrill
6) loud = audible without a stethoscope

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21
Q

when are right sided murmurs louder?

A

louder with inspriation

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22
Q

what could aortic stenosis cause to heart sounds?

A

2nd sound splitting

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23
Q

what sound could also be heard in aortic regurgitation?

A

= 3rd sound

24
Q

what is an innocent (functional) murmur?

A

= soft (less than 3/6severity)
= position dependent
- often early systolic

25
Q

what are diastolic murmurs always?

A

always pathological

26
Q

what are 3 types of valvular heart disease?

A

1) valve stenosis
2) valve regurgitation
3) mixed valve disease

27
Q

what is valve stenosis?

A

= valves which don’t open properly

28
Q

what is valve regurgitation?

A

= valves which don’t close properly

29
Q

what is mixed valve disease?

A

= valves which neither open properly nor close properly

30
Q

what would you find in the history and physical examination in a patient with valvular disease?

A

History
= restriction & functional capacity

Physical examination
= murmurs & signs of heart failure

31
Q

what investigations should be done if you suspect valvular heart disease?

A

1) non-invasive
= echo

2) invasve
= catheter cauterisation

32
Q

what are 3 characteristics of AORTIC STENOSIS?

A

= degenerative (age related)

= congenital (e.g. bicuspid valve)

= rheumatic

33
Q

what are symptoms of AORTIC STENOSIS?

A

1) breathlessness
2) chest pain
3) dizziness/syncope
ON EXERTION

34
Q

what are signs of AORTIC STENOSIS?

A

1) low volume pulse
2) forceful displaced apex
3) ejection systolic murmur that can radiate to carotids

35
Q

what 3 things can you do to treat AORTIC STENOSIS?

A

1) conventional valve replacement
2) trans-catheter aortic valve replacement (TAVI)
or
trans-catheter aortic valve insertion (TAVI)
3) balloon aortic valvotomy (BAV)

36
Q

what are the 2 types of prothetic heart valves used in AORTIC STENOSIS?

A

1) mechanical
- lasts longer
- younger patients
- warfarin (patient will need anti-coagulants)

2) bio-prosthetic (tissue valves)
- 10 years lifespan
- older patients
- no warfarin

37
Q

compare aortic valve replacement (AVR) to trans-catheter aortic calc insertion (TAVI) used in AORTIC STENOSIS?

A

AVR

  • preferred
  • long term
  • no contra-indications
  • CABG as well

TAVI

  • co-morbidity
  • previous sternotomy
38
Q

what are 4 causes of MITRAL REGURGITATION?

A

1) leaflets
2) chord rupture (degenerative)
3) papillary muscles rupture
4) annular dilatation

39
Q

what are the causes of leaflets in MITRAL REGURGITATION?

A
  • prolapse
  • rheumatic
  • myxomatous
  • endocarditis
40
Q

what is the cause of chord rupture in MITRAL REGURGITATION?

A
  • prolapse/flail leaflets
41
Q

what is the cause of papillary muscles rupture in MITRAL REGURGITATION?

A

= ischaemic

42
Q

what is the cause of annular dilatation in MITRAL REGURGITATION?

A

= functional

43
Q

what are the symptoms of MITRAL REGURGITATION?

A
  • breathlessness
  • peripheral oedema
  • fatigue
44
Q

what are the signs of MITRAL REGURGITATION?

A
  • displaced apex
  • pan systolic murmur
    = axilla
45
Q

what are the 3 options to treat MITRAL REGURGITATION?

A

1) Medication
- diuretics & heart failure (ACE inhibitors)

2) surgical
- repair = prolapse
- replace = degenerative

3) per-cutaneous
- clips in infancy

46
Q

what is the main cause of MITRAL STENOSIS?

A

= rheumatic is main cause

  • congenital is rare
47
Q

what are the symptoms of MITRAL STENOSIS?

A
  • breathlessness
  • fatigue
  • palpitations (AF)
48
Q

what are the signs of MITRAL STENOSIS?

A
  • malar flush
  • tapping apex beat
  • mid diastolic rumbling diastolic murmur localised to apex
49
Q

how could you treat mitral stenosis?

A

1) medication
= diuretics & treat AF

2) surgery
= valve replacement

3) balloon valvuloplasty
= widens the mitral valve so that blood flows more easily through the heart

50
Q

what are the causes of AORTIC REGURGITATION?

A

1) leaflets

2) annulus

51
Q

what causes leaflets in AORTIC REGURGITATION?

A
  • endocarditis
  • connective tissue diseases
  • rheumatic
52
Q

what causes annulus in AORTIC REGURGITATION?

A
  • marfans

- aortic dissection

53
Q

what are then symptoms of AORTIC REGURGITATION?

A
  • breathlessness
54
Q

what are the signs of AORTIC REGURGITATION?

A
  • collapsing pulse
  • wide pulse pressure
  • displaced apex
  • early diastolic murmur left sternal edge
55
Q

how would you treat AORTIC REGURGITATION?

A

1) medication
= ACE inhibitors

2) surgery
= symptoms and LV dilatation
= valve replacement

Cardiovascular (Annie) (36 decks)

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