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Medicine, Year 3, Cardiovascular and Respiratory Medicine > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What is the name given to the assessment tool used to predict Infective Endocarditis?

A

Duke’s Criteria

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2
Q

What are the Major and Minor criteria for Duke’s to diagnose Infective Endocarditis?

A

Major criteria:

  • 2 positive blood cultures for infectious agents causing Infective Endocarditis
  • Echocardiographic evidence of endocardial involvement

Minor criteria:

  • Predisposition i.e. heart conditions, IVDU
  • Fever >38 degrees
  • Vascular phenomena i.e. Janeway lesions
  • Immunological phenoma i.e. Roth spots, Osler nodes, Glomerulonephritis
  • Positive culture not meeting Major criteria
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3
Q

What criteria for Dukes must be satisfied for a Definite Diagnosis of Infective Endocarditis?

A
  • 2 major criteria
  • 1 major + 3 minor
  • 5 minor
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4
Q

What criteria for Dukes must be satisfied for a Possible Diagnosis of Infective Endocarditis?

A
  • 1 major + 1 minor

- 3 minor

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5
Q

What antibiotic prophylaxis is given to dental patients at risk of developing Infective Endocarditis?

A

None is recommended by NICE, unless they already have an existing infection

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6
Q

INFECTIVE ENDOCARDITIS

  1. What valve is most commonly affected?
  2. What valve is affected in IVDUs?
  3. What is the most common cause of IE?
  4. What is the most common cause in the developing world?
  5. Which organism is from indwelling lines?
  6. Which organism is found in the oral cavity?
  7. Which organism is associated with colorectal cancer?
  8. Which organism is associated with animals?
A
  1. Mitral valve
  2. Tricuspid valve
  3. Staph aureus (Gram positive)
  4. Strep viridian
  5. Staph epidermidis
  6. Strep viridians
  7. Strep bovis
  8. Coxiella burnetti
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7
Q

What might be seen in urinalysis in patients with Infective Endocarditis?

A

Septic emboli i.e. RBC / WBC casts

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8
Q

Discuss the significance of Staph aureus with respect to Infective Endocarditis. Where is it found? What is it associated with?

A

Staph aureus is the most common cause of Infective Endocarditis in the developed world. Is found on skin flora and is associated with IVDU. Commonly involves the tricuspid valve / right side of the heart

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9
Q

Discuss the significance of Viridians Streptococci with respect to Infective Endocarditis. Where is it found?

A

Viridians Streptoccoci commonly causes Infective Endocarditis in the developing world. Is found in the mouth and is associated with poor dental hygiene

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10
Q

Discuss the significance of Staph Epidermidis with respect to Infective Endocarditis

A

Commonly associated with patients who have prosthetic valves

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11
Q

Discuss the significance of Coxiella Burnetii with respect to Infective Endocarditis

A

Commonly obtained from infected animals

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12
Q

What are the HACEK organisms which can cause Infective Endocarditis?

A
  • Haemophilus
  • Actinobacilli
  • Cardiobacterium
  • Eikenella
  • Kingella
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13
Q

Where are Janeway lesions and Osler’s nodes found? Which are painful?

A

Janeway: Palms / soles of hands / feet (Painless)

Osler’s: Distal fingers (Painful)

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14
Q

What is the name given to non-infectious endocarditis? What condition is it associated with?

A

Libman-Sacks Endocarditis

Associated with SLE

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15
Q

What is the most common type of Valvular heart disease? What is the second most common?

A 
Aortic stenosis (most common)
Mitral regurgitation (2nd most common)
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16
Q

What are the two valves on the left hand side of the heart?

A

Aortic valve

Mitral valve

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17
Q

What are the positions to auscultate the Aortic, Pulmonary, Tricuspid and Mitral valves?

A

Aortic - R 2nd intercostal, parasternal
Pulmonary - L 2nd intercostal, parasternal
Tricuspid - L 4th intercostal, parasternal
Mitral - L 5th intercostal, mid-clavicular

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18
Q

Which of the heart valves are trileafleted and bileafleted?

A

Aortic, Pulmonary, Tricuspid - trileafleted

Mitral - bileafleted

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19
Q

State four examples of mid-systolic murmurs

A

Aortic stenosis
Pulmonic stenosis
HOCM
ASD

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20
Q

State three examples of pan-systolic murmurs

A

Mitral regurgitation
Tricuspid regurgitation
VSD

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21
Q

State one example of late-systolic murmurs

A

Mitral valve prolapse

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22
Q

State three examples of early diastolic murmurs

A

Aortic regurgitation
Pulmonic regutation
Austin flint

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23
Q

State two examples of mid/late-diastolic murmurs

A

Mitral stenosis

Tricuspid stenosis

24
Q

What sort of murmur does a Patent Ductus Arteriosis (PDA) give?

A

Systolic murmur

25
Q

What are some causes of Aortic Stenosis? 5 examples

A
  • Age related degenerative stenosis (6th/7th decade)
  • Congenital bicuspid valve (5th decade)
  • Rheumatic aortic valve disease
  • William’s syndrome (Supravalvular stenosis)
  • Rare: Paget’s disease, SLE, hyperparathyroidism
26
Q

In rheumatic aortic valve disease causing aortic stenosis, what other finding might be present?

A

The mitral valve almost always has stenosis as well

27
Q

On examination what findings might be present in patients with Aortic Stenosis, for example:

On auscultation?
On carotid pulse?
Heaves / thrills?

A

On auscultation: A right-sided, second intercostal space ejection (crescendo-decrescendo) systolic murmur, with radiation to the carotids, louder on expiration. A soft S2 sound may be heard as well as S4

On carotid pulses: Slow rising with low volume, with narrow pulse pressure

Left ventricular heave and a thrill may be present

28
Q

What are the three main symptoms in patients with Aortic Stenosis?

A
  • Exertional angina
  • Exertional syncope / dizziness
  • Exertional dyspnoea
29
Q

For asymptomatic patients with Aortic Stenosis, what is the treatment?

A

Observe the patient as a general rule, unless they have a valvular gradient > 40mmHg then consider surgery

30
Q

For symptomatic patients with Aortic Stenosis, what is the treatment?

A

Surgery i.e. Mechanical / Biological valves or if not fit for surgery then a Balloon Valvuloplasty

31
Q

What are the anticoagulant requirements for Mechanical and Biological valves for valve replacement?

A

Mechanical - lifelong anti-coagulation

Biological - anti-coagulation for first 3 months

32
Q

Explain the RILE mnemonic

A

Right sided murmurs are Louder on Inspiration (Pulmonary / Tricuspid)
Left sided murmurs are Louder on Expiration (Aortic / Mitral)

33
Q

The Austin Flint murmur is a diastolic murmur associated with?

A

Severe aortic regurgitation

34
Q

What are some causes of Aortic Regurgitation?

A
  • Disease of Aortic Root: Aneurysm / Dissection
  • Connective tissue Disease: Marfan’s, Ehlers-Danlos, Osteogenesis Imperfecta
  • Inflammatory Disease: Rheumatoid Arthritis, Ankylosing Spondylitis, Infective Endocarditis, Rheumatic Fever
35
Q

On examination what findings might be present in patients with Aortic Regurgitation, for example:

On auscultation?
On carotid pulse?
Heaves / thrills?

A

On auscultation: A right-sided, second intercostal space decrescendo diasystolic murmur. A soft S2 sound may be heard

On carotid pulses: Collapsing, with wide pulse pressure

Heaves and a thrill may be present

36
Q

Aortic Stenosis / Regurgitation sounds louder on…?

A

Expiration

37
Q

What is the collapsing pulse in Aortic Regurgitation called?

A

Corrigan’s Pulse

38
Q

What is De Musset’s sign? What condition is it associated with?

A

Head bobbing with pulse, associated with Aortic Regurgitation

39
Q

What is Corrigan’s pulse? What condition is it associated with?

A

Collapsing pulse, associated with Aortic Regurgitation

40
Q

What is Quincke’s sign? What condition is it associated with?

A

Pulsating nail bed capillaries, associated with Aortic Regurgitation

41
Q

What is Muller’s sign? What condition is it associated with?

A

Pulsating Uvulva, associated with Aortic Regurgitation

42
Q

What is the size of a normal Aortic valve orifice? How stenosed must it be, to become symptomatic?

A

3-4cm sq initially

<1.5cm sq - symptomatic

43
Q

What is the size of a normal Mitral valve orifice? How stenosed must it be, to become symptomatic?

A

4-5cm sq initially

<2cm sq - symptomatic

44
Q

What are some risk factors to Mitral stenosis?

A

Rheumatic fever, congenital valve defects, mitral valve calcification, infective endocarditis

45
Q

What is the facial symptom experienced in patients with Mitral Stenosis?

A

Malar flush

46
Q

What condition is also concurrent in patients with Mitral Stenosis?

A

Atrial fibrillation

47
Q

What does a Mitral Stenosis murmur sound like on auscultation?

A

A mid-diastolic murmur, heard loudest in the 5th intercostal space mid-clavicular line on expiration. No radiation. A loud opening snap (S1) may also be heard

48
Q

What ECG findings may be present in patients with Mitral Stenosis / Regurgitation?

A

P wave Mitrale (Upright p waves in Lead 1, and bifid M-shaped P waves in Lead 2)
Atrial fibrillation

49
Q

Why is Mitral Stenosis quite rare in developed countries?

A

Due to it commonly being caused by rheumatic fever, which is rare in developed countries

50
Q

Mitral Regurgitation has both primary and secondary causes. What are they?

A

Primary: Disease affecting mitral valve / chordae tendinae / papillary muscles i.e. Rheumatic fever, IE, Mitral valve prolapse

Secondary:

1) Due to LV dilatation stretching the mitral valve / chordae tendinae / papillary muscles
2) Due to myocardial ischaemia causing papillary muscle dysfunction

51
Q

What does a Mitral Regurgitation murmur sound like on auscultation?

A

Pansystolic murmur, sounding loudest in the 5th intercostal space mid-clavicular line, with radiation to the axilla. Heard loudest on expiration, and has a soft first heart sound (S1). There is also a laterally displaced apex beat

52
Q

What does an Echocardiogram show in patients with Mitral Stenosis / Regurgitation?

A

Left atrial dilatation for Stenosis / Regurg

In Stenosis also: Reduced mitral valve orifice

53
Q

Malar flush is associated with which murmur?

A

Mitral stenosis

54
Q

PROSTHETIC VALVES

  1. Patients who have had a valve replacement may have what scars?
  2. What are the two broad types of valves?
  3. What is the lifespan of each?
  4. What valve requires anticoagulation?
  5. What are the different types of mechanical valves?
  6. Of the mechanical valves, which has the highest and lowest risk of thrombus formation?
  7. What are 3 complications of mechanical valves?
  8. A “click” in S1 and S2 corresponds to what type of heart valve?
  9. When is a TAVI indicated?
  10. Outline the procedure of a TAVI
  11. What is the pros and cons of a TAVI
A
  1. Midline sternotomy (aortic or mitral valve replacement), or a right-sided mini thoracotomy (mitral valve)
  2. Bioprosthetic vs. Mechanical
  3. Bioprosthetic = 10 years, Mechanical = 20 years
  4. Mechanical valves
  5. Starr-Edwards, Tilting disc, St. Judes
  6. Starr-Edwards = highest, St. Judes = lowest
  7. Thrombus formation, Infective endocarditis, Haemolysis
  8. S1 = mitral valve replacement, S2= aortic valve replacement
  9. For patients with severe aortic stenosis who will not survive open surgery
  10. Catheter into femoral artery, fed by a guide wire under X-ray guidance, followed by balloon inflation to stretch the stenosed aortic valve and bioprosthetic valve insertion
  11. Pros = no anticoagulation required. Cons = Long term outcomes still unclear
55
Q

MURMURS

  1. What does S1 represent?
  2. What does S2 represent?
  3. What does S3 represent? Is it normal?
  4. What does S4 represent? Is it normal?
  5. What valves are on the LHS?
  6. What valves are on the RHS?
  7. What are the grades of murmurs?
A
  1. S1 is the closure of the atrioventricular valves (Tricuspid and Mitral)
  2. S2 is the closure of the semilunar valves (Pulmonary and Aortic)
  3. S3 represents rapid ventricular filling. It is normal in young adults, abnormal in older people ?heart failure
  4. S4 represents a stiff hypertrophic ventricle. ALWAYS abnormal
  5. LHS = Aortic and Mitral
  6. RHS = Tricuspid and Pulmonary
  7. Grade 1: Difficult to hear
    Grade 2: Quiet
    Grade 3: Easy to hear
    Grade 4: Easy to hear with a palpable thrill
    Grade 5: Can hear with stethoscope barely touching chest
    Grade 6: Can hear with stethoscope off the chest

Medicine, Year 3, Cardiovascular and Respiratory Medicine (19 decks)

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