Valvular Heart Disease

Question 1

what is chest pain in valvular disease like?

Answer 1

heavy, squeezing and crushing

Question 2

what is breathlessness in valvular disease usually related to?

Answer 2

increased activity

may come on at rest in very severe cases

Question 3

what is a common side effect of stenosed vessels?

Answer 3

collapse

Question 4

what non-invasive investigation can be done for valvular disease?

Answer 4

ECHO

Question 5

what invasive investigation can be done for valvular disease?

Answer 5

cardiac catheterisation

Question 6

what classification is used to express how much someones breathlessness due to cardiac disease affects their lives?

Answer 6

the new york heart association functional classification

Question 7

name three signs of right heart failure

Answer 7

raised JVP
pitting oedema
hepatic congestion

Question 8

what does a raised JVP suggest?

Answer 8

fluid overload associated with heart failure

Question 9

what two locations may pitting oedema be found in?

Answer 9

ankles

sacrum

Question 10

where is the apex beat normally found?

Answer 10

in the 5th ICS, midclavicular line

Question 11

what happens to the apex beat in mitral stenosis?

Answer 11

it creates a tapping beat

Question 12

what causes a displaced and diffuse apex beat?

Answer 12

LV dilation due to volume overload

Question 13

what causes a heaving and displaced apex beat?

Answer 13

LV hypertrophy due to pressure overload

Question 14

where is the hand placed to feel for a parasternal heave?

Answer 14

left of the sternum

Question 15

what does the presence of a parasternal heave suggest?

Answer 15

RV overload

may be due to cor pulmonale, pulmonary hypertension or a congenital heart disease

Question 16

what is a cardiac murmur?

Answer 16

the audible turbulence of blood flow

Question 17

what causes the first heart sound?

Answer 17

closure of the mitral and tricuspid valves

Question 18

what does S1 mark?

Answer 18

the start of systole

Question 19

what are two systolic murmurs?

Answer 19

aortic stenosis

mitral regurgitation

Question 20

what causes the second heart sound?

Answer 20

the closure of the aortic and pulmonary valves

Question 21

what does S2 start?

Answer 21

the end of systole

the start of diastole

Question 22

what are two diastolic murmurs?

Answer 22

aortic regurgitation

mitral stenosis

Question 23

what two types of systolic murmurs are there?

Answer 23

pansystolic

ejection systolic

Question 24

what is a pansystolic murmur?

Answer 24

one loud, continuous sound

Question 25

what is an ejection systolic murmur?

Answer 25

one that gets louder and the quieter again

Question 26

what two types of diastolic murmurs are there?

Answer 26

early diastolic | mid diastolic

Question 27

where does the murmur from aortic stenosis radiate to?

Answer 27

carotids

Question 28

where does the murmur from mitral regurgitation radiate to?

Answer 28

the axilla

Question 29

what are the grades for murmurs and what does each mean?

Answer 29

``` 1 = very quiet 2 = quiet but easy to hear 3 = loud 4 = loud with a thrill 5 = very loud with a thrill 6 = audible without a stethoscope ```

Question 30

which sided murmurs are louder with inspiration?

Answer 30

right sided (mitral)

Question 31

which sided murmurs are louder with expiration?

Answer 31

left sided (aortic)

Question 32

who is an innocent murmur common in?

Answer 32

young, thin patients

Question 33

describe an innocent murmur

Answer 33

soft (less than 3/6) early systolic

Question 34

what type of murmur is always pathological?

Answer 34

diastolic

Question 35

what is stenosis of valves?

Answer 35

when valves do not open properly

Question 36

what valve regurgitation?

Answer 36

when valves do not close properly

Question 37

what occurs in mixed valve disease?

Answer 37

valves that do not open or close properly

Question 38

name three causes of aortic stenosis

Answer 38

degenerative congenital bicuspid aortic valve rheumatic fever

Question 39

what is a bicuspid aortic valve?

Answer 39

when the valve has two cusps instead of three

Question 40

what causes symptoms in aortic stenosis?

Answer 40

not enough blood getting round the body

Question 41

name three symptoms of aortic stenosis

Answer 41

breathlessness chest pain syncope

Question 42

describe the murmur associated with aortic stenosis

Answer 42

ejection systolic murmur that can radiate to the carotids

Question 43

name two signs associated with aortic stenosis

Answer 43

low volume pulse forceful displaced apex

Question 44

name three possible treatments for aortic stenosis

Answer 44

valve replacement (most common) TAVI balloon aortic valvotomy (BAV)

Question 45

what is a TAVI?

Answer 45

trans catheter aortic valve replacement

Question 46

what are the two types of prosthetic valve?

Answer 46

mechanical | bio-prosthetic

Question 47

which type of prosthetic valve needs to be changed every 10 years?

Answer 47

bio-prosthetic

Question 48

which type of valve will result in life long warfarin treatment for the patient?

Answer 48

mechanical

Question 49

what is AVR?

Answer 49

aortic valve replacement

Question 50

name four causes of mitral regurgitation

Answer 50

problems with valve leaflets chordae rupture papillary muscle rupture annular dilation

Question 51

what can cause problems with leaflets that can lead to mitral regurgitation?

Answer 51

prolapse rheumatic fever endocarditis

Question 52

what may cause chordae rupture?

Answer 52

ischaemia | degeneration

Question 53

name three symptoms of mitral regurgitation

Answer 53

breathlessness peripheral oedema fatigue

Question 54

describe the murmur associated with mitral regurgitation

Answer 54

pansystolic murmur that radiates to the axilla

Question 55

name three things involved in treatment of mitral regurgitation

Answer 55

diuretics + ACEI surgical repair surgical replacement

Question 56

what treatment is done if mitral regurgitation occurs in infancy?

Answer 56

clips

Question 57

what is the main cause of mitral stenosis?

Answer 57

rheumatic fever

Question 58

name three symptoms of mitral stenosis

Answer 58

breathlessness fatigue palpitations (AF)

Question 59

name two signs associated with mitral stenosis

Answer 59

malar flush | tapping apex beat

Question 60

describe the murmur associated with mitral stenosis

Answer 60

mid diastolic rumbling murmur localised to the apex

Question 61

what three things can be done to treat mitral stenosis

Answer 61

diuretics valve replacement balloon valvuloplasty

Question 62

name a symptom of aortic regurgitation

Answer 62

breathlessness

Question 63

name three signs of aortic regurgitation

Answer 63

collapsing pulse wide pulse pressure displaced apex

Question 64

describe the murmur associated with aortic regurgitation

Answer 64

early diastolic murmur at the left sternal edge

Question 65

outline treatment for aortic regurgitation

Answer 65

ACEI | valve replacement