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Hugh's MD2 Intersession 2 > Valvular Heart Disease (core) > Flashcards

Valvular Heart Disease (core) Flashcards

1
Q

What is a TAVI?

A

Transcathetic aortic valve implant

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1
Q

How does auscultation of AS change with increasing severity of the disease?

A

The more severe, the more widely it’s heard on the precordium

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1
Q

When is the valve replaced in AS?

A

Severe AS on echo + Symptoms

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3
Q

What types of hypersensitivity mediates rheumatic fever?

A

Type II

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4
Q

What causes MR?

A

Myxomatous degeneration (mitral valve prolapse)

Ruptured chordae tendinae

Infective endocarditis

MI - ruptured papillary muscle

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5
Q

When do you operate in AR?

A

Once the LV starts to increase in size (on echo)

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5
Q

What are some signs of MS?

A

Mitral facies

Tapping apex beat

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6
Q

How is rheumatic fever managed long term?

A

Long term antibiotic prophylaxis

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7
Q

Describe the murmur in MR?

A

Pansystolic

Rumbling

Mostly heard at the apex (occasionally at the base too)

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8
Q

What are the pros and cons of bioprosthetic valve?

A

Pros: Don’t need anticoagulants

Cons: Shorter life (10-15years)

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9
Q

What is a TOE best for?

A

Mitral valve

Thombus in the LV

Endocarditis on valves or pacemaker leads

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11
Q

What has happened to the LV at onset of symptoms in regurg?

A

Irreversibly damaged

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12
Q

How does the LV compensate for regurgitation? What happens at decompensation?

A

Increases EDV while ESV remains the same = an increase in SV and EF

Pump failure: EDV further increases

ESV increases

EF decreases

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13
Q

What causes aortic regurg?

A

Aortic leaflet damage - endocarditis, rheumatic fever

Aortic root dilated - Marfan’s syndrome, aortic dissection, syphilus

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14
Q

How does the LV change in AS?

A

Concentric hypertrophy

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16
Q

What are the pros and cons of mechanical valves?

A

Pros: they last forever

Cons: require anticoagulation with warfarin (INR 2-3)

17
Q

How do you decide which type of valve to use?

A

Age

>70 - Bioprosthetic

18
Q

What are some peripheral signs of AS?

A

Slow upstroke of carotid pulse

Heaving apex beat

Thrill over upper R sternal edge

19
Q

What causes TR?

A

RVF - due to pulmonary hypertension

Endocarditis

Pacemaker leads

20
Q

What are some signs of AR?

A

Collapsing pulse - fast up and down stroke

Wide pulse pressure

Early diastolic murmur

Various other signs

21
Q

What are the symptoms of AS?

A

SOB

Chest pain

Syncope

22
Q

What are the two major types of degenerative valvular disease?

A

Aortic calcification - Aortic stenosis

Mitral prolapse - Mitral regurg

23
Q

Characterise the sound of AS

A

Ejection systolic - crescendo-decrescendo

Best heard at upper R sternal edge with diaphragm

Can also be heard elsewhere on precordium

24
Q

What are some complications of MS?

A

Atrial dilatation and AF

Thrombo-embolism

Pulmonary hypertension

RHF

25
Q

How does infective endocarditis present most commonly?

A

Fever and murmur

26
Q

What are the clinical features of rheumatic fever?

A

Fever

Arthritis - migratory polyarthritis, large joints

Rash - erythema marginatum

Subcutaneous nodules - over bones, tendons

Murmur

Sydenham’s chorea

27
Q

What are the causes of AS?

A

Age related calcification

Congenital - AS, bicuspid

Rheumatic fever

28
Q

How is rheumatic fever diagnosed?

A

By clinical feature only, using the Jone’s criteria

29
Q

What is the major cause of mitral stenosis?

A

Rheumatic fever

30
Q

Describe the murmur in MS?

A

Pan-diasystolic

OS opening snap mitral opening

31
Q

What is the pathophysiology of rheumatic fever?

A

Type II hypersensitivity response occurs 2-3 weeks post strept pyogenes infection - typically pharyngitis or scarlett fever

32
Q

Which valvular pathologies are asymptomatic until the onset of HF?

A

AR

MR

33
Q

What are some common agents of IE?

A

Strep viridans

Strep bovis

Staph aureas

Staph epidermidis

34
Q

How do you treat IE? When do you do surgery?

A

Long term abx via PICC line

If HF or uncontrolled infection

35
Q

What blood/urine results might you get with IE?

A

Anaemia

Leukocytosis

Elevated ESR or CRP

Microhaematuria

Hugh's MD2 Intersession 2 (14 decks)

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