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Year 3 Cardiovascular core conditions > Valvular heart disease (mitral stenosis, regurg, prolapse. // Aortic stenosis, regurg) > Flashcards

Valvular heart disease (mitral stenosis, regurg, prolapse. // Aortic stenosis, regurg) Flashcards

1
Q

What are the causes of mitral stenosis?

A
  • Rheumatic fever
  • congenital
  • endocardial fibroelastosis
  • prosthetic valve
  • malignant carcinoid
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2
Q

How does mitral stenosis present?

A

The normal mitral valve orifice is 4-6cm2, when this becomes less than 2cm2 symptoms:

  • SOB
  • fatigue
  • palpitations
  • chest pain
  • systemic emboli
  • haemoptysis
  • chronic bronchitis like picture (daily productive cough)
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3
Q

What are the examination signs of mitral stenosis?

A
  • malar flush (due to decreased cardiac output)
  • low volume pulse
  • AFib

Ascultation:

  • loud S1
  • opening snap
  • rumbling mid diastolic murmur (heard best in expiration with patient on left side)
  • graham steell murmur may occur
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4
Q

What is the classical murmur heard in mitral stenosis?

A

-rumbling mid diastolic murmur (heard best in expiration with patient on left side)

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5
Q

What is the cause of a rumbling mid diastolic murmur>?

A

mitral stenosis

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6
Q

What murmur is best heard in expiration with the patient rolled onto their left side

A

mitral stenosis - rumbling mid diastolic murmur

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7
Q

What tests are done for mitral stenosis?

A

1) ECG
- AFib
- P-mitrale if sinus rhythm
- Right ventricular hypertrophy

2) CXR
- left atrial enlargement
- pulmonary oedema
- miitral valve calcification

3) Echocardiography is diagnostic

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8
Q

P-mitrale is seen (if sinus rhythm) on an ECG - what is it and what valve disease does it signify?

A
  • P-mitrale is a bifid P wave, it shows left atrial enlargement.

(seen in mitral stenosis / regurg, aortic stenosis)

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9
Q

What is seen on the CXR of mitral stenosis?

A
  • left atrial enlargement
  • pulmonary oedema
  • mitral valve calcification
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10
Q

What are the indications for cardiac catheterisation?

A
  • previous valvotomy
  • other valve disease
  • angina
  • severe pulmonary hypertension
  • calcified mitral valve
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11
Q

How is mitral stenosis managed?

A
  • Afib - control rate
  • Anticoagulate with warfarin
  • Diuretics to decrease pre load / pulmonary congestion
  • balloon valvuloplasty
  • mitral valve replacement
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12
Q

When abx is used as prophylaxis for rheumatic fever?

A

oral penicillin

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13
Q

What are the complications of mitral stenosis?

A
  • Emboli
  • pulmonary hypertension
  • pressure from left atrium on local structures (e.g. recurrent laryngeal nerve - hoarseness, dysphagia, bronchial obstruction)
  • infective endocarditis
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14
Q

How can hoarse voice be related to mitral stenosis?

A
  • Left atrium enlargement from mitral stenosis can put pressure on the recurrent laryngeal nerve —-> hoarsness.
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15
Q

What are the causes of mitral regurgitation?

A
  • LV dilatation
  • mitral annular calcification
  • rheumatic fever
  • infective endocarditis
  • mitral valve prolapse
  • ruptured chordae tendinae
  • papillary muscle dysfunction/rupture
  • connective tissue (Ehlers-Danlos / Marfan’s)
  • cardiomyopathy
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16
Q

What are the symptoms of mitral regurgitation?

A
  • SOB
  • fatigue
  • palpitations
  • infective endocarditis
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17
Q

What are the signs of mitral regurg?

A
  • Afib
  • displace apex
  • RV heave
  • soft S1

PANSYSTOLIC MURMUR at apex radiating to axilla

18
Q

What murmur identifies mitral regurg?

A

Pansystolic murmur at the apex radiating to axilla

19
Q

” pansystolic murmur at the apex radiating to axilla” is classical of what valvular disease?

A
  • Mitral regurgitation has a pansystolic murmur at the apex radiating to the axilla
20
Q

What tests are done for mitral regurg?

A

1) ECG
- AF
- P-mitrale (sign of increased LA size)
- left ventricle hypertrophy

2) CXR:
- enlarged LA / LV
- mitral valve calcification
- pulmonary oedema

3) Echo
4) Cardiac catheterization to confirm mitral regurg and exclude other valve / artery disease.

21
Q

What is the treatment for mitral regurg?

A

-control AF
- anticoagulate (if AF / emboli history)
- prosthetic valve
- diuretics
-

22
Q

mitral valve prolapse is the most common valve abnormality, it can occur on its own or with other conditions. What conditions are these?

A
  • Patent ductus arteriosus
  • turner’s syndrome
  • marfan’s
23
Q

What are the symptoms of mitral valve prolapse?

A
  • asymptomatic OR
  • atypical chest pain
  • palpitations
24
Q

What are the signs of mitral valve prolapse?

A

Mid systolic click and/or late systolic murmur

25
Q

what valve condition has a Mid systolic click and/or late systolic murmur ?

A

mitral valve prolapse has mid-systolic click and/or late systolic murmur.

26
Q

What are the complications of mitral valve prolapse?

A
  • mitral regurg
  • emboli
  • arrhythmias
  • sudden death
27
Q

What drug can help palpitations and chest pain in mitral valve prolapse>

A

beta blockers

28
Q

What is the cause of aortic stenosis?

A
  • calcification due to age

congenital:

  • bicuspid valve
  • williams syndrome

-rheumatic heart disease

29
Q

An elderly person presents with chest pain, exertional SOB, or syncope - which valve condition comes to mind first?

A
  • Aortic Stenosis
30
Q

What are the symptoms / presentation of Aortic stenosis?

A

Over 60 with the classic triad of:

  • angina
  • syncope
  • heart failure
  • SOB
  • dizziness
  • faints
  • systemic emboli (infective endocarditis)
  • sudden death
31
Q

A slow rising pulse with narrowed pulse pressure is a sign of what valve disease?

A

Aortic stenosis has a slow rising pulse with narrowed pulse pressure

32
Q

What are the signs of aortic stenosis?

A
  • slow rising pulse with narrowed pulse pressure
  • heaving
  • non displaced apex beat
  • LV heave
  • aortic thrill
  • ejection systolic murmur (heard at base, left sternal edge and aortic area - radiates to carotids)
  • ejection click
33
Q

What murmur is heard with aortic stenosis?

A

Ejection sysolic murmur

heard at the base, left sternal edge and aortic edge - radiates to carotids

34
Q

what valve condition has an ejection click?

A

Aortic stenosis (ejection click)

Mitral stenosis (mid systolic click)

35
Q

What tests are done for aortic stenosis?

A

1) ECG
- P-mitrale
- LVH

2) CXR
- LVH
- calcified aortic valve
- dilation of ascending aorta

3) ECHO is diagnostic
4) cardiac catheter

36
Q

What is the management of aortic stenosis?

A

surgery (valve replacement)

37
Q

What are the causes of aortic regurg?

A
  • infective endocarditis
  • marfans
  • ehler’s - danlos
  • SLE
  • rheumatic fever
38
Q

What are the symptoms of aortic regurg?

A
  • Exertional SOB
  • Orthopnoea
  • paroxysmal nocturnal dysnopnoea
  • palpitations
  • angina
  • syncope
  • CCF
39
Q

Collapsing water hammer pulse is a sign of what valve disease?

A

aortic regurgitation

40
Q

What is a high pitched early diastolic murmur a sign of?

A

aortic regurgitation

41
Q

what are the classical signs of aortic regurgitation?

A
  • collapsing water hammer pulse

- high pitched early diastolic murmur

Year 3 Cardiovascular core conditions (10 decks)

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