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CVS > Valvular Heart Disease + Murmurs > Flashcards

Valvular Heart Disease + Murmurs Flashcards

1
Q

What makes the S1 heart sound?

A
  • closing of the atrioventricular valves
  • at the start of systolic contraction of ventricles
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2
Q

What makes the S2 heart sound?

A

Closing of the semilunar valves
Once systolic contraction is complete

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3
Q

When is the S3 heart sound heard?

A

0.1s after S2 if present

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4
Q

When is the S4 heart sound heart?
What does it indicate?

A

Directly before S1
Stiff/hypertrophic ventricle > turbulent flow

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5
Q

Where is the best place to listen to the heart sounds?

A

Erb’s point
3rd ICS left sternal border

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6
Q

Where is Erb’s point?

A

3rd ICS left sternal border

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7
Q

What position can you put a patient in to listen to mitral stenosis clearer?

A

Turn the patient onto their left hand side

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8
Q

What position can you put the patient in to help you heard aortic regurgitation?

A

Sit up
Lean forward
Breathe out + hold

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9
Q

What features of a murmur do you need to assess?

A

SCRIPT
- Site
- Character
- Radiation
- Intensity
- Pitch - indicates velocity
- Timing - systolic or diastolic

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10
Q

What murmurs can radiate and where?

A
  • aortic stenosis > carotids
  • mitral regurgitation > axilla
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11
Q

How do you grade murmurs?

A
  • grade 1: difficult to hear
  • grade 2: quiet
  • grade 3: easy to hear
  • grade 4: easy to hear with palpable thrill
  • grade 5: hear with stethoscope barely touching chest
  • grade 6: can hear with stethoscope off chest
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12
Q

What is atrial stenosis caused by?

A
  • idiopathic age related calcification (most common)
  • bicuspid aortic valve
  • chronic kidney disease
  • rheumatic heart disease
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13
Q

Describe an aortic stenosis murmur

A
  • ejection-systolic high pitched murmur
  • crescendo-decrescendo character
  • radiates to the carotids
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14
Q

Signs of aortic stenosis

A
  • ejection systolic high pitched murmur
  • crescendo-decrescendo
  • radiates to carotids
  • thrill on palpation
  • slow rising pulse
  • narrow pulse pressure
  • exertional syncope
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15
Q

Three classical symptoms of aortic stenosis

A

Angina
Heart failure
Syncope

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16
Q

What can aortic stenosis cause?

A
  • microangiopathic haemolytic anaemia
  • LV hypertrophy
  • left sided heart failure > angina + syncope
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17
Q

Indications for surgery in an aortic stenosis patient

A
  • symptoms caused by AS (regardless of severity)
  • asymptomatic severe AS with LVSD
  • asymptomatic severe AS with abnormal exercise test
  • asymptomatic severe AS at time of other cardiac surgery
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18
Q

What causes aortic regurgitation?

A
  • idiopathic age related weakness
  • bicuspid aortic valve
  • connective tissue disorders e.g. Marfan’s syndrome, Ehlers-Danilo’s syndrome
  • rheumatic disease
  • infective endocarditis
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19
Q

Describe an aortic regurgitation murmur

A
  • early diastolic soft murmur
  • can cause an Austin-Flint murmur - heart attack apex as diastolic rumbling due to blood regurgitating + causing mitral valve to vibrate
  • may be better heard if you ask patient to sit up, lean forwards, breathe in + hold
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20
Q

What are the signs of aortic regurgitation?

A
  • early diastolic soft murmur
  • rumbling murmur in apex
  • thrill on palpation
  • collapsing pulse
  • wide pulse pressure
  • heart failure + pulmonary oedema
  • De Musset’s sign (head bobbing)
21
Q

What are the indications for surgery in aortic regurgitation patients?

A
  • symptomatic severe AR
  • asymptomatic severe AR with early LVSD
  • asymptomatic AR of any severity with aortic root dilation
22
Q

What position can you put the patient in to heard aortic regurgitation better?

A

Sit up
Lean forward
Breathe in + hold

23
Q

What causes mitral stenosis?

A
  • rheumatic heart disease
  • infective endocarditis
24
Q

Describe the murmur in mitral stenosis

A
  • mid diastolic low pitched rumbling
  • snap as valve opens followed by diastolic rumble
  • better heard if you turn patient to their left side
25
Q

How can you position the patient to better heard mitral stenosis

A

Turn them to their left side

26
Q

Signs of mitral stenosis

A
  • mid diastolic low pitched rumbling
  • tapping apex beat
  • malar flush
  • AF
27
Q

What causes mitral regurgitation?

A
  • idiopathic weakening of the valves with age
  • ischaemic heart disease
  • infective endocarditis
  • rheumatic heart disease
  • connective tissue disorders e.g. Ehlers-Danlos syndrome, Marfan syndrome
28
Q

Describe the murmur is mitral regurgitation

A
  • pansystolic, high pitched whistling
  • radiates to left axilla
29
Q

Signs of mitral regurgitation

A
  • pansystolic high pitched whistling murmur
  • Thrill in mitral area on palpation
  • heart failure signs + pulmonary oedema
  • AF
30
Q

Indications for surgery in mitral regurgitation patients

A
  • symptomatic MR
  • asymptomatic MR with mild-moderate LV dysfunction
31
Q

Pharmacological therapy of mitral regurgitation

A
  • diuretics
  • if LVSD is present, treatment with ACEi + B blockers + CRT have reduced severity of MR
32
Q

What does mitral regurgitation cause?

A
  • LV hypertrophy
  • reduced EF > congestive heart failure
33
Q

What is used in assessment + investigations of valvular disease?

A

Echocardiogram
Can assess severity + impact on rest of the heart e.g. LV function

34
Q

What can mitral stenosis cause?

A
  • increased LA pressure > LA dilation:
    • AF > thrombus fomration
    • oesophagus compression > dysphagia
  • increased LA pressure > pulmonary oedema + hypertension > RV hypertrophy
35
Q

What does a collapsing pulse indicate?

A

Aortic regurgitation
Blood flows back into heart as you lift arm up

36
Q

What does a pansystolic murmur indicate?

A

Mitral regurgitation

37
Q

What does an ejection systolic high pitched murmur indicate?

A

Aortic stenosis

38
Q

What does an early diastolic soft murmur indicate?

A

Aortic regurgitation

39
Q

What does a snap followed by a mid diastolic low pitched rumbling murmur indicate?

A

Mitral stenosis

40
Q

Risk factors of infective endocarditis

A
  • IV drug users
  • valvular heart disease
  • prosthetic heart valves
  • congential heart disease
  • implantable cardiac devices e.g. pacemaker
  • poor dental hygiene
  • immunocompromised
  • chronic kidney disease
41
Q

What microorganisms cause infective endocarditis?

A
  • staphylococcus aureus (most common)
  • streptococcus
  • enterococcus
42
Q

Key examination findings in infective endocarditis

A
  • new or changing heart murmur
  • petechiae
  • Janeway lesions
  • Osler’s nodes
  • splinter haemorrhages
  • Roth spots
  • splenomegaly
  • clubbing
43
Q

What are Roth spots?

A

Haemorrhages on retina seen in fundoscopy
Sign of infective endocarditis

44
Q

Investigations of infective endocarditis

A
  • 3 blood cultures at least 6 hours apart + taken from different sites
  • transoesophageal echocardiogram
  • CXR
  • ECG
  • FBCs, U&Es + LFTs
45
Q

What criteria is used to diagnose infective endocarditis?

A

Modified Duke Criteria

46
Q

What is the Modified Duke Criteria?
What is it used to diagnose

A

Infective endocarditis
- one major + there minor criteria OR five minor criteria needed to diagnose
.
Major:
- persistently positive blood cultures
- specific imaging findings e.g. vegetation found on echo
.
Minor:
- Predispotion
- fever over 38 degrees
- vascular phenomena e.g. Janeway lesions, splenic infarction
- immunological phenomena e.g. Osler’s nodes, Roth spots
- microbiological phenomena

47
Q

Management of infective endocarditis

A
  • IV broad spectrum antibiotics e.g. amoxicillin
  • more specific antibiotic once causative organism identified
  • antibiotics continued for 4 weeks or 6 weeks if prosthetic heart valves
  • surgery
48
Q

When might surgery be required in infective endocarditis?

A
  • heart failure relating to valve pathology
  • large vegetations or abscesses
  • infections not responding to antibiotics
  • relapse after optimal medical therapy
  • valve obstruction
49
Q

Complications of infective endocarditis

A
  • heart valve damage > regurgitation
  • heart failure
  • infection + non infective emboli > abscesses, strokes, splenic infarction
  • glomerulonephritis > renal impairment

CVS (20 decks)

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