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MRCS A > CARDIOLOGY - Valvular Heart Disease and Bacterial Endocarditis > Flashcards

CARDIOLOGY - Valvular Heart Disease and Bacterial Endocarditis Flashcards

1
Q

Short term consequence of valvular inflammation

A

Collagen exposure
Thrombus development

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2
Q

Long term consequence of valvular inflammation

A

Post inflamm scarring

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3
Q

Which side valves are more commonly affected?

A

L

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4
Q

What is the most common cause of valve scarring

A

rheumatic fever

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5
Q

children who get rheumatic fever? clinical picture

A

inv tonsilitis/pharyngitis caused by GAS
ab GAS cross reacts cardiac antigen –> SL myocarditis/pericarditis
–> progressive fibrosis of valve leaflets + chordae tendinae

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6
Q

What is aortic stenosis is most commonly due to?

A

Calcification of congenital bicuspid aortic valve

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7
Q

Congenital cause pulmonary stenosis

A

Fallot’s tetralogy

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8
Q

Congenital cause mitral stenosis

A

Lutembacher’s syndrome

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9
Q

Congenital causes Tricuspid regurg

A

Ebstein’s anomaly

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10
Q

Ischaemic cause mitral regurg

A

Papillary mm dysfunction post infarction

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11
Q

Conditions causing cardiac remodelling (5)

A

SLE
Marfans
Ehler-Danlos
Syphillis
Ankylosing spondylitis

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12
Q

In what position is a patient postitioned to best hear a mitral valve murmur?

A

LHS

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13
Q

pathophysiology mitral stenosis

A

LA can’t empty –> pulmonary HTN
LA becomes hypertrophied+ dilated
Pulm HTN –> RHF
AF develops b/c mm hypertrophy

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14
Q

Sx Mitral stenosis (5)

A

Dyspnoea
Haemoptysis
Fatigue/weakness
Abdo/L limb oedema
Palps

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15
Q

Signs Mitral stenosis (5)

A

Malar flush
Small vol pulse
JV distension
L parasternal heave
Rumbling mid-diastolic murmur (just prior to systole)

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16
Q

Tx Mitral stenosis

A

AF (rate control + anti-coags)
Diuretics
Surgery if these measures fail

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17
Q

Surgical Mx mitral stenosis

A

Balloon valvuloplasty (if valve pliable)
Or
Open valvotomy

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18
Q

Causes mitral regurg

A

Rheumatic scarring
Post infarction papillary mm dysfunction
LV dilation
Mitral prolapse

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19
Q

Sx mitral regurg

A

Palps
dyspnoea/orthopnoea
Fatigue
Features RHF/CCF

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20
Q

Signs mitral regurg

A

lat apex beat w/ systolic thrill
Pansystolic murmur
AF?

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21
Q

Tx mitral regurg

A

Tx AF
Tx HF
Surgery if Sx deteriorate

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22
Q

In what position are aortic murmurs best heard

A

With patient sitting forward
Breath held on expiration

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23
Q

Causes aortic stenosis

A

Calcification
RF
Senile calcific degeneration

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24
Q

Prognosis aortic stenosis

A

2-3yrs - death

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25
Q

Sx aortic stenosis (3)

A

Exercise induced syncope
Dyspnoea
Angina

26
Q

Signs aortic stenosis (5)

A

Small volume, slow rising carotid pulse
Narrow pulse pressure
Normal apex beat
Ejection systolic murmur w/ cresendo’ character
Signs LVF

27
Q

Tx aortic stenosis

A

Prompt valve replacement

28
Q

Causes aortic regurg (4)

A

Post-inflamm scarring
Infective endocarditis
Age-related calcification
Dilation aortic root b/c syphillis,AS

29
Q

Sx Aortic regurg

A

Asymp
Until acute LVF

30
Q

Signs aortic regurg (4)

A

Bounding/collapsing pulse
Wide pulse P
Early diastolic murmur w/ decresendo
Signs LVF

31
Q

Quinke’s sign

A

Aortic regurg sign severe disease
Capillary pulsation in nail beds

32
Q

De Musset’s sign

A

Aortic regurg sign severe disease
Head nodding with each heart beat

33
Q

Duroziez’s sign

A

Aortic regurg sign severe disease
Murmur on femoral aa if pressure applied distally

34
Q

Pistol shot femorals

A

Aortic regurg sign severe disease
Sharp bang in time w/ heart beat if femorals auscultated

35
Q

Tx aortic regurg

A

Replace valve

36
Q

When are R sided murmurs louder?

A

On inspiration

37
Q

PS Tricuspid stenosis

A

Sx RHF
Pre-systolic liver thrill
Mid-diastolic murmur

38
Q

PS Tricuspid regurg

A

Sx RHF
Systolic liver thrill
Pan-systolic murmur

39
Q

PS Pulmonary stenosis

A

Sx RHF
RV heave
Ejection systolic murmur

40
Q

PS Pulmonary regurg

A

Asymp
+ diastolic murmur

41
Q

Ix heart murmurs (4)

A

ECG
CXR - hypertrophy, is dilation of aorta present
Echo - visualise valves + diagnostic stenosis
Doppler - regurgitant flow

42
Q

When are heart catheterisations indicated

A

If diagnosis of heart murmurs is uncertain after echo

43
Q

What is Eisenmenger syndrome

A

Persistently raised pulmonary flow 2’ to congenital heart disease

44
Q

Why is early detection of Eisenmenger syndrome v important

A

B/c once pulmn HTN develops - = considered irreversible

45
Q

Sx Eisenmenger syndrome + age onset

A

Rare before 20
Dyspnoea
Fatigue
Chest pain
Syncope

46
Q

O/E Eisenmenger syndrome

A

RV heave
Clubbing
Cyanosis

47
Q

Mx Eisenmenger syndrome

A

H-L transplant

48
Q

What is infective endocarditis?

A

Infection of endocardial surface of heart

49
Q

Mortality bacterial endocarditis

A

15-30%

50
Q

What 2 symptoms are indicative of BE until proven otherwise

A

Fever
New murmur

51
Q

Which patients are at risk of BE?

A

IVDU
Valve replacement
Dental patients

52
Q

Most common bacteria causing BE

A

Strep viridans
+ staph aureus
+ HACEK
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella

53
Q

O/E BE - FROM JANE

A

Fever
Roth spots
Osler nodes
Murmur

Janeway lesions
Anemia
Nail bed haemorrhages
Emboli

54
Q

Ix BE

A

Bloods - FBC/CRP/ESR/U+E
Cultures - 3 sets at different times
Urinalysis
ECG
CXR
Transthoracic echocardiography

55
Q

What are you looking for - CXR - BE

A

Evidence HF
Abscess/emboli

56
Q

What are Duke’s major criteria?

A

3x +ve culture
Endocardial involvement on echo

57
Q

Duke minor criteria

A

Predisposing factors
Fever >38
Vascular phenomena
Immunological signs
Culture/echo not sufficient for mejor

58
Q

Using Duke’s criteria - when can a diagnosis of BE?

A

2 major
1 major + 3 minor
Or all minor

59
Q

Complications infection endocarditis (3)

A

Systemic emboli
Valvular incompetence + CCF
Glomerulonephritis

60
Q

Tx BE

A

ABx - penicillin’s 4-6 w

61
Q

If patient w/ suspected BE is not responding to ABx, what other diagnosis should be considered? (4)

A

PE
Abscess
Dx reaction
Different infection

MRCS A (36 decks)

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