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Cardiovascular > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What is Rheumatic Fever?

A

Immune response to Group A beta haemolytic strep (Strep pyogenes). Antibody cross reactivity precipitates Type II hypersensitivity.

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2
Q

Epidemiology Rheumatic fever?

A
  • Commonest in children 6-15y.

- Rare in AUS except NT

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3
Q

Clinical features Rheumatic Fever?

A
  • Fever
  • Arthritis: migratory polyarthrititis affecting large joints.
  • Rash: erythema marginatum
  • S/C nodules: over bones, tendons
  • Murmur
  • Sydenham’s chorea
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4
Q

Mx Rheumatic Fever?

A
  • ABx
  • NSAIDs
  • Long term ABx prophylaxis
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5
Q

What is the effect of aortic regurgitation?

A

LV eccentric hypertrophy

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6
Q

What is the effect of mitral regurgitation?

A

LV eccentric hypertrophy

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7
Q

What is the effect of aortic stenosis?

A

LV concentric hypertrophy

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8
Q

What are the causes of aortic stenosis?

A
  • Congenital 0.33% births
  • Bicuspid aortic valve 1-2%
  • Rheumatic fever (rare)
  • Calcific (most common)
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9
Q

What are the symptoms of aortic stenosis?

A
  • SOBOE
  • CP on exertion
  • Syncope
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10
Q

When do symptoms of stenosis appear?

A

-When stenosis is severe (asymptomatic mild-mod stenosis)

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11
Q

Signs of aortic stenosis in carotid pulse?

A

-Slow upstroke: “plateau pulse”

Indicative of reduced systolic ejection.

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12
Q

Apex beat in aortic stenosis?

A
  • Not displaced

- Heaving

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13
Q

Does aortic stenosis have a thrill?

A

Over upper R sternal edge (if loud murmur)

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14
Q

What causes the murmur in aortic stenosis?

A

Due to turbulence at LV to Ao pressure gradient during systolic ejection.

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15
Q

What is the type of murmur in aortic stenosis?

A

Crescendo decrescendo “ejection systolic” murmur.

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16
Q

What aortic valve area on echo correlates with stenosis?

A 
Ao Valve area 
N = 3-4cm2
Mild = 1.5+
Mod = 1 - 1.5
Severe = 1
17
Q

Mx severe AS (w/ symptoms)?

A

Replace valve:

  • Open aortic valve replacement
  • Transcatheter aortic valve implant (TAVI)
18
Q

What are the causes of aortic regurgitation?

A
  • Aortic leaflet damage (endocarditis, rheumatic fever)
  • Aortic root dilated so leaflets don’t close:
  • ->Marfan’s
  • -> Aortic dissection
  • -> Collagen vascular disorders
  • -> Syphilis
19
Q

Symptoms of AR?

A

Even severe AR asymptomatic (until LV decompensates) ==> then Sx of HF e.g. SOB.

20
Q

What are the signs of AR?

A

Relate to high volume pulse:

  • Collapsing pulse (fast up and down stroke)
  • Wide pulse pressure
  • Early diastolic murmur
21
Q

Mx AR?

A
  • Echo monitoring 6-12 monthly for severe AR

- Indicators of decompensation (increase in LV size or decrease in fxn) trigger for op before symptoms occur.

22
Q

What are the causes of mitral regurgitation?

A
  • Myxomatous degeneration (mitral valve prolapse)
  • Ruptured chordae tendinae (flail leaflet)
  • Infective endocarditis
  • MI -> papillary muscle rupture
  • Rheumatic fever
  • Collagen vascular disease
  • Cardiomyopathy -> change in ventricle shape
23
Q

What causes the murmur in mitral regurgitation?

A

Pressure gradient from LV to LA: pan systolic murmur.

Very high gradient throughout systole so murmur has same intensity.

24
Q

Where is mitral regurgitation usually heard?

A

Usually confined to the apex but

-severe: also at base (upper R sternal edge)

25
Q

Mx mitral regurgitation?

A
  • Follow with 6-12/12 echo

- Indicators of early LV dysfunction (change in size or function) ==> operation before onset of symptoms

26
Q

What are the causes of mitral stenosis?

A

-Rheumatic Fever (commonest cause)

27
Q

Symptoms of mitral stenosis?

A

When severe-

  • SOB
  • Oedema
28
Q

What are the signs of mitral stenosis?

A
  • Mitral facies - facial flushing

- “tapping” apex beat correlated with loud S1

29
Q

Auscultation of mitral stenosis?

A
  • Diastolic opening snap (mitral valve opens after S2)
  • Diastolic rumbling murmur
  • Pre systolic accentuation due to atrial systole
30
Q

Describe the progression / complications of MS?

A
  • Atrial dilation
  • AF
  • Thromboembolism (high risk if MS + AF)
  • Pulmonary oedema
  • Pulmonary HTN
  • RHF
31
Q

Mx mitral stenosis?

A
  • Follow w/ echo
  • Anticoags esp if AF
  • Treat AF
  • Diuretics
  • Mitral valve intervention
32
Q

Echo features followed in MS?

A
  • Mitral gradient
  • LA size
  • Pulmonary artery pressure
33
Q

Causes of TR?

A
  • Usually RHF
  • Endocarditis (esp IVDU)
  • Pacemaker leads interfering with valve
34
Q

Signs of TR?

A
  • Peripheral oedema
  • High JVP
  • Liver congestion
35
Q

How does infective endocarditis usually present?

A

-Fever
-+/- heart murmur
Signs of inflammation/embolisation now rare.

36
Q

How is infective endocarditis diagnosed?

A
  • Blood culture

- Echo (esp TOE)

37
Q

How is infective endocarditis managed?

A

-Prolonged ABx via PICC (usually requires HITH)

Cardiovascular (22 decks)

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