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CP3 @ UoN - Medicine & Surgery > Heart Valve Disease > Flashcards

Heart Valve Disease Flashcards

1
Q

Define valvular heart disease

A

Damage to or a defect in one or more of the four heart valves

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2
Q

What are the four valves in the heart?

A

Mitral - LA to LV
Aortic - LV to Aorta
Tricuspid - RA to RV
Pulmonary - RV to Pulmonary aa

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3
Q

What are the main causes of valvular heart disease?

A 
Congenital
Rheumatic
Degenerative
Cardiac remodelling
Infective endocarditis
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4
Q

Describe congenital VHD

A

VHD caused by a congenital defect

-bicuspid aortic valve causes aortic stenosis

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5
Q

Describe rheumatic VHD

A

Damage to connective tissue of heart valves caused by rheumatic fever
-mitral/tricuspid/aortic stenosis

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6
Q

Describe degenerative VHD

A

Progressive process of slow degeneration

-mitral/tricuspid

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7
Q

Describe cardiac remodelling VHD

A

Cardiac remodelling can lead to VHD

  • hypertrophy/dilatation leading to regurg
  • raised pressure causing stenosis
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8
Q

Describe how infective endocarditis can cause VHD

A

Heart valves not directly supplied with blood, hard to fight infection
-aortic regurgitation

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9
Q

Describe the difference between stenotic and regurgitation valvular disease

A

Stenosis - narrowing of a valve opening causing lowered blood flow
Regurgitation - blood flows back through valve after leaflets close

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10
Q

What are the main causes of mitral stenosis?

A

Rheumatic heart disease

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11
Q

What are the main sx/signs of mitral stenosis?

A

Sx - Dysnpoea, haemoptyis, palpitations (AF), RHF

Signs - Malar flush, JVP, left parasternal heave

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12
Q

Describe the murmur of mitral stenosis

A

Low pitched mid-diastolic murmur

-heard loudest at apex

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13
Q

What are the main causes of mitral regurgitation?

A

Endocarditis
Papillary muscle rupture post MI
LV dilation (LVF, HOCM)
Mitral prolapse

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14
Q

What are the main sx/signs of mitral regurgitation?

A

Sx - Palpitations (AF), dyspnoea/orthopnoea, RHF/CCF

Signs - Displaced apex beat, systolic thrill

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15
Q

What are the main causes of aortic stenosis?

A

Calcification of aortic valve
Rheumatic fever
Congenital bicuspid (most common)

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16
Q

What are the main sx/signs of aortic stenosis?

A

Sx - Angina, exercise induced syncope/dyspnoea

Signs - Small volume, slow rising carotid, narrow pulse pressure, systolic thrill

17
Q

Describe the murmur of aortic stenosis

A

Ejection systolic crescendo-decrescendo murmur

-in aortic area, radiates to carotids

18
Q

Describe the murmur of mitral regurgitation

A

Pansystolic murmur

-at apex, radiating into axilla

19
Q

What are the main causes of aortic regurgitation?

A

Infective endocarditis
Age-related calcification
Dilation of aortic root (syphilis, AS)

20
Q

What are the main sx/signs of aortic regurgitation?

A

Sx - Asymptomatic until LVF, angina, dyspnoea

Signs - Bounding/collapsing pulse, wide pulse pressure, LVF

21
Q

Describe the murmur of aortic regurgitation

A

Diastolic decrescendo murmur

22
Q

What non-invasive tests can be used to assess the heart valves?

A

ECG
CXR
Echo

23
Q

What is the treatment for Mitral Stenosis?

A

Treat any AF
Diuretics - Reduce pre-load/congestion
Surgical - Balloon valvuloplasty/valvotomy

24
Q

What is the treatment for Mitral Regurgitation?

A

Treat AF
Treat heart failure
Surgery

25
Q

What is the treatment for Aortic Stenosis?

A

Prompt valve replacement

Percutaneous valvuloplasty if unfit for surgery

26
Q

What is the treatment for Aortic Regurgitation?

A

Replace valve before LV dysfunction

27
Q

How are mitral valve murmurs best heard?

A

Pt on left hand side

28
Q

How are aortic valve murmurs best heard?

A

Pt lent forward, expiration

29
Q

How are right sided murmurs best heard?

A

Loudest in inspiration

30
Q

Describe tricuspid stenosis

A

Sx of RHF, signs of pre-systolic liver thrill

Mid-diastolic murmur

31
Q

Describe tricuspid regurgitation

A

Sx of RHF, signs of systolic liver thrill

Pan-systolic murmur

32
Q

Describe pulmonary stenosis

A

Sx of RHF, signs of RV heave

Ejection systolic murmur

33
Q

Describe pulmonary regurgitation

A

Asymptomatic

Diastolic murmur

34
Q

What are the indications for cardiac catheterizations?

A

Uncertain diagnosis to:

  • measure chamber pressure
  • assess movement of blood across valves
  • measure metabolites, show oxygenation etc.
35
Q

What do the 1st and 2nd heart sounds correspond to?

A

1st - Closure of mitral & tricuspid valves

2nd - Closure of aortic & pulmonary valves

36
Q

What is the relationship between heart sounds and pulse?

A

1st - Starts w/ pulse

2nd - Starts as pulse disappears

37
Q

When is a systolic murmur heard?

A

Between 1st & 2nd heart sound

-in time w/ pulse

38
Q

When is a diastolic murmur heard?

A

Between 2nd & 1st heart sound

-not in time w/ pulse

39
Q

When do metallic valve clicks tend to be heard?

A

Often 1st heart sound

-mitral

CP3 @ UoN - Medicine & Surgery (135 decks)

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