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NW Studies > Heart Valve Disease > Flashcards

Heart Valve Disease Flashcards

1
Q

Rheumatic Fever (1)- Organism- Signs of Infection [2]- Hypersensitivity Type

A
  • Organism: Strep Pyogenes (Group A Beta Hemolytic)- Signs: Pharyngitis + Scarlet Fever- Hypersensitivity Type II (Antibody cross-reactivity)
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2
Q

Rheumatic Fever (2)- Epidemiology: Commonest in [ XX ]- [ XX ] weeks - Clinical Features [(6)]

A
  • Epidemiology: Commonest in 6-15yo- develops 2-3 weeks post-infection- Clinical Features: > Fever > Arthritis (migratory polyarthritis, large joints) > Rash: Erythema Marginatum > Subcutaneous Nodules (over bones & tendons) > Murmur > Sydenham’s Chorea (St Vitus Dance)
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3
Q

Rheumatic Fever (3)- Dx [1]- Management [+1]- Occurrence in Australia

A
  • Dx: Jones Criteria (Joint involvement, myOcarditis, Nodules/subcutaneous, Erythema marginatum, Sydenham’s chorea)- Management: NSAIDs & Antibiotics (+/-long-term - can recur) - Occurrence in Australia rare, except NT
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4
Q

Echocardiography- What does it assess [4]- Doppler

A
  • Assess: > Chamber Size & Function (EF) > Wall Thickness > Cardiac Structure > Valve Morphology- Doppler shows flow velocities & direction
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5
Q

Transesophageal Echo (TOE)… used to identify [3]

A
  • Valve Details, especially Mitral- Atrial Thrombus- Endocarditis including on pacing leads
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6
Q

LV Response to Regurgitation- [Short Term=? + 4 effects, Long-term=? + 3 effects]- Onset of Symtpoms when: short vs. long term

A

Short Term: Compensation- ↑ EDV- ↑ Stroke Volume ( = EDV - ESV)- ↑ Ejection Fraction (= SV/EDV)- constant ESV Long Term: Deterioration of LV (if severe regurge)- ↑↑ EDV- ↑ ESV- ↓ EF–> IRREVERSIBLE + Time of Symptom ONSET ( if symptoms appear, damage has already occurred)

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7
Q

Aortic Regurgitation1) Chamber Affected2) Volume or Pressure Load?3) Effect4) Symptoms indicate [surgery/irreversible]5) Other Effects

A

1) LV2) Volume3) Eccentric Hypertrophy, i.e. Enlargement4) Coincide with irreversible LV changes5) None

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8
Q

Mitral Regurgitation1) Chamber Affected2) Volume or Pressure Load?3) Effect4) Symptoms indicate [surgery/irreversible]5) Other Effects

A

1) LV2) Volume3) Eccentric Hypertrophy, i.e. Enlargement4) Coincide with irreversible LV changes5) Pulmonary Hypertension

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9
Q

Aortic Stenosis1) Chamber Affected2) Volume or Pressure Load?3) Effect4) Symptoms indicate [surgery/irreversible]5) Other Effects

A

1) LV2) Pressure3) Concentric Hypertrophy4) Trigger for surgery –> LVH regresses5) None

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10
Q

Mitral Stenosis1) Chamber Affected2) Volume or Pressure Load?3) Effect4) Symptoms indicate [surgery/irreversible]5) Other Effects

A

1) LA2) Pressure3) LA Enlargement4) Trigger for Surgery5) Pulmonary Hypertension

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11
Q

Valve Replacement:Mechanical vs. Prosthetic

A

Mechanical: last forever, but need anticoagulantsBioprosthetic: shorter life, but no need for anticoagulants

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12
Q

Valve Repair/Surgery- Valvuloplasty - what is it?Other Types- Repair - especially for [ valve condition ]- TAVI = ?- Clips for [ valve ]

A

Valvuloplasty- for stenosis- Surgical; using BalloonOther Types- Repair - esp. mitral valve prolapse- Stent Valves - Transcatheter Aortic Valve Implant (TAVI)- Mitral Valve Clips

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13
Q

Commonest valve lesion needing surgery

A

Aortic Stenosis

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14
Q

Aortic Stenosis - Causes [3]

A

1) Calcific - most common cause; increases with age2) Congenital- Aortic Stenosis Births (0.33%)- Bicuspid Aortic Valve (1-2%) - may become stenotic later3) Rheumatic Fever - rare

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15
Q

Aortic Stenosis - Symptoms[3][onset at what stage]

A
  • SOB- Exertional Chest Pain- SyncopeOnset when stenosis severe. No symptoms at mild-moderate stenosis.
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16
Q

Aortic Stenosis - Findings- Palpation Findings [3; describe aortic pulse]- Describe Murmur

A
  • Carotid Pulse: slow upstroke “plateau pulse” (indicative of reduced systolic ejection)- Apex Beat: heaving (not displaced)- Thrill: over upper R) sternal edge (if loud murmur)- Murmur: ejection systolic murmur; best at R) upper sternal edge
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17
Q

Aortic Stenosis (Severity)- How to test severity + [2 of this test’s] findings

A

Echocardiography- Gradient >50mm- Aortic Valve Area

18
Q

Aortic Stenosis (Management) [3]A) If mild-moderate OR no symptomsB) If severe OR symptomatic

A

A) Observe.B) Replace Valve (2 options):- Open Operation: Aortic Valve Replacement- TAVI (Transaortic Valve Implant)

19
Q

Aortic Stenosis: What are the effects of valve replacement surgery?

A

LVH regresses

20
Q

Aortic Regurgitation:Causes [2 types; with 2 and 4 causes respectively]

A
  • Aortic Leaflet Damage:Endocarditis, Rheumatic Fever- Aortic Root Dilation (so leaflets can’t close)Marfan’s Syndrome, Aortic Dissection, Collagen Vascular Disorder, Syphilis
21
Q

Aortic Regurgitation:- At what stage does AR cause symptoms?- What are these symptoms?

A

No symptoms even if severe.Only once LV decompensates–> Symptoms of HF –> SOB

22
Q

Aortic Regurgitation:Exam findings / signs [3]

A

Related to high volume pulse- “Collapsing Pulse” - fast up and down stroke- Wide pulse pressure- Early Diastolic Murmur

23
Q

Aortic Regurgitation:Management

A

Regular Echocardiography (6-12 months)–> SURGERY if detect Decompensation (↑LV Size, ↓LV Function), but before symptoms occur

24
Q

Mitral Regurgitation:Causes [7]

A
  • Myxomatous Degeneration (Mitral Valve Prolapse)- Ruptured Chordae Tendinae (Flail Leaflet)- Infective Endocarditis- Myocardial Infarct (Ruptured Papillary Muscle)- Rheumatic Fever- Collagen Vascular Disease- Cardiomyopathy (change in ventricular shape)
25
Q

Mitral RegurgitationSymptoms [+ at what stage]

A

Severe: no symptomsThen HF Symptoms: SOB + Ankle Edema

26
Q

Mitral Regurgitation Murmur

A
  • Pansystolic Murmur- systolic; same intensity throughout
27
Q

Mitral Regurgitation:Management

A

For severe: Regular Echocardiography (6-12 months)–> SURGERY if detect - Decompensation (↑LV Size, ↓LV Function), - or Pulmonary Hypertension, - but before symptoms occur

28
Q

Mitral Regurgitation: Surgical Procedures [2, generally]

A

Mitral Valve Replacement OR Repair

29
Q

Mitral Stenosis:Causes

A

Rheumatic Fever- most common effect is MS- especially in female

30
Q

Mitral StenosisSymptoms [2; + stage]

A

If severe:- SOB- Edema

31
Q

Mitral StenosisSigns [2 + stage; except murmur]

A

If severe prolonged MS- Mitral Facies (Facial Flushing)- “Tapping” Apex Beat - correlates with loud S1

32
Q

Mitral StenosisConsequences [6]

A
  • Atrial Dilation- AF- Thromboembolism (esp. if MS + AF)- Pulmonary: Hypertension–> Chronic Hypoxia –> Pulmonary Vasoconstriction- Pulmonary: Congestion & Edema- R) Heart Failure
33
Q

Mitral Stenosis:Management [5]

A
  • Echocardiography: (a) Mitral Gradient, (b) LA Size (c) Pulmonary Artery Pressure- Anticoagulation (esp. if AF)- Treat AF- Diueretics- Mitral Valve Intervention
34
Q

Mitral StenosisInterventions [3]

A
  • Mitral Valvotomy (open or closed heart surgery)- Balloon Valvuloplasty- Mitral Valve Replacement
35
Q

Tricuspid RegurgitationCauses [3]

A
  • RV Failure, due to Pulmonary Hypertension (lung disease, left heart failure)- Endocarditis (especially IV drug user)- Pacemaker Lead (interfere with valve)
36
Q

Tricuspid RegurgitationClinical Exam findings / Signs[3]

A
  • Peripheral Edema- High JVP- Liver Congestion
37
Q

Tricuspid RegurgitationManagement [2]

A
  • usually Diuretics- occasionally surgery
38
Q

Infective EndocarditisDefinition

A

Bacterial Infectionon Heart Valve or Pacemaker Lead

39
Q

Infective Endocarditis- Infective Agent [4]- How is it contracted [2]

A
  • Strep Viridans or Bovis- Staph Aureus or EpidermidisPathway- via Bloodstream- Daily Activities- Dental or Surgical Procedure
40
Q

Infective Endocarditis:Clinical Exam findings / Signs [3]

A
  • usually Fever +/- Heart Murmur- Today rarely: Splinter hemorrhage, Osler’s Nodes, (Signs of Inflammation or Embolization) etc.
41
Q

Infective Endocarditis:Diagnosis [+1; also FBE etc. results?]

A

Blood Cultures + Echocardiogram/TOE(Also: High WCC, ESR, CRP, Anemia, Microhematuria)

42
Q

Infective Endocarditis:Management [2]

A
  • Specialist Team (Cardiologist, Cardiac Surgeon, ID)- Prolonged Antibiotics via PICC (at home/hospital)- Valve Replacement Surgery - if HF or uncontrolled Infection

NW Studies (3 decks)

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