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First Year random > Valves/ Infective endocarditis - Disease profiles > Flashcards

Valves/ Infective endocarditis - Disease profiles Flashcards

1
Q

What is the first heart sound due to?

A
  • Mitral and tricuspid valve closing
  • Start of systole
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1
Q

What is the Second heart sound due to?

A
  • Aortic and pulmonary valves closing
  • Start of diastole
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2
Q

What is diastolic murmur?

A

Early - aortic regurgitation
Mid - mitral stenosis

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3
Q

What is systolic Murmur?

A

Ejection - Aortic stenosis
Pansystolic - mitral regurgitation

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4
Q

What grades hear thrills?

A

IV, V

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5
Q

What murmur do you hear with the 2nd heart sound splitting?

A

aortic stenosis

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6
Q

What murmur do you hear with the 4th heart sound?

A

mitral stenosis

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7
Q

What murmur do you hear with the 3rd heart sound?

A

aortic regurgitation

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8
Q

What murmur do you hear with systolic clicks?

A

continuous murmur

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9
Q

What murmur do you hear with Innocent murmurs?

A

Triscucipside reguritation

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10
Q

What murmur do you hear with mitral regurgitation

A

Pericardial Rub

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11
Q

Valves that do not open properly are what?

A

stenosis

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12
Q

Valves that do not close properly are what?

A

reguritation

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13
Q

Investigations for aortic stenosis

A

CXR + ECG > left ventricular hypertrophy
Echocardigam

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14
Q

Symptoms of aortic regurgitation

A

Angina, breathlessness, more develop after LV failure

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15
Q

What is used to help mitral regurgitation? and a backup

A

Percutaneous→ clips in infancy which show encouraging results
MitraClip if can’t tolerate open heart surgery

16
Q

Describe innocent murmur

A

Tend to be quite soft so no thrills or heaves

Only in early systolic murmur

Come on via exercise

17
Q

A 70-year-old man was successfully thrombolysis for an inferior myocardial infarction two weeks ago and was subsequently discharged five days after the thrombolysis. He has now returned and is re-admitted with symptoms of hypotension, tachycardia, and pulmonary oedema. An echocardiogram shows severe mitral regurgitation.

What is the most likely diagnosis?

A

Papillary muscle rupture

18
Q

A 61-year-old female patient is being treated for infective endocarditis in the cardiology ward. She has been on antibiotics for the past 5 days but has suddenly become acutely short of breath whilst mobilising to the toilet. She has a proven mitral valve vegetation on trans oesophageal echocardiogram and s.viridans positive blood cultures from 2 different sites.

On examination she is acutely short of breath and is saturating 94% on 3 litres of oxygen with a respiratory rate of 25 breaths/min, she has bilateral crackles on lung auscultation and her JVP is elevated. Her heart rate is 107 bpm and her blood pressure is 111/63 mmHg with a pan systolic murmur audible at the apex which you think is louder than on previous days. She is afebrile.

What would be your next management step with this patient? and why

A

Referral for mitral valve replacement

= The above situation represents that of acute mitral regurgitation, likely secondary to a known vegetation present upon this patient’s mitral valve

19
Q

A 70-year-old woman presents to the cardiology clinic for review following an echocardiogram. Her echocardiogram reports an aortic root diameter of 4.1cm. She is currently asymptomatic.

What would be the most appropriate management of this patient?

A

3 monthly surveillance
= Reserved for patients with 4.5-5.4cm aortic root dilation.

20
Q

What is the most sensitive imaging modality for detecting vegetation on the heart valves?

A

Transoesophageal echocardiogram

21
Q

Which feature would be an indication for surgical repair in this patient?

A

Prolonged PR interval on ECG, with evidence of any valve involvement on echocardiogram

22
Q

A 60-year-old former intravenous drug user presents to his GP with a fever and worsening shortness of breath over the past 3 days. Examination reveals a pan systolic murmur loudest over the lower left sternal edge. Blood cultures grow Streptococcus bovis. A transthoracic echocardiogram (TTE) reveals vegetation on the tricuspid valve.

Which of the following investigations is necessary to investigate the underlying cause of his bacteraemia?

A

Colonoscopy

Streptococcus bovis infection is associated with colorectal carcinoma; hence a colonoscopy should be performed to rule this out. S. bovis is part of the normal gut flora, and this may indicate haematogenous spread of bacteria from the colon due to breakdown of the gut wall

23
Q

What is also known as a collapsing pulse and what does that relate to?

A

Water hammer pulse

= aortic regurgitation

24
Q

What is known as a weak pulse and what is it associated with?

A

Pulsus Parvus et Tardus

= aortic stenosis

25
Q

Atrial fibrillation is a consequence to what valve defect?

A

Chronic mitral regurgitation

26
Q

What valve disease has an opening snap?

A

Mitral stenosis

27
Q

What valve is well associated with left bundle branch block?

A

Aortic stenosis

28
Q

Where is aortic stenosis heard best?

A

Second intercostal space on the right

29
Q

If the patient is asymptomatic, what is to happen to their treatment?

A

Checkup. Only TAVI or valve replacement if symptomatic

30
Q

An echocardiogram reports an aortic root diameter of 4.1cm and is asymptomatic. What’s the treatment

A

Yearly surveillance as its less than 4.5cm

31
Q

De Musset’s sign is what?

A

Presence of head nodding associated with aortic regurgitation

32
Q

Corrigan’s sign is what?

A

Bounding carotid pulse is seen as neck pulsations and is associated with aortic regurgitation.

33
Q

Muller’s sign is what?

A

Pulsation of the uvula associated with aortic regurgitation

34
Q

Quincke’s pulse is what?

A

The flushing and blanching of the capillaries of nailbeds and lips associated with aortic regurgitation

35
Q

Major Criteria for DUKES is what (IE)

A

Blood Cultures - more than 1
Evidence of Endocardial Involvement: Echo

36
Q

Minor Criteria for DUKES is what (IE)

A

Fever
Immunological phenomena
Vascular phenomena
Echocardiogram minor criteria
Predisposing features
Microbiological evidence that does not meet major criteria.

37
Q

A 60 year old former intravenous drug user presents to his GP with a fever and worsening shortness of breath over the past 3 days. Examination reveals a pan systolic murmur loudest over the lower left sternal edge. Blood cultures grow Streptococcus bovis. A transthoracic echocardiogram (TTE) reveals vegetation on the tricuspid valve.

Which investigation is necessary to investigate the underlying cause of his bacteraemia?

A

Colonoscopy

First Year random (35 decks)

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