Valvular Defects Flashcards

Question

When is surgery indicated

Answer 1

Severe AR (whole LV filled after one diastole) Increasing symptoms Enlarging LV

Answer 2

LV has to accommodate SV + regurg volume If acute poorly tolerate as no time for wall to adapt Increased EDV and pressure = hypertrophy HEART FAILURE

Answer 3

EF <50% CCF >12 months NHYA Class III or IV

Answer 4

Degeneration Post MI IE as vegetation prevent closure (if MR + fever) Rheumatic but more classically cause stenosis Connective tissue - Marfan / Ehlor Mitral valve prolapse LV dilatation as pulls leaflet apart = functional regurgitation - Cardiomyopathy - MS treatment

Answer 5

``` Asymptomatic until LV begins to fail when SV and CO can't be maintained Then leads to CCF Fatigue SOB Palpitations Oedema Hypotension Pulmonary oedema and hypertension Arrhythmia Cariogenic shock ```

Answer 6

Pansystolic murmur High pitched whistle due to high velocity Radiates to apex

Answer 7

``` Displaced apex due to dilatation of LV Split S2 and reduced S1 (MS has loud S1) Pulse is normal or reduced AF develops as LA dilates RHF develops = JVP + heave HF signs if develop ```

Answer 8

ECHO - MR severity, flow into pulmonary vein ECG CXR - cardiomegaly / calcification Aniogram

Answer 9

LA dilatation so PR >0.12 ECHO - MR severity - Larger LV and dilated LA - EF is often under-estimated as some blood going into LA in systole (so if 55% and 5 goes into LA really 50%)

Answer 10

``` Reduce preload and after load Nitrate Diuretic Inotrope Na nitroprusside ?? ACEI / BB / spironolactone - if in HF Treat AF and anti-coagulate Surgery if severe ```

Answer 11

Repair better than replacement

Answer 12

Ventricle doesn't have time to compensate | ESP and EDV decrease to decrease wall tension

Answer 13

``` EDV and ESV return to normal LV hypertrophy to accommodate extra blood Heart becomes less efficient More severe = moer hypertrophy HEART FAILURE ``` Surgery if EF falls or significant LV dilatation on ECHO or symptoms Otherwise treat AF - Can't do rhythm as LA dilated

Answer 14

Mitral valve prolapse - Very common in young girls - As get older AS more common

Answer 15

``` ASD PDA Cardiomyopathy Turner Marfan Osteogenesis imperfecta WPW ```

Answer 16

``` Asymptomatic Aytypical chest pain Palpitations Autonomic Sx Late systolic due to sudden stretch of chordae or prolapsed leaflet Low volume pulse ```

Answer 17

ECHO | ECG

Answer 18

BB for palpitation / chest pain | Surgery if severe

Answer 19

Can progress to MR Emboli Arrythmia Sudden death

Answer 20

``` Congenital Rheumatic HD !!!!! Other rheumatic - SLE / RA Infective endocarditis Carcinoid - more effects R side of heart but can affect L if mets in lung ```

Answer 21

``` Mid-diastolic Rumbling Difficult to hear - Should be no sound before Lub dub - RRRR lub dub ```

Answer 22

``` Pulmonary hypertension Pulmnary oedema Heart failure SOB Haemoptysis Chronic bronchtiis Fatigue Palpitations Tachycardia - worse on exercise / illness ```

Answer 23

``` Loud S1 as large force needed to shut Tapping apex beat Rumbling murmur after JVP RV heave Diastolic thrill Malar flush - Sign of low CO state due to pulmonary HTN = vasodilatation Normal pulse - may have low volume AF - any problem causing LA dilatation Signs of pulmonary HTN ```

Answer 24

AF due to LA dilatation

Answer 25

ECG - RVH / P mitrale (bifid P wave) if sinus and AF if not CXR - RVH / oedema / LA enlargement ECHO = diagnostic Angiogram

Answer 26

Manage AF Diuretic to reduce preload and afterload and for pulmonary oedema Valve repalcement = gold standard - Can be difficult if pulmonary HTN developed

Answer 27

Tight MV = pressure increases in LA and dilates Embolization due to LA enlargement Hoarse voice - LA presses on recurrent laryngeal rare Bronchial obstruciton / dysphagia IE Increased pressure goes into PV and PA = RV hypertrophy Pulmonary HTN and cor-pulmonale

Answer 28

Trans valvular Flow rate | Pressure

Answer 29

``` Aortic stenosis Pulmonary stenosis HCM ASD Tetrology of fall out ```

Answer 30

Mitral regurgitation Tricuspid regurgitation VSD

Answer 31

MVP | Coarctation

Answer 32

Aortic regurgitation | Pulmonary regurgitation

Answer 33

Mitral stenosis Severe aortic regurgitation Anything obstructing mitral orifice - thrombus / myxoma

Answer 34

Do if have time

Answer 35

Cor pulmonale - pan-systolic

Answer 36

``` SCRIPT Site Character Radiation Intensity Pitch Timing Grade 1-6 (1 hard to hear, 6 can hear without stethoscope)V ```

Answer 37

Dilatation

Answer 38

Hypertrophy

Answer 39

Usually sternotomy scar (also CABG) Open heart surgery = remains 1st line if young nd fit TAVI

Answer 40

Bio | Mechanical

Answer 41

10 years No anti-coagulation Better in elderly

Answer 42

20 years Life long anti-coagulation with warfarin Target INR = 2.5-3.5

Answer 43

Thrombus Embolism IE Haemolysis

Answer 44

S1 if mitral | S2 if aortic

Answer 45

``` Rapid ventricular emptying Physiological if <30 Typically LVF Dilated cardiomyopathy Constrictive pericarditis MR ```

Answer 46

Due to atrial contraction against stiff ventricle (suggest L ventricle hypertrophy) Aortic stenosis HOCM Hypertension

Answer 47

L ventricle systolic dysfunction as reduced flow rate

Answer 48

Loudness | Need ECHO to assess valve function

Answer 49

Valsalva reduces the peripheral pressure Heart fills with more blood and hence the chamber opens up Means the narrowing at the level of the aortic valve is reduced so the murmur is quieter

Answer 50

HOCM due to massive left atrium

Answer 51

Carcinoid syndrome | - If Hx flushing / wheeze / diarrhoea

Answer 52

If tumour has mets in lung so go into pulmonary vascular and to L side of heart

Answer 53

Louder inspiration

Answer 54

Louder expiration

Answer 55

All congenital heart - Tetrology, ASD, VSD, PDA IE