Valvular Disease Flashcards Preview

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Flashcards in Valvular Disease Deck (59):
1

Why does rheumatic fever contribute to valve disease?

Inflammation caused by rheumatic fever is resolved with scarring and laying down of fibrous tissue, increasing the likelihood go bacteria attaching and forming a vegetation

2

What does a tapping apex beat indicate?

Mitral stenosis

3

What does a diffuse apex beat indicate?

Left sided failure and cardiomyopathy

4

Which 5 features should you use to describe murmurs?

1) Intensity (according to Levine's grading)
2) Timing, eg. early, late or mid systolic/diastolic, pansystolic, holosystolic
3) Character & pitch (quality - plateau, crescendo etc; high/low pitch; blowing/rumbing character)
4) Location
5) Radiation

5

Mid-systolic ejection murmur, heard best over the aortic area, with radiation into the carotid, particularly on the right

Aortic stenosis

6

High pitched early diastolic decrescendo murmur a with soft blowing character the left sternal edge with no radiation

Aortic regurgitation

7

Mid-diastolic decrescendo murmur with low pitched rumbling/tapping character heard best over the apex with no radiation

Mitral stenosis

8

Pansystolic murmur with blowing character heard best in the apex which radiates to the axilla

Mitral regurgitation

9

Pansystolic murmur heard best at the left lower sternal border

Tricuspid regurgitation

10

Which underlying conditions predispose to infective endocarditis?

• Valvular heart disease, with stenosis or regurgitation (e.g calcifications or post rheumatic fever)
• Valve replacement surgery
• Structural congenital heart disease
• IV drug abuse
• Invasive vascular procedures such as intravascular lines

11

Which antibiotics should be used for streptococci viridians?

Benzylpenicillin + Gentamicin IV

12

Which antibiotics should be used for enterococcus faecalis?

Amoxicilin/Vancomycin + gentamicin IV

13

Which antibiotics should be used for staph aureus?

Flucloxacillin IV (non MRSA)
Vancomycin IV + rifampicin PO (MRSA)

14

Which antibiotics should be used for staph epidermis?

Vancomycin + gentamicin IV + rifampicin PO

15

What is a cardiac murmur?

Audible turbulence of blood flow

16

What is the most common value lesion?

Aortic stenosis

17

What are the main underlying causes of aortic stenosis?

Degenerative process (age related) or congenital eg. bicuspid valve (2 cusps rather than 3) or rheumatic

18

What is the pathophysiology of aortic stenosis?

Calcium deposits occur on the cusps and the cusps actually fuse, limiting the volume of blood throug

19

What are the symptoms of aortic stenosis?

SOB, chest pain and dizziness

20

What kind of murmur occurs in aortic stenosis?

Ejection systolic murmur that can radiate to the carotids

21

What are the other signs of aortic stenosis?

• Low volume pulse
• Forceful displaced apex
• Murmur

22

What is the treatment of aortic stenosis?

Valve replacement, either:
- Conventional valve replacement
- Trans catheter aortic valve replacement (TAVI)
- Balloon Aortic valvotomy (BAV)

23

What is rheumatic heart disease?

Immune reaction following infection of streptococci

24

Abnormalities of which structures can cause mitral regurg?

- Leaflets eg. prolapse or rheumatic
- Chordae rupture
- Papillary muscle rupture
- Annular dilation

25

What are the symptoms of mitral regurg?

• Breathlessness
• Peripheral oedema
• Fatigue

26

What are the signs of mitral regurg?

• Displaced apex
• Pansystolic murmur in mitral area radiating to the axilla

27

What is the treatment for mitral regurgitation?

- Primarily treat the HF that occurs with medicine
- Surgical: repair prolapse or replace

28

What is the main cause of mitral stenosis and what is the underlying pathophysiology?

Mitral stenosis - cusps become almost completely fused

29

What are the symptoms of mitral stenosis?

• Breathlessness
• Fatigue
• Palpitations (AF)
(As the left atria has to work harder to force blood through the narrowed valve, it hypertrophies which makes it more likely to fibrillate)

30

What are the signs of mitral stenosis?

• Malar flush
• Tapping apex beat
• Mid diastolic rumbling diastolic murmur localised to apex (mitral area)

31

What is the treatment for mitral stenosis?

- Medication: Diuretics and treat AF
- Surgery: Valve replacement
- Balloon Valvuloplasty: Essentially uses a catheter to crack the valve open

32

What kind of problem is aortic regurg fundamentally?

Volume overload problem as opposed to pressure overload

33

What are the causes of aortic regurg in terms of the structures affected?

Leaflets:
- Endocarditis
- Connective tissue disease
- Rheumatic
Annulus:
- Marfans
- Aortic dissection

34

Marfans

Genetic disorder of connective tissue associated with long arms, high arched pallate, ocular problems and spontaneous pneumothorax

35

What are the signs of aortic regurg?

• Collapsing pulse
• Displaced apex (due to a volume problem)
• Early diastolic murmur left sternal edge in the tricuspid area

36

What is the treatment for aortic regurg?

- Medication: ACE inhibitors
- Surgery: Symptoms and LV dilatation or Valve replacement

37

Which valvular condition will cause a murmur in the aortic area?

Aortic stenosis

38

Which valvular conditions will cause a murmur in the mitral area?

Mitral regurg and mitral stenosis

39

Which valvular condition will cause a murmur in the tricuspid area?

Aortic regurg

40

True or False: Blood is normally sterile

True, bacteria in the blood stream is bacteraemia

41

What are predisposing factors to endocarditis?

- Heart valve abnormality eg. calcification/sclerosis in elderly, congenital heart disease or post rheumatic fever
- Prosthetic heart valve
- Intravenous drug users
- Intravascular lines

42

What is the pathogenesis of endocarditis?

1. Heart valve damaged
2. Turbulent blood flow over roughened endothelium
3. Platelets / fibrin deposited
4. Bacteraemia (may be very transient) e.g. from dental treatment or central line - Organisms settle in fibrin/platelet thrombi becoming a microbial vegetation
6. Infected vegetations are friable and break off, becoming lodged in the next capillary bed they encounter causing abscesses or haemorrhage - may be fatal

43

Which side of the heart is most commonly affected in endocarditis?

Left

44

Which organisms most commonly cause endocarditis?

Viridians streptococci
Staph aureus
Enterococci
Staph epidermidis
Plus atypical eg. coxiella

45

Which is the presentation of acute endocarditis?

Overwhelming sepsis and cardiac failure

46

Which is the presentation of chronic endocarditis?

Symptoms:
• Fever
• malaise
• Weight loss
• Tiredness
• Breathlessness
Signs:
• New or changing heart murmur
• finger clubbing
• splinter haemorrhages
• splenomegaly
• Janeway's lesions/osler's nodes and roth spots

47

How is endocarditis diagnosed?

1) 3 sets of blood cultures
2) If negative, serology for atypical organisms
3) Echo

48

Which side of the heart is most commonly affected by IVDU?

Right (tricuspid valve)

49

What is the most common organisms associated with early-presenting prosthetic valve endocarditis?

Staph aureus or epodermidis - Valve infected at the time of insertion

50

Which organism is most associated with endocarditis with IVDUs?

Staph aureus

51

Which antibiotics are used for native valve endocarditis?

Amoxicillin & gentamicin IV

52

Which antibiotics are used for prosthetic valve endocarditis?

Vancomycin & gentamicin IV & rifampicin PO
But usually valve replacement is required

53

Which antibiotics are used for drug user endocarditis?

Flucloxacillin IV

54

Which antibiotics are used for endocarditis caused by viridian's strep?

Benzylpenicillin & gentamicin IV

55

Which antibiotics are used for endocarditis caused by staph epidermidis?

Vancomycin & gentamicin IV & rifampicin P

56

Myocarditis

Inflammation of cardiac muscle

57

What is the presentation of myocarditis?

Symptoms: fever, chest pain, shortness of breath, palpitations
Signs: arrythmia, cardiac failure

58

How is myocarditis diagnosed?

• viral PCR
• Throat swab and stool for enteroviruses
• Throat swab for influenza

59

Which side are you more likely to notice an innocent murmur in?

Right, because if you were going to hear it you'd hear it in an area of low pressure