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Valvular disease Flashcards

(47 cards)

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1
Q

What is a tapping apex beat a sign of?

A

Mitral Stenosis

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2
Q

What is a parasternal heave a sign of?

A

Right ventricular overload e.g. cor pulmonale/ pulmonary hypertension

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3
Q

What is a cardiac murmur?

A

audible turbulence of blood flow either innocent or pathological

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4
Q

What are the descriptors of a murmur?

A 
Systole or diastole?
What type of murmur?
Where is it loudest?
Where does it radiate to?
What grade of murmur?
(Influenced by respiration?)
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5
Q

What does the first heart sound signal?

A

The start of systole

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6
Q

What does the second heart sound signal?

A

The start of diastole

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7
Q

What murmur will commonly radiate to the carotids?

A

Aortic stenosis

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8
Q

What murmur will commonly radiate to the axilla?

A

Mitral regurgitation

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9
Q

What are the grades of murmurs?

A 
I. Very quiet 
II. Quiet - easy to hear
III. Loud
IV. Loud with a thrill
V. Very loud with a thrill
VI. Loud  - audible without a 				stethoscope
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10
Q

What murmurs are louder with inspiration?

A

Right-sided murmurs

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11
Q

What are the 5 common murmurs?

A 
Innocent Murmur
Mitral Regurgitation
Aortic Stenosis
Aortic Regurgitation
Mitral Stenosis
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12
Q

What is an innocent (functional) murmur?

A

A soft (<3/6) early systolic murmur. Diastolic murmurs are always pathological but listen carefully to systolic to see if it is innocent

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13
Q

What is valve stenosis?

A

The valves don’t open properly

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14
Q

What is valve regurgitation?

A

The valves don’t close properly

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15
Q

What is mixed valve disease?

A

The valves don’t open or close properly

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16
Q

What are the cardiac investigations which can be carried out?

A

Non-invasive - Echo

Invasive - cardiac catheterisation

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17
Q

What are the causes of aortic stenosis?

A

Degenerative (age related)
Congenital - bicuspid valve instead of tricuspid
Rheumatic

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18
Q

What are the symptoms of aortic stenosis?

A

Breathlessness
chest pain
Dizziness/ syncope

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19
Q

What are the clinical signs of aortic stenosis?

Study These Flashcards
A

Low volume pulse
Forceful displaced apex
Ejection systolic murmur that can radiate to the carotids

20
Q

How do you treat aortic stenosis?

Study These Flashcards
A

Conventional valve replacement
Trans catheter aortic valve replacement (TAVI)
Balloon Aortic valvotomy (BAV)

21
Q

What are the general history signals that it may be valvular disease?

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A

Chest pain
Breathlessness
Collapse/ dizzy spells
Exertional symptoms are characteristic

22
Q

What are the complications of aortic stenosis?

Study These Flashcards
A

Left ventricular hypertrophy

23
Q

What are the descriptors of cardiac chest pain?

Study These Flashcards
A

Gripping
Squeezing
Heavy
Crushing

24
Q

What are the characteristics of cardiac breathlessness?

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A

Related to activity (usually)
Often associated with ankle swelling
Orthopnoea
Paroxysmal Nocturnal Dyspnoea (PND)

25
What are the Classes in the New York Heart Association Functional Classification (NYHA) - (for breathlessness due to heart problems - heart failure of valvular disease)?
Class I - No limitation Class II - Slight limitation of ordinary activity Class III - Marked limitation of less than ordinary activity Class IV - Severe limitation of minimal activity or at rest
26
What are the factors to consider in mechanical valves?
They last longer - potentially for life There is a mechanical click of the second heart sound Patient needs to be on lifelong warfarin - high risk especially as they get older Given to younger patients
27
What are the factors to consider in Bio-prosthetic valves?
They don't need to take warfarin They only last 10 years They are generally given to older patients
28
When is TAVI offered?
To patients who are not suitable for conventional surgery Done through the groin Stroke risk is a bit higher than conventional surgery
29
What is currently preferred aortic valve replacement or TAVI?
AVR - there is more long term evidence
30
What are the causes of mitral regurgiation?
``` Leaflet - Prolapse - Rheumatic - Myxomatous (floppy) (congential) - Endocarditis Chordae rupture (degenerative) - Prolapse/flail leaflet Papillary muscles rupture (infarct where the chords attach to the muscle ischemic mitral regurgitation) Annular dilatation - Functional (due to cardiac failure) ```
31
What are the symptoms of mitral regurgitation?
Breathlessness Peripheral Oedema Fatigue
32
What are the clinical signs of mitral regurgitation?
Displaced apex beat | Pansystolic murmur in the axilla (throughout systole)
33
What are the complications of Mitral regurgitation?
Left ventricular failure | Pulmonary hypertension
34
What is the medical treatment of mitral regurgitation?
Diuretics and heart failure medication if needed (ACE inhibitors)
35
What is the surgical treatment of mitral regurgitation?
repair - when prolapse of the valve replacement - when there is degenerative disease of the valve (only conventional surgery - repair will always be
36
What is a mitral clip?
a percutaneous technique were the leaflets are pulled together with a clip - not that popular
37
What causes mitral stenosis?
Rheumatic disease or congenital but very rare
38
What are the symptoms of mitral stenosis?
Breathlessness Fatigue Palpitations (AF)
39
What are the clinical signs of mitral stenosis?
Malar flush Tapping apex beat Mid-diastolic rumbling murmur localised to apex - turning the patient on their left helps to hear it
40
Medical treatment of mitral stenosis?
treat the AF diuretics
41
Surgical treatment of mitral stenosis?
Valve replacement and balloon valvuloplasty
42
What are the causes of aortic regurgitation?
``` The leaflets can be affected by - endocarditis - connective tissue diseases - rheumatic Annulus affected by - marfans - aortic dissection ```
43
Symptoms of aortic regurgitation?
Breathlessness
44
Clinical signs of aortic regurgitation?
Collapsing pulse Wide pulse pressure Displaced apex beat Early diastolic murmur left sternal edge
45
What are the medications given for aortic regurgitation?
ACE inhibitors - to preserve heart function
46
What is cardiomegaly?
An enlarged heart
47
What are the potential surgical interventions for aortic regurgitation?
valve replacement - only conventional is an option | Given in patients who are symptomatic and have LV dilatation

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