valvular disease

Question 1

clinical history

Answer 1

chest pain 
SOB 
ankle swelling 
orthopnoea 
paroxysmal nocturnal dyspnoea 
collapse/dizzy spells

Question 2

signs of right heart failure

Answer 2

raised JVP
pitting oedema
hepatic congestion

Question 3

description of murmur

Answer 3

systolic or diastolic
what type of murmur
where is it loudest
where does it radiate to - carotids aortic stenosis, axilla mitral regurgitation
grade of murmur 1-6
influenced by respiration - right sided are louder with inspiration

Question 4

innocent murmur

Answer 4

less than 3/6 severity
position dependent
often early systolic

Question 5

valve stenosis

Answer 5

valves which do not open properly

Question 6

valve regurgitation

Answer 6

valves which do not close properly

Question 7

mixed valve disease

Answer 7

valves which neither open properly nor close properly

Question 8

murmur investigations

Answer 8

non-invasive - echo

invasive - cardiac catherization

Question 9

aortic stenosis

Answer 9

degenerated - age related 
congenital 
rheumatic 
SOB, chest pain, dizziness/syncope 
low volume pulse, forceful displaced apex, ejection systolic murmur can radiate to the carotids

Question 10

prosthetic heart valves

Answer 10

mechanical - longevity, warfarin, young patients

bio-prosthetic - no warfarin, 10 years, older patients

Question 11

mitral regurgitation causes

Answer 11

leaflets - prolapse, rheumatics, myxomatous, endocarditis
chordae rupture
pipillary muscle rupture
annular dilation

Question 12

mitral regurgitation

Answer 12

SOB
peripheral oedema 
fatigue 
displaced apex beat 
pansystolic murmur - axilla

Question 13

mitral regurgitation

Answer 13

medications - diuretics and heart failure - ACE
surgical - repair prolapse, replace degeneration
percutaneous - clips in infancy

Question 14

mitral stenosis

Answer 14

rheumatic main cause 
congenital rare
SOB, fatigue, palpitations AF
malar flush, tapping apex beat, mid diastolic rumbling
straight left heart border

Question 15

mitral stenosis treatment

Answer 15

medication - diuretics and treat AF
surgery valve replacement
balloon valvulopasty

Question 16

aortic regurgitation causes

Answer 16

leaflets - endocarditis, connective tissue diseases, rheumatic
annulus - Marfans, arotic dissection

Question 17

aortic regurgitation

Answer 17

SOP
collapsing pulse
wide pulse pressure 
displaced apex
early diastolic murmur
cardiomegaly

Question 18

aortic regurgitation treatment

Answer 18

ACE inhibitor

surgery - symptoms and LV dilatation, valve replacement

Question 19

aortic stenosis treatment

Answer 19

conventional valve replacement
trans catheter aortic valve replacement TAVI
balloon aortic valvotomy BAV