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cardio disease profiles > valvular heart disease > Flashcards

valvular heart disease Flashcards

1
Q

clinical history

A
  • chest pain
  • breathlessness
  • collapse/ dizzy spells
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2
Q

Cardiac Breathlessness

A
  • Related to activity (usually)
  • Often associated with ankle swelling
  • Orthopnoea
  • Paroxysmal Nocturnal Dyspnoea (PND)
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3
Q

Class I -

A

No limitation

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4
Q

class II -

A

Slight limitation of ordinary activity

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5
Q

Class III -

A

Marked limitation of less than ordinary activity

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6
Q

Class IV -

A

Severe limitation of minimal activity or at res

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7
Q

Signs of Right Heart Failure

A

Raised JVP

Pitting oedema

Hepatic congestion

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8
Q

What is a cardiac murmur?

A
  • Audible turbulence of blood flow
  • Innocent and pathological
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9
Q

1st Heart sound

A
  • Mitral and tricuspid valve closing
  • Start of systole
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9
Q

2nd Heart sound

A
  • Aortic and pulmonary valves closing
  • Start of diastole
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10
Q

Where does it radiate to?

A

Carotids (aortic stenosis)
Axilla (mitral regurgitation)

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11
Q

Grading 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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12
Q

Innocent (functional) Murmur

A

Soft (less than 3/6 severity)
Position dependent
Often early systolic (diastolic murmurs always pathological)

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13
Q

VALVE STENOSIS

A

Valves which do not open properly

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14
Q

VALVE REGURGITATION

A

Valves which do not close properly

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15
Q

MIXED VALVE DISEASE

A

Valves which neither open properly nor close properly

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16
Q

types of Aortic Stenosis

A
  • Degenerative (age related)
  • Congenital
    E.g bicuspid valve
  • Rheumatic
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17
Q

Aortic Stenosis symptoms

A

Breathlessness

Chest pain

Dizziness/syncop

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18
Q

aortic stenosis signs

A

Low volume pulse

Forceful displaced apex

Ejection systolic murmur that can radiate to the carotids

19
Q

aortic stenosis Treatment

A

Conventional valve replacement

Trans catheter aortic valve replacement (TAVI)

Balloon Aortic valvotomy (BAV)

20
Q

mechanical heart valve

A

Longevity

Warfarin

Younger patients

21
Q

bio-prothetic heart valve

A

No warfarin

10 years

Older patients

22
Q

what is better AVR or TAVI

A

AVR due to long term outcomes

23
Q

Mitral Regurgitation - causes

A
  • Leaflets
  • Chordae rupture (degenerative)
  • Papillary muscles rupture
  • Annular dilatation
24
Q

Mitral Regurgitation symptoms

A

Breathlessness

Peripheral oedema

Fatigue

25
Q

Mitral Regurgitation signs

A

Displaced apex

Pansystolic murmur
- Axilla

26
Q

murmur syncronised w corotid pulse =

A

systole

27
Q

murmur NOT syncronised w corotid pulse =

A

diastole

28
Q

mitral regurgitation investigations

A
  • CXR
  • ECG
  • Echocardiogram - to confirm diagnosis and assess severity
  • Others if indicated: CMR, coronary angiography
29
Q

mitral regurgitation treatment medications

A

Diuretics and heart failure (ACE inhibitors)

30
Q

mitral regurgitation treatment surgery

A

Repair – prolapse
Replacement - degenerative

  • open heart surgery and valve repair or replacement
  • MitraClip if can’t tolerate open heart surgery
31
Q

main cause of mitral stenosis

A
  • Due to Rheumatic fever
  • Congenital (rare)
  • Calcification related to age
32
Q

mitral stenosis symptoms

A
  • Dyspnoea (breathlessness)
  • Fatigue
  • Palpitations (AF)
    • Mitral stenosis causes the pressure in the left atria to remain elevated, so the atria enlarges → can cause AF
33
Q

mitral stenosis signs

A
  • Mid-diastolic murmur best heard at the apex
  • Malar flush
  • Tapping apex beat
    • due to pressure overload
  • Presents with Atrial Fibrillation (palpilations)
34
Q

mitral stenosis investigations

A
  • auscultations
  • CXR
  • ECG
  • Echocardiogram
35
Q

mitral stenosis Medical therapy

A
  • Diuretics
  • Treat AF
36
Q

mitral stenosis Surgery

A
  • Valve replacement
  • Balloon valvuloplasty if can’t tolerate valve replacement
37
Q

causes of aortic regurgitation

A

valve disease
aortic route disease

38
Q

what is aortic regurgitation

A

Reflux of blood from the aorta through the aortic valve into the left ventricle during diastole (diastolic murmur)

39
Q

aortic regurgitation symptoms

A
  • Significant symptoms occur late, do not develop until LV failure develops
  • Angina
  • Dyspnoea
40
Q

aortic regurgitation signs

A
  • High-pitched early diastolic murmur best heard at the left sternal edge in the fourth intercostal space with the patient leaning forwards and the breath held in expiration
  • Collapsing pulse
  • Apex beat is displaced laterally and downwards and is forceful in quality
41
Q

aortic regurgitation investigations

A
  • ECG
  • CXR
  • Echocardiogram
42
Q

aortic regurgitation Medical therapy

A
  • Treat underlying cause if appropriate
  • Patients with acute aortic regurgitation may need treatment with vasodilators and inotropes
  • ACE inhibitors are useful in individuals with chronic severe AR and heart failure
  • Beta-blockers may slow aortic dilation in Marfan’s patients
43
Q

aortic regurgitation surgery

A
  • indicated in symptomatic patients, and in asymptomatic patients when LV function begins to deteriorate
  • Surgical management involves valve replacement
44
Q

what is aortic stenosis

A

Aortic valve is too small, narrow, or stiff, resulting in the obstruction of blood flow from the left ventricle to the aorta during systole

45
Q

what is mitral regurgitation

A

Occurs when blood leaks back through the mitral valve during systole

46
Q

what is mitral stenosis

A

Occurs when there is obstruction to flow through the mitral valve during diastole

cardio disease profiles (16 decks)

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