Valvular Heart disease

Question 1

when are symptoms of valvular heart disease shown?

Answer 1

on exertion

= exertional symptoms

Question 2

what are symptoms of valvular heart disease?

Answer 2

1) chest pain
- gripping
- squeeing
- heavy
- crushing
2) breathlessness
3) collapse
4) dizzy spells
= exertional symptoms

Question 3

what 4 things is cardiac breathlessness associated with?

Answer 3

1) related to activity
2) associated with ankle swelling
3) orthopnoea (SOB when lying flat)
4) paroxysmal Nocturnal dyspnoea (PND) = waking from sleep unable to breathe

Question 4

what is used for functional classification?

Answer 4

Class I = no limitation
Class II = slight limitation on ordinary activity
Class III = mark limitation of less than ordinary activity
Class IV = severe limitation of minimal activity

Question 5

what are 3 signs of right heart failure?

Answer 5

1) raised JVP
2) pitting oedema
- ankles or sacrum
3) hepatic congestion

Question 6

what would the apex beat be in mitral stenosis?

Answer 6

= tapping apex

Question 7

when would the apex beat be displaced and diffused?

Answer 7

= In left ventricular dilation (volume overload)

Question 8

when would the apex beat be heaving and displaced?

Answer 8

= in left ventricular hypertrophy (pressure overload)

Question 9

where would you find a parasternal heave?

Answer 9

= hand of left sternum

Question 10

what would a parasternal heave show?

Answer 10

= right ventricular overload

- cor pulmonale/pulmonary hypertension

Question 11

what is a cardiac murmur?

Answer 11

= audible turbulence of blood flow

- can be innocent & pathological

Question 12

what 6 questions should you cover when describing cardiac murmurs?

Answer 12

1) systole or diastole?
2) what type of murmur?
3) where is it loudest?
4) where does it radiate to?
5) what grade of murmur?
6) (influenced by respiration)?

Question 13

how would you know if the murmur is in systole or diastole?

Answer 13

1st heart sound
= start of systole
= mitral & tricuspid closing

2nd heart sound
= start of diastole
= aortic & pulmonary closing

Question 14

when is aortic stenosis heard?

Answer 14

systole

Question 15

when is mitral regurgitation usually heard?

Answer 15

systole

Question 16

when is aortic regurgitation usually heard?

Answer 16

diastole

Question 17

when is mitral stenosis usually heart?

Answer 17

diastole

Question 18

what are the 2 types of systolic and diastolic murmur?

Answer 18

Systolic

1) pan systolic
2) ejection systolic

Diastolic

1) early diastolic
2) mid diastolic

Question 19

what 2 areas might the murmurs radiate to?

Answer 19

1) carotids (aortic stenosis)

2) axilla (mitral regurgitation)

Question 20

describe the grading of murmurs?

Answer 20

1) very quiet
2) quiet
3) Loud
4) loud with a thrill
5) very loud with a thrill
6) loud = audible without a stethoscope

Question 21

when are right sided murmurs louder?

Answer 21

louder with inspriation

Question 22

what could aortic stenosis cause to heart sounds?

Answer 22

2nd sound splitting

Question 23

what sound could also be heard in aortic regurgitation?

Answer 23

= 3rd sound

Question 24

what is an innocent (functional) murmur?

Answer 24

= soft (less than 3/6severity)
= position dependent
- often early systolic

Question 25

what are diastolic murmurs always?

Answer 25

always pathological

Question 26

what are 3 types of valvular heart disease?

Answer 26

1) valve stenosis 2) valve regurgitation 3) mixed valve disease

Question 27

what is valve stenosis?

Answer 27

= valves which don't open properly

Question 28

what is valve regurgitation?

Answer 28

= valves which don't close properly

Question 29

what is mixed valve disease?

Answer 29

= valves which neither open properly nor close properly

Question 30

what would you find in the history and physical examination in a patient with valvular disease?

Answer 30

History = restriction & functional capacity Physical examination = murmurs & signs of heart failure

Question 31

what investigations should be done if you suspect valvular heart disease?

Answer 31

1) non-invasive = echo 2) invasve = catheter cauterisation

Question 32

what are 3 characteristics of AORTIC STENOSIS?

Answer 32

= degenerative (age related) = congenital (e.g. bicuspid valve) = rheumatic

Question 33

what are symptoms of AORTIC STENOSIS?

Answer 33

1) breathlessness 2) chest pain 3) dizziness/syncope ON EXERTION

Question 34

what are signs of AORTIC STENOSIS?

Answer 34

1) low volume pulse 2) forceful displaced apex 3) ejection systolic murmur that can radiate to carotids

Question 35

what 3 things can you do to treat AORTIC STENOSIS?

Answer 35

1) conventional valve replacement 2) trans-catheter aortic valve replacement (TAVI) or trans-catheter aortic valve insertion (TAVI) 3) balloon aortic valvotomy (BAV)

Question 36

what are the 2 types of prothetic heart valves used in AORTIC STENOSIS?

Answer 36

1) mechanical - lasts longer - younger patients - warfarin (patient will need anti-coagulants) 2) bio-prosthetic (tissue valves) - 10 years lifespan - older patients - no warfarin

Question 37

compare aortic valve replacement (AVR) to trans-catheter aortic calc insertion (TAVI) used in AORTIC STENOSIS?

Answer 37

AVR - preferred - long term - no contra-indications - CABG as well TAVI - co-morbidity - previous sternotomy

Question 38

what are 4 causes of MITRAL REGURGITATION?

Answer 38

1) leaflets 2) chord rupture (degenerative) 3) papillary muscles rupture 4) annular dilatation

Question 39

what are the causes of leaflets in MITRAL REGURGITATION?

Answer 39

- prolapse - rheumatic - myxomatous - endocarditis

Question 40

what is the cause of chord rupture in MITRAL REGURGITATION?

Answer 40

- prolapse/flail leaflets

Question 41

what is the cause of papillary muscles rupture in MITRAL REGURGITATION?

Answer 41

= ischaemic

Question 42

what is the cause of annular dilatation in MITRAL REGURGITATION?

Answer 42

= functional

Question 43

what are the symptoms of MITRAL REGURGITATION?

Answer 43

- breathlessness - peripheral oedema - fatigue

Question 44

what are the signs of MITRAL REGURGITATION?

Answer 44

- displaced apex - pan systolic murmur = axilla

Question 45

what are the 3 options to treat MITRAL REGURGITATION?

Answer 45

1) Medication - diuretics & heart failure (ACE inhibitors) 2) surgical - repair = prolapse - replace = degenerative 3) per-cutaneous - clips in infancy

Question 46

what is the main cause of MITRAL STENOSIS?

Answer 46

= rheumatic is main cause - congenital is rare

Question 47

what are the symptoms of MITRAL STENOSIS?

Answer 47

- breathlessness - fatigue - palpitations (AF)

Question 48

what are the signs of MITRAL STENOSIS?

Answer 48

- malar flush - tapping apex beat - mid diastolic rumbling diastolic murmur localised to apex

Question 49

how could you treat mitral stenosis?

Answer 49

1) medication = diuretics & treat AF 2) surgery = valve replacement 3) balloon valvuloplasty = widens the mitral valve so that blood flows more easily through the heart

Question 50

what are the causes of AORTIC REGURGITATION?

Answer 50

1) leaflets | 2) annulus

Question 51

what causes leaflets in AORTIC REGURGITATION?

Answer 51

- endocarditis - connective tissue diseases - rheumatic

Question 52

what causes annulus in AORTIC REGURGITATION?

Answer 52

- marfans | - aortic dissection

Question 53

what are then symptoms of AORTIC REGURGITATION?

Answer 53

- breathlessness

Question 54

what are the signs of AORTIC REGURGITATION?

Answer 54

- collapsing pulse - wide pulse pressure - displaced apex - early diastolic murmur left sternal edge

Question 55

how would you treat AORTIC REGURGITATION?

Answer 55

1) medication = ACE inhibitors 2) surgery = symptoms and LV dilatation = valve replacement