Valvular Heart Disease

Question 1

Clinical History of Valvular heart disease

Answer 1

Cardiac chest pain, breathlessness, collapse, dizzy spells Exertional symptoms

Question 2

What particular type of breathlessness is related to valvular heart disease

Answer 2

Orthopnea- breathless lying down Paroxysmal Nocturnal dyspnoea- waking up SOB

Question 3

What is a useful question to ask about when gauging the level of SOB

Answer 3

How many pillows do you use? More pillows the worse orthopnea

Question 4

Right sided heart failure

Answer 4

raised JVP, pitting oedema, hepatic congestion

Question 5

Parasternal Heave

Answer 5

left of sternum placed vertically right ventricular overload

Question 6

Causes of parasternal heave

Answer 6

Cor pulmonale, pulmonary hypertension

Question 7

Six questions for assessing an murmur

Answer 7

Systole or Diastole What type? Where is it located? Where does it radiate too? What grade is it? Is it influenced by inspiration?

Question 8

How does the grading for murmurs work?

Answer 8

Grade 1- very quiet Grade 6- audible without a stethoscope Grade 4+ - murmur accompanied by a thrill

Question 9

Which murmur is affected by respiration?

Answer 9

Right sided murmurs are louder on inspiration

Left sided murmurs are louder on expiration

Question 10

What causes a constant murmur?

Answer 10

A patent ductus arteriosus

Question 11

Describe an innocent murmur?

Answer 11

Soft less than a 3 Very localised with no radiation

Question 12

Symptoms of Aortic stenosis

Answer 12

Breathless

Increased fatigue

Chest pain

Dizziness

Question 13

Signs of aortic stenosis

Answer 13

Low volume pulse

Forceful displaced apex

High pressure gradient between ventricle and aorta

My show large ST complex due to hypertrophy V1-V6

Question 14

Murmur of aortic stenosis

Answer 14

Ejection systolic murmur

Rdaiates to the carotids

Question 15

Treatment for aortic stenosis

Answer 15

Valve replacement

Trans catheter aortic valve replacment

baloon aortic valvotomy

Question 16

Benefits of mechanical valve replacement in aortic stenosis

Answer 16

Infinite lifespan

Often in younger patients

Question 17

Benefits of bio prosthetic valve replacement in aortic stenosis

Answer 17

No warfirin required

Better for older patients

Question 18

Causes of mitral regurgitation

Answer 18

Prolapse, Rheumatic, Myxomatous (floppy), endocarditis

Question 19

Name a degenerative cause of mitral regurgitation

Answer 19

Chordae rupture

Question 20

Name an ischaemic cause of mitral regurgitation

Answer 20

Papilliary muscle rupture

Question 21

Symptoms of mitral regurgitation

Answer 21

Breathlessness

Peripheral oedema

Fatigue

Question 22

Signs of mitral regurgitation

Answer 22

Displaced apex

Pansystolic murmur

Question 23

What medication would you give for mitral regurgitaion

Answer 23

Diuretics and ARB and ACE inhibitors

Question 24

Surgical options for mitral regurgitation

Answer 24

Prolapse- Repair

Degeneration- Replacement

Infancy- percutaneous clip attatchment

Question 25

Mitral Stenosis

Answer 25

Main cause is essentially rheumatic Congenital is rare

Question 26

Symptoms of mitral stenosis

Answer 26

Atrial fibrillation- atria dilates as pressure builds up as increased volume stored in atria SOB Fatigue

Question 27

Symptoms of mitral stenosis

Answer 27

Mallar flush- plum red cheeks due to CO2 retention Tapping apex beat

Question 28

Murmur associated with mitral stenosis

Answer 28

Mid diastolic rumbling murmur localised to the apex beat

Question 29

Medication for mitral stenosis

Answer 29

Treat the atrial fibrilation - anticoagulants, Beta blockers Ca2+ channel blockers Diuretics

Question 30

Aortic regurgitation causes

Answer 30

Endocarditi,connective tissue diseases, rheumatic, marfans, aortic dissection

Question 31

Signs or aortic regurgitation

Answer 31

Collapsing pulse Wide pulse pressure Displaced Apex

Question 32

Murmur associated with aortic regurgitation

Answer 32

Early diastolic murmur Located at left sternal edge

Question 33

Treatment for Prosthetic valve infection

Answer 33

Gentamicin+ Vancomycin IV Add rifiampacin 3-5 days later Often valve replacement

Question 34

Treatment for native valve endocarditis

Answer 34

Amoxycillin + gentamicin IV Usually Viridans Streptococci

Question 35

Treatmant for drug user endocarditis

Answer 35

Flucloxacillin IV

Question 36

Subacute Presentation of infective endocarditis

Answer 36

Clubbing Splinter haemorrhage New Murmur Fever Fatigue Roth spots