Valvular Heart Disease (core) Flashcards Preview

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Flashcards in Valvular Heart Disease (core) Deck (35)
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1

What is a TAVI?

Transcathetic aortic valve implant

1

How does auscultation of AS change with increasing severity of the disease?

The more severe, the more widely it's heard on the precordium

1

When is the valve replaced in AS?

Severe AS on echo + Symptoms

 

3

What types of hypersensitivity mediates rheumatic fever?

Type II

4

What causes MR?

Myxomatous degeneration (mitral valve prolapse)

Ruptured chordae tendinae

Infective endocarditis

MI - ruptured papillary muscle

5

When do you operate in AR?

Once the LV starts to increase in size (on echo)

5

What are some signs of MS?

Mitral facies

Tapping apex beat

6

How is rheumatic fever managed long term?

Long term antibiotic prophylaxis

7

Describe the murmur in MR?

Pansystolic

Rumbling

Mostly heard at the apex (occasionally at the base too)

8

What are the pros and cons of bioprosthetic valve?

Pros: Don't need anticoagulants

 

Cons: Shorter life (10-15years)

9

What is a TOE best for?

Mitral valve

Thombus in the LV

Endocarditis on valves or pacemaker leads

11

What has happened to the LV at onset of symptoms in regurg?

Irreversibly damaged

12

How does the LV compensate for regurgitation? What happens at decompensation?

Increases EDV while ESV remains the same = an increase in SV and EF

 

Pump failure: EDV further increases

ESV increases

EF decreases

13

What causes aortic regurg?

Aortic leaflet damage - endocarditis, rheumatic fever

Aortic root dilated - Marfan's syndrome, aortic dissection, syphilus

14

How does the LV change in AS?

Concentric hypertrophy

16

What are the pros and cons of mechanical valves?

Pros: they last forever

 

Cons: require anticoagulation with warfarin (INR 2-3)

17

How do you decide which type of valve to use?

Age

>70 - Bioprosthetic

18

What are some peripheral signs of AS?

Slow upstroke of carotid pulse

Heaving apex beat

Thrill over upper R sternal edge

19

What causes TR?

RVF - due to pulmonary hypertension

Endocarditis

Pacemaker leads

20

What are some signs of AR?

Collapsing pulse - fast up and down stroke

Wide pulse pressure

Early diastolic murmur

Various other signs

21

What are the symptoms of AS?

SOB

Chest pain

Syncope

22

What are the two major types of degenerative valvular disease?

Aortic calcification - Aortic stenosis

Mitral prolapse - Mitral regurg

23

Characterise the sound of AS

Ejection systolic - crescendo-decrescendo

Best heard at upper R sternal edge with diaphragm

Can also be heard elsewhere on precordium

 

24

What are some complications of MS?

Atrial dilatation and AF

Thrombo-embolism

Pulmonary hypertension

RHF

25

How does infective endocarditis present most commonly?

Fever and murmur

26

What are the clinical features of rheumatic fever?

Fever

Arthritis - migratory polyarthritis, large joints

Rash - erythema marginatum

Subcutaneous nodules - over bones, tendons

Murmur

Sydenham's chorea

27

What are the causes of AS?

Age related calcification

Congenital - AS, bicuspid

Rheumatic fever

28

How is rheumatic fever diagnosed?

By clinical feature only, using the Jone's criteria

29

What is the major cause of mitral stenosis?

Rheumatic fever

30

Describe the murmur in MS?

Pan-diasystolic

OS opening snap mitral opening