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Flashcards in valvular heart disease Deck (36)
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1
Q

what is the clinical history of valvular heart disease?

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

what does cardiac chest pain feel like?

A
  • gripping
  • squeezing
  • heavy
  • crushing
3
Q

describe cardiac breathlessness?

A
  • related to activity (usually)
  • often associated with ankle swelling
  • orthopnoea = SOB on lying flat
  • paroxysmal nocturnal dyspnoea (PND)
4
Q

what are the NYHA classifications?

A
1 = no limitation
2 = slight limitation of ordinary activity
3 = marked limitation of less than ordinary activity
4 = severe limitation of minimal activity or at rest
5
Q

what are the signs of right sided heart failure?

A
  • raised JVP
  • pitting oedema
  • hepatic congestion
6
Q

how do you examine the apex beat?

A
  • normally in 5th interostal mid clavicular line
  • tapping apex beat = mitral stenosis
  • displaced and diffuse in left ventricular dilation (volume overload)
  • heaving and may e displaced in left ventricular hypertrophy (pressure overload)
7
Q

where is parasternal heave felt and why is it present?

A
  • hand left of sternum

- right ventricular overload = cor pulmonale/pulmonary hypertension

8
Q

what are the steps used in order to describe a murmur?

A
  1. systole / 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?
9
Q

how to work out if it is systolic or diastolic?

A
  • 1st heart sound = mitral and tricuspid valve closing, start of systole
  • 2nd heart sound = aortic and pulmonary valves closing, start of diastole
10
Q

what are the types of systolic murmurs?

A
  • pansystolic

- ejection systolic

11
Q

what are the types of diastolic murmurs?

A
  • early diastolic

- mid diastolic

12
Q

what are the grades 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
13
Q

which sided murmur is louder on inspiration?

A
  • right-sided
14
Q

what is an innocent murmur?

A
  • soft (less than 3/6 severity)
  • position dependent
  • often early systolic (diastolic murmurs always pathological)
15
Q

what happens in valve stenosis?

A
  • valves do not open properly
16
Q

what happens in valve regurgitation?

A
  • valves which do not close properly
17
Q

what happens in mixed valve disease?

A
  • valves which neither open properly nor close properly
18
Q

what is aortic stenosis?

A
  • degenerative (age related)
  • become calcified restricting the opening of the valve
  • congenital (eg bicuspid valve)
  • rheumatic
19
Q

what are the symptoms of aortic stenosis?

A
  • breathlessness
  • chest pain
  • dizziness / syncope
20
Q

what are the signs of aortic stenosis?

A
  • low volume pulse
  • forceful displaced apex
  • ejection systolic murmur that can radiate to the carotids
21
Q

what may an ECG show for aortic stenosis?

A
  • LVH

but this does not diagose it

22
Q

how do you treat aortic stenosis?

A
  • conventional valve treatment
  • trans catheter aortic valve replacement (TAVI)
  • balloon aorticvalvotomy (BAV)
23
Q

what types of prosthetic heart valves can you get?

A
  • mechanical = longevity, warfarin required for prevention of clots within the valve, better for younger patients
  • bio-prosthetic (tissue valve) = no warfarin required, last 10 years, better for older patients
24
Q

what are the differences between aortic valve replacement and transcatheter valve implantation?

A
AVR = preferred, long term outcomes, no contra-indications, CABG as well
TAVI = co-morbidity, previous sternotomy
25
Q

what are the causes of mitral regurgitation?

A
  • leaflets = prolapse, rheumatic, myxomayous (floppy), endocarditis
  • chrodae rupture (degenerative) = prolapse/flail leaflet
  • papillary muscles rupture = ischaemic
  • annular dilation = functional
26
Q

what are the symptoms of mitral regurgitation?

A
  • breathlessness
  • peripheral oedema
  • fatigue
27
Q

what are the signs of mitral regurgitation?

A
  • displaced apex

- pan systolic murmur (axilla)

28
Q

what is the treatment of mitral regurgitation?

A
  • medication = diuretics and heart failure (ACE inhibitors)
  • surgical = repair (prolapse) and replacement (degenerative)
  • percutaneous = clips in infancy (encourgaing results)
29
Q

what causes mitral stenosis?

A
  • rheumatic

- congenital rare

30
Q

what are the symptoms of mitral stenosis?

A
  • breathlessness
  • fatigue
  • palpitations (AF)
31
Q

what are the signs of mitral stenosis?

A
  • malar flush
  • tapping apex beat
  • mid diastolic rumbling diastolic murmur localised to apex
32
Q

what is the treatment of mitral stenosis?

A
  • mediaction = diuretics and treat AF
  • surgery = valve replacemnet
  • balloon valvuloplasty
33
Q

what are the causes of aortic regurgitation?

A
  • leaflets = endocarditis, connective tissue diseases, rheumatic
  • annulus = marfans, aortic dissection
34
Q

what are the symptoms of aortic regurg?

A
  • SOB
35
Q

what are the signs of aortic regurg?

A
  • collapsing pulse
  • wide pulse pressure
  • displaced apex
  • early diastolic murmus left sternal edge
36
Q

what is the aortic regurg treatment?

A
  • meidiaction - aCE

- surgeyr = LV dilation, valve replacment