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51 Cards in this Set
- Front
- Back
Incidence of valvular heart disease increases with
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advancing age
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Patients feel breathless because
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increased left atrial pressure causes pulmonary congestion and lungs become stiff/non-compliant
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Symptoms of increased LA pressure/LV strain:
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breathless + angina on exertion, symptoms of HF, palpitations
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What clinical signs would you expect?
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cardiac murmurs(!)/thrills, HF signs (JVP, basal insp crackles, peripheral oedema), heave, apex displacement
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An ejection vs pansystolic murmur points towards...
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Ejection = pulmonary or aortic; Pan = tricuspid or mitral
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Where can murmurs radiate to?
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carotid or axilla
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Intensity can be graded. What grade is moderately loud?
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Grade 3
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A flow murmur is
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benign, soft systolic over pulmonary valve, no radiation, no other signs of cardiac disease
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A bell is useful to listen to low pitch sounds, such as
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mitral stenosis
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What would a high speed doppler be suggestive of?
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stenosis (high speed going through narrowing)
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Aortic valve disease is common in people with
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bicuspid valve
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AORTIC STENOSIS
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(calcific deposits on aortic valve)
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The most common cause of A. stenosis is
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degenerative calcific stenosis of normal valve presenting in 7th decade (risk factor = atherosclerosis)
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The second most common cause of A. stenosis is
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degenerative calcific stenosis of bicuspid valve presenting in 5th/6th decade (+ aortic root/asc. aorta dilatation)
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Another less common cause of A. stenosis is
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rheumatic stenosis (+ mitral valve stenosis)
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Symptoms of A. stenosis (3)
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dyspnoea, syncope, angina
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A. stenosis murmur findings:
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ejection systolic, crescendo-decrescendo, aortic valve area, radiation to carotids
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Progression of A. stenosis: normal Vmax <1m/s... severe Vmax = ?
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normal <1m/s; mild <3m/s; moderate <4m/s; severe >4m/s
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When should you treat A. stenosis?
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at the onset of symptoms (angina, syncope, failure)
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Aortic sclerosis is when some valves have calcific change and generate a typical
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stenotic murmur but no gradient
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Time taken for aortic sclerosis to progress to severe A. stenosis is
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~8years
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What is the prognosis of A. stenosis without valve replacement?
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extremely poor vs very good
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AORTIC REGURGITATION
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(leaky aortic valve)
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Aortic regurgitation has 2 underlying causes:
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leaflet pathology and root dilatation
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Aortic leaf pathology can be due to
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bicuspid aortic valve; endocarditis; rheumatic valve disease; vasculitis; dopamine agonists
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Aortic root dilatation can be due to
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idiopathic; HTN; aortic dissection; Marfan's; syphilis
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A. regurg murmur findings:
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early diastolic, quiet grade 2 murmur
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A. regurg clinical findings:
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LV dilatation -> apex displacement; wide pulse pressure and collapsing; visible nail bed pulsation (Quincke's); pistol shot sound when femoral a. is compressed (Duroziez's)
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What is Quincke's sign?
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visible nail bed pulsation
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What is Duroziez's sign?
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pistol shot when fem. a. compressed
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What is de Musset's sign?
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head nodding in time with heart beat
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Who with a. regurg. should be considered for valve replacement?
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symptomatic or asymptomatic with LV dilatation/systolic impairment
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MITRAL REGURGITATION
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(leaky mitral valve)
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Underlying causes include
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LV impairment dilatation (post MI, cardiomyopathy); Valve leaflet disease (endocarditis, rheumatic heart disease, papillary muscle rupture)
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M. regurg causes
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LA dilatation -> AF and elevated pulmonary pressures
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M. regurg murmur findings:
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pansystolic murmur, loud at LLSE, may radiate to axilla, structural leaflet disease (e.g. mitral prolapse) louder
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M regurg clinical findings:
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apex displacement, AF, elevated JVP, signs of HF
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MR: Type 1 dilated annulus is when
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the leaflets don't properly shut closed
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MR: Type 2 rupture/prolapse is when
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the chordae tendinae breaks and flap goes back into atrium
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MR: Type 3a/b (rheumatic/ischaemic) is when
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flaps are inflammed/papilla weak
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Treatment of severe m. regurg: surgery indicated if
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symptoms of HF; LV dilatation/impairment of LV Fx; valve suitable for repair
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MITRAL STENOSIS
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(calcific changes on mitral valve -> stiff)
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M. stenosis is most common valvular manifestation of
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rheumatic heart disease
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What is the Duckett-Jones criteria for Acute Rheumatic Fever?
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MAJOR: carditis, arthritis, chorea, erythema marginatum, SC nodules; MINOR: arthralgia, fever, ESR, CRP, prolonged PR [2 major or 1 major + 2 minor]
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What organism causes rheumatic fever?
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strep Group A
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What gradient in m. stenosis is unusual?
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high gradient between LA and LV
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M. stenosis causes elevated pulmonary pressures and
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LA dilatation -> AF
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M. stenosis murmur findings:
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quiet mid diastolic, low pitch rumbling
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M. stenosis clinical finidngs:
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pulmonary HTN signs (loud P2, elevated JVP, mitral facies, RV heave), AF
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Treatment for M. stenosis includes
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balloon valvuloplasty or mitral valve replacement
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NEW TREATMENTS OF VALVE DISEASE:
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self-expanding multi-level support frame, mitral annuloplasty, Alfieri mitraclip
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