valvular disorders

Question 1

what are Spondylarthropathies

Answer 1

basically arthritis of the vertebral column
subtypes include:
enteropathic arthritis (EA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), and reactive arthritis (ReA)

Question 2

what valvular disorder can be caused by Spondylarthropathies and how

Answer 2

aortic regurgutation
the cellular inflammation causes proliferative endarteritis (inflammation of inner lining of artery) which thickens the cusps of the aorta = aortic regurgitation (cant close properly)

Question 3

what is a severe sign of AR

Answer 3

de mussets - head bobbing (in time with heart beat as patient can feel systolic pulse due to wide pulse pressure)

Question 4

early diastolic murmur is assocaited with what?

Answer 4

AR - intensity is increased by handgrip manoeuvre
mid-diastolic murmur = severe

Question 5

what type of pulse is palpated in AR

Answer 5

collapsing pulse- as blood is pushed out at high pressure but leaks back into ventricles

also pulsating nail bed

Question 6

what are the causes of aortic regurg - aortic root

Answer 6

aortic dissection
biscuspid valve - most common in developed countries
rheumatic fever - most common in developing countries
spondylarthropathies
hypertension
syphilis
marfans and EDS

Question 7

what is the pharmacological management of AR

Answer 7

lorsartan - targeted at reducing aortic root dilation by lowering systolic bp

Question 8

what type of medication is contraindicated in AR

Answer 8

beta blockers - they increase time in diastole thus increase regurgitation

Question 9

What is the definitive management of aortic regurgitation?

Answer 9

aortic valve replacement

Question 10

what are the criteria for aortic valve replacement

Answer 10

-symptomatic AR
-asymptomatic AR with reduced EF or ventricular dilation
-enlargement of ascending aorta
-infective endocarditis

Question 11

diagnostic investiagtions for AR

Answer 11

1. echo
2. cardiac MRI
3. invasive cardiac catheterisation

Question 12

how is AR heard the best

Answer 12

left sternal edge, on expiration and leaning forward

Question 13

how is AS heard best

Answer 13

expiration, leaning forward,

Question 14

what are the initial investigations for suspected AS

Answer 14

ecg
cxr

Question 15

What is the management of symptomatic aortic stenosis?

Answer 15

aortic valve replacement

Question 16

left ventricular hypertrophy can cause what in AS

Answer 16

apex displacement

Question 17

Surgical management of symptomatic aortic stenosis

Answer 17

aortic valve replacement
young - surgical as risk is low
elderly - risk is high so transatheter aortic valve implantation

Question 18

when is pulmonary stenosis loudest

Answer 18

on inspiration

Question 19

what are the main causes of aortic stenosis (above and below 65)

Answer 19

above = degenerative calcification
below = bicuspid aortic valve

Question 20

history of rheumatic fever is a risk factor for what valvular disease

Answer 20

aortic stenosis

Question 21

what are the indications for surgical management of mitral regurg

Answer 21

reduced EF
left ventricular dilation
pulmonary artery systolic BP rise >60mmHg upon exercise testing

Question 22

what might be seen on CXR of mitral regurg

Answer 22

cardiomegaly

Question 23

what arrhythmia is associated with MR

Answer 23

AF - due to left atrial enlargement

Question 24

what associated issues cause the symptoms of MR

Answer 24

left ventricular failure - dyspnoea and fatigue
pulmonary hypertension - Haemoptysis and breathlessness
AF - palpitations

Question 25

what is The most common ischaemic cause of acute mitral regurgitation

Answer 25

MI - chordae tendinae or papillary msucles can be damaged by MI

Question 26

what is the management for AF secondary to MS

Answer 26

warfarin - 1st line and BB

Question 27

S1 sound in MS

Answer 27

loud snap

Question 28

what is the most common presentation of Mitral stenosis

Answer 28

exertional dyspnoea

Question 29

Management options for symptomatic mitral stenosis:

Answer 29

diuretic (furosemide = first line) balloon valvotomy / valve replacement

Question 30

main cause of Mitral S

Answer 30

rheumatic fever ( strep antigens)

Question 31

what is the likley cause of an extra sound heard after S2

Answer 31

- S3 gallop, occurs at end of rapid diastolic filling within the ventricle = heart failure and increased ventricular filling pressure

Question 32

mid-systolic click (best heard over the left 5th intercostal space)

Answer 32

mitral valve prolapse - leg raise and squatting improve symptoms

Question 33

holosytolic murmur which increases with inspiration

Answer 33

tricuspid regurgitation - severe cases show signs of right-HF inc. JV distension, hepatosplenomegaly, ascities and peripheral odema