Medicine 1 > Week 5 > Flashcards

Week 5 Flashcards

(53 cards)

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1
Q

describe mitral stenosis

A

blood is obstructed from flowing across the mitral valve from the left atrium to the left ventricle

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2
Q

mitral stenosis leads to increased pressure with the left ventricle

a. true
b. false

A

b. false

increased pressure within the left atrium, the pulmonary vasculature and consequently the right side of the heart

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3
Q

what are the causes of Mitral Stenosis

A
  • Rheumatic Fever/Heart disease *

(more rarely - congential mitral stenosis, lupus or rheumatoid arthritis)

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4
Q

Name some key symptoms of Mitral valve stenosis

A
  1. SOB (dyspnoea) - due to increased pulmonary press/oedema
  2. Haemoptysis - due to increased pressure/congestion - thin walled veins/bronchial veins rupture
  3. Hoarseness of voice - LA enlargement- compresses L reccurent larygngealnerve
  4. systemic emboli - LA and Left atrial appendage hypertrophy
  5. Atrial fibrillation (secondary to LA hypertrophy)
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5
Q

Clinical signs (on examination) of Mitral Valve Stenosis

A
  • Mid-Late diastolic murmur - best heard on expiration
  • Loud S1 sound (easily snapping closed)
  • Low volume pulse (less blood pumped out)
  • Malar flush/Mitral faces
  • RV heave (due to dilation) / diastolic thrills (papable murmurs)
  • Tapping Apex beat
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6
Q

When is a murmur heard in a patient with Mitral Valve Stenosis

A

Mid - late diastole

easier heard on expiration

(possible loud S1 sound of valves snapping shut)

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7
Q

Malar flush is classically associated with what valvular dysfunction

A

Mitral Valve Stenosis

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8
Q

How is Mitral Valve Stenosis diagnosed

A

Echocardiogram - will show thickening and scarring of leaflet

CXR - might see enlargement of LA

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9
Q

How is Mitral Valve Stenosis treated

A
  • Anti-coagulants - esp if A-Fib and high risk of stroke - WARFARIN reccomended
  • Diuretics /lower Na+ to reduce oedema in lungs
  • Percutaneous -> widen the valve with balloon (VALVOTOMY)
  • Surgery (MV replacement)
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10
Q

Mitral Valve Stenosis is more apparent when someone is tachycardic

a. true
b. false

A

a. true

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11
Q

describe mitral regurgitation

A

blood leaks back through the Mitral Valve and into the LA during systole (when should be shut)

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12
Q

what is the overall result of mitral regurgitation on the blood pumped around the body?

A

there is LESS blood pumped through the body with each contraction

Oxygen demands may exceed what the heart can supply

Leads to fatigue -> heart failure

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13
Q

Why might people with Mitral valve regurgitation feel fatigued

A

The heart cannot pump out enough blood through the body

Oxgyen supply does not meet the demand

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14
Q

What can cause mitral valve regurigtation

A
  • Coronary Artery Disease/MI - insult to chordae tendinae or papillary muscles
  • Mitral valve prolaspe/deformities of the leaflets
  • Infective endocarditis - vegetations from organisms colonising the hear and growing on MV - prevent it from closing
  • Rheumatic fever
  • Genetic
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15
Q

Risk factors for Mitral Valve Regurgitation

A
  • Collagen disorders -> marfans syndrome or Ehlers-Danos syndrome
  • Female sex
  • Prior myocardial infarction, or valve prolaspe
  • Lower body mass
  • Renal dysfunction
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16
Q

symptoms of mitral valve regurgitation

A
  • Palpitations - due to A-Fib/arrythmias
  • SOB - pulmonary hypertension and oedema
  • Fatigue

symptoms mainly due to LV failure

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17
Q

Clincial signs on Examination of mitral valve regurigitation

A
  • Pan-systolic murmur (throughout systole)
  • blowing sound
  • heard over APEX
  • radiates to Axilla
  • S1 may be quiet - due to incomplete closer of the valve
  • RV heave - backed up blood - increased pressure in pulmonary circulation
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18
Q

Investigations for Mitral valve regurgitation?

A

ECG - broad P waves (indicative of atrial enlargement)

CXR - cardiomegaly (enlarged heart - LA + LV)

Echocardiogram * crucial

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19
Q

What would an ECG show in a patient with Mitral valve regurgitation?

A
  • broad P waves (indicative of Atrial enlargement)
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20
Q

How would mitral valve regurigitation show on a CXR

A

Cardiomegaly - LA enlargement/LV

or Calcifications on mitral annulus

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21
Q

Medical management of Mitral Valve regurigitation involves

A
  1. Nitrates (vasodilators) - Sodium Nitroprusside (lower preload/afterload)
  2. Positive ionotropes - Dobatumine
  3. Diruetics - reduce symptoms

If in heart failure (ACEi, Beta-Blockers, Spironalactone)

Surgery! will eventually all need (repair or replacement)

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22
Q

Features of Aortic Stenosis - how it eventually causes Heart Failure

Study These Flashcards
A

It is difficult for the LV to pump blood through the aorta

pressure increases within the Left Ventricle/Left Atria

leading to hypertrophy

this increases the myocardial oxygen demand and eventually causes HF

23
Q

causes of Aortic Stenosis

Study These Flashcards
A
  • Degenerative disease - inflammatory process (> 65 yo, thickens, calcifies, atheroscelorosis)
  • Bicuspid Aortic valve (< 65 yo) - younger patients
  • post - Rheumatic disease
24
Q

Symptoms of Aortic Stenosis

Study These Flashcards
A

A long time is spent in asymptomatic phase

And then (sudden decline)

* Syncope/pre-syncope - exertional dizziness
* SOB (dyspnoea)
* Chest pain
* Heart failure

(triad : SOB, syncope and angina - chest pain)

25
The classic triad of symptoms in aortic stenosis
1. SOB - Dyspnea 2. Chest pain - angina 3. Syncope
26
Clinical examination findings in aortic stenosis
* Ejection Systolic Murmur - radiates to carotids * Slow rising pulse/low BP * Aortic thrill * LV heave due to hypertrophy * Low (narrow) pulse pressure - due to low SV
27
Pulse pressure
Systolic - Diastolic blood pressure narrow (low) - aortic stenosis wide (high) - aortic regurgitation
28
ejection systolic murmur
murmur which is due to blood flow through a narrowed vessel during heart muscle contraction * aortic stenosis -> radiates to the carotids
29
investigations for aortic stenosis
ECG - LV strain (ST depression, T wave inversion) CXR - calcification of valve Echo - leaflet thickening/pressure-gradients with doppler echo
30
What does the pulse feel like in Aortic Stenosis?
Slow rising pulse
31
What might you feel when palpating the chest of someone with aortic stenosis
Aortic thrill LV heaves - due to hypertrophy
32
Treatment for Aortic stenosis
* Valve replacement /repair * give meds for HF in meantime
33
describe aortic regurigitation
Blood flows back through the aortic valve *during ventricular diastole * Blood therefore backs up within the LV LV volume and pressure increases LV hypertrophy Increased 02 demand of myocardiu Ischamia and HF
34
Valvular diseases that can cause Aortic regurgitation
* Rheumatic fever * Connective tissue disorders (SLE, rheumatoid arthritis) * Biscupid aortic valve * ACUTE -> infective endocarditis
35
Causes of Aortic regurigitation due to Aortic Root disease
* Marfans, Ehler-Danlos Syndrome * Syphillis * Hypertension * Spondlarthropathies (anklyosing spondylitis) * biscupid aortic valve (affects valves and root)
36
symptoms of aortic regurgitation
* LV failure * Cyanosis * Dyspnoea Can go for a long period of time without symtoms SOB on exertion
37
clinical examination findings in aortic regurigitation
* Early diastolic murmur (soft) - intensity increases with handgrip maneover * Collasping pulse* *WIDE pulse pressure *displaced and hyperdynamic APEX beat
38
Collasping pulse could be a sign of?
Aortic regurgitation
39
How is the pulse pressure normally described in aortic regurigitation?
WIDE pulse pressure (blood regurigitates back to LV during diastole - the diastole pressure in arota decreases - therefore leading to an increase in pulse pressure)
40
Why is there a wide pulse pressure in aortic regurigitation
(blood regurigitates back to LV during diastole - the diastole pressure in arota decreases - therefore leading to an increase in pulse pressure)
41
Describe the murmur in aortic regurgitation
EARLY diastolic murmur (soft) intensity increases with handgrip manouver
42
Suspected Aortic regurigitation should be investigated with ?
Echocardiography AV thickening, prolaspe, vegetations LV function/hypertrophy Doppler-echo - shows regurgitant flow
43
How can we treat aortic regurgitation
* Vasodilators can prolong the need for surgery but will eventually need to be surgically repaired
44
Long QT 1 is associated with
exertional syncope, often swimming
45
Long QT 2 is associated with
syncope occurring following emotional stress, exercise or auditory stimuli
46
Long QT 3 is associated with
events often occur at night or at rest
47
Electrolyte abnormalities that can cause long QT
hypokalaemia, hypocalcaemia hypomagnesaemia.
48
Management of Long QT
1/ Avoid drugs which prolong the QT interval and other precipitants if appropriate (e.g. Strenuous exercise) 2/ ***Beta-blockers* 3/ implantable cardioverter defibrillators in high risk cases*****
49
cause of Long QT
blockage or loss of function of K+ channels
50
Long QT syndrome (LQTS) is an inherited condition associated with delayed repolarization of the ventricles a. true b. false
a. true normally due to blockage or loss of function of K+ channels
51
Infective endocarditis increases the risk of emboli a. true b. false
a. true leading to stroke
52
orthopnoea (breathlessness when lying down) is a distinguishing feature of?
HEART FAILURE can distinguish from COPD
53
orthopnoea (breathlessness when lying down) is a distinguishing feature of?
HEART FAILURE can distinguish from COPD
Medicine 1
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