2.04 - Cardiac Valve Disease Flashcards
Describe the relationship of the cardiac valves (i.e. posterior, anterior, right and left) when looking from a superior view
Tricuspid: Posterior, Right
Pulmonary: Anterior, Middle
Mitral: Posterior, Left
Aortic: Middle, Middle
What terms are used to describe murmurs on auscultation?
P: Pulse and Pressure - where is it loudest, what does the pulse feel like?
Q: Quality - harsh, rumbling, blowing
R: Respiration - does the murmur increase or decrease with inspiration and expiration
S: Spread - where does it radiate to?
T: Timing - systolic of diastolic
What are the three broad categories for valve disease?
Narrowing (stenosis), Leak (regurgitation/incompetence) or Both (mixed valve disease)
What changes occur in the heart with valve stenosis?
Increase in pressure required to drive blood across valve
Thickening of muscle in chamber behind the valve
Increase in pressure in veins behind the valve (pulmonary veins for the mitral valve)
Pressure gradient across the valve
What changes occur in the heart in valvular reguritation?
Volume load increase for chamber of veins behind the valve. E.g. Aortic regurgitation –> LV dilatation
Later venous engorgement (pulmonary, systemic or both)
What are some causes of valve disease?
Congenital
Rheumatic: acute rheumatic fever, complication of childhood strep. infection
Infective
Degenerative: elederly
Secondary to other heart or vessel disease
What are common symptoms of left sided valve disease?
Dyspnoea (which usually increases gradually over time)
Exertional chest tightness or syncope
What are some symptoms of right sided valve disease?
Rarly occur in isoltation unless congenital.
Oedema, fatigue, dyspnoea, cyanosis
What investigations would you order for suspected valve disease?
Echocardiography (most useful)
Echo with Doppler (blood flow rather than anatomy)
Chest X-Ray (no longer routine but may be useful)
ECG (not very specific but may reveal rhythm disturbances secondary to valve disease)
