Cardiac Valve Defects Flashcards
What is S1?
Closure of the AV valves (mitral, tricuspid)
What is S2?
Closure of the semilunar valves (pulmonary, aortic)
How do you describe a murmur?
- Location (where heard loudest)
- When? Systolic/diastolic?
- Ejection (at the start)/ Pan (throughout)?
- Pitch?
- Radiation?
What is valve stenosis?
Failure of a valve to open completely, usually due to a chronic process.
What is valve regurgitation?
Failure of a valve to close completely which may be due to an acute/chronic process.
What are the causes of mitral regurgitation?
Mitral valve prolapse, infective endocarditis, post rheumatic fever, rupture of papillary muscle post-MI, LV dilation (stretching of valve ring).
What is the process occurring in acute mitral regurgitation?
- Sudden onset usually due to infective endocarditis/papillary muscle rupture post-MI.
- Heart does not have time to undergo compensatory changes.
- Blood backflows in the LA, increasing the pressure in the LA.
- Increases pressure in the pulmonary circulation = pulmonary oedema.
What is the process occurring in chronic mitral regurgitation?
- Dilation of mitral valve ring, prolapse, post-RF, or papillary muscle ischaemia.
- Heart has time to undergo compensatory changes.
- LA dilates without substantial increase in pressure, LV undergoes hypertrophy to mitigate effects of regurgitation.
- Asymptomatic for years, then decompensation and LVF.
What are the symptoms of chronic mitral regurgitation?
Dyspnoea, fatigue, palpitations, AF (due to dilated left atrium).
What is this describing?
Pansystolic murmur at apex radiating to axilla.
Mitral regurgitation
What is this describing?
Rumbling mid-diastolic murmur.
Mitral stenosis
What is this describing?
Malar flush, P mitrale (bifid P wave) on ECG (enlarged R atrium). Commonly caused by rheumatic fever.
Mitral stenosis
What causes tricuspid regurgitation?
Dilation due to pulmonary hypertension induced by LV failure, rheumatic fever, endocarditis especially from IVDU.
What are the symptoms of tricuspid regurgitation?
Fatigue, hepatic pain on exertion (hepatic congestion), ascites, oedema.
What is this describing?
Pansystolic murmur in tricuspid region.
Tricuspid regurgitation
What is this describing?
Early diastolic murmur in tricuspid region.
Tricuspid stenosis
What is this describing?
Exertional dyspnoea, palpitations, angina, syncope. Collapsing pulse (water hammer), high pitched early diastolic murmur, de Musset’s sign, Quincke’s sign.
Aortic regurgitation
What are the causes of aortic stenosis?
Senile calcification is the most common cause, calcification of congested bicuspid valve (by 30 years), post-rheumatic fever (rare in UK).
What is the underlying process in aortic stenosis?
- LV undergoes compensatory hypertrophy.
- This reduces compliance of the ventricle resulting in elevation of diastolic LV pressure.
- This causes LA hypertrophy, as a result of compensatory changes there is a long asymptomatic period.
- Elevated LA pressure = pulmonary congestion = right ventricular failure
What is the typical presentation of aortic stenosis?
Eventually the heart decompensates:
Elderly person with chest pain, exertional dyspnoea or syncope.
What is the classic triad in aortic stenosis?
- Angina
- Syncope on exertion
- Congestive heart failure
What is this describing?
Slow rising pulse, ejection systolic crescendo-decrescendo murmur, radiates to carotids.
Aortic stenosis
What is the treatment for aortic stenosis?
Conventional aortic valve replacement or transcatheter aortic valve implantation (TAVI).
What is aortic valve sclerosis and how does it present?
- Thickening and calcification of aortic valve leaflets without motion restriction (still opens and closes normally).
- Ejection systolic murmur, no carotid radiation, normal pulse.
What is this describing?
Decrescendo murmur in early diastole in pulmonary region.
Pulmonary regurgitation
What are the causes of pulmonary stenosis?
Usually congenital (Turner’s, tetralogy of Fallot), post-rheumatic fever.
What is this a presentation of?
Dyspnoea, fatigue, oedema, ascites. Ejection systolic murmur.
Pulmonary stenosis
What are the haemodynamic effects of a cardiac valve defect?
- Pressure overload (aortic stenosis) - increased afterload as the LV has to work harder to open aortic valve, leads to LVH.
- Volume overload (aortic regurgitation, mitral regurgitation) - increased preload due to increased volume of blood in LV, leads to LV dilation.
