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CVS > Cardiac Valve Defects > Flashcards

Cardiac Valve Defects Flashcards

1
Q

What is responsible for the heart sounds heard on auscultation?

A

Valves snapping back shut make the heart sounds

S1 - Sound from the AV valves shutting (LUB dub)
S2 - Sound from the semi-lunar valves shutting (Lub DUB)

Additional heart sounds heard are pathological

S3 - Occurs in early diastole
- Normal in those 15-40
- Can indicate CHF in elderly
(Lub DE dub)

S4 - Due to increased stiffness of the left ventricle
- Always abnormal
(LE lub dub)

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2
Q

What are the 2 atrioventricular valves?

A

Mitral valve - Also knows an bicuspid valve, positioned between the left atrium and left ventricle

Tricuspid valve - positioned between the right atrium and right ventricle

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3
Q

What are murmurs?

A

Murmurs are a whooshing sound heard on auscultation due to turbulent blood flow

ASK MR ARMS

AS - Aortic Stenosis or Pulmonary Stenosis
MR - Mitral Regurgitation or Tricuspid Regurgitation
AR - Aortic Regurgitation or Pulmonary Regurgitation
MS - Mitral Stenosis or Tricuspid Stenosis

=> Ejection systolic murmurs:

  • Aortic stenosis
  • Pulmonary stenosis
  • Hypertrophic obstructive cardiomyopathy

=> Pan-systolic:

  • Mitral regurgitation
  • Tricuspid regurgitation
  • Ventricular septal defect

=> Early diastolic:

  • Aortic regurgitation
  • Pulmonary regurgitation

=> Mid-late diastolic:
- Mitral stenosis

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4
Q

What is Aortic Stenosis

A
  • Stenosis is the failure of a valve to open completely
  • Chronic process therefore its gradual development allows for compensatory changes
  • Best heard on the RHS, 2nd intercostal space

S1…GAP…MURMUR

Referred to as Ejection Systolic Murmur as it is heard louder during systole

An Ejection Systolic Murmur that does not radiate to the carotid arteries is known an Aortic Sclerosis

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5
Q

What are the risk factors of Aortic stenosis?

A
  • Age > 60
  • Congenital Bicuspid Aortic Valve
  • Rheumatic fever
  • CKD
  • High cholesterol levels
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6
Q

What are the clinical features of Aortic Stenosis?

A
  • Chest pain
  • Dyspnoea
  • Syncope
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7
Q

What is the differential diagnosis of Aortic Stenosis?

A
  • Aortic Sclerosis => the thickening or calcification of the aortic valve that does not cause motion restriction
  • Ischaemic Heart Disease
  • Hypertrophic cardiomyopathy
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8
Q

What are the causes of Aortic Stenosis?

A
  • Degenerative calcification in > 65
  • Bicuspid aortic valve in < 65
  • Williams syndrome (supravalvular aortic stenosis)
  • Post rheumatic disease
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9
Q

What is the pathophysiology of Aortic Stenosis?

A
  • LV must work harder to pump blood through narrower valve, leading to compensatory LV hypertrophy
  • This reduces the compliance of the LV wall, leading to LA hypertrophy and raised end diastolic pressure
  • Compensatory changes allow for asymptomatic period until heart decompensates
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10
Q

What are the investigations one for Aortic Stenosis?

A
  • Echo
  • ECG
  • Cardiac MRI
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11
Q

What are the routes of management of Aortic Stenosis?

A
  • If asymptomatic then just observe
  • If symptomatic than valve replacement
  • If asymptomatic but valvular gradient > 40 mmHg with features such as left ventricular systolic dysfunction then consider surgery
  • Aortic balloon valvuloplasty limited to those not fit for valve replacement
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12
Q

What is Mitral Regurgitation?

A
  • Regurgitation if the failure of a valve to close properly
  • Can be acute or chronic so clinical features depend on this
  • Known as pan-systolic murmur
  • Associated with collagen disorders such as Marfans Syndrome and Ehlers-Danlos Syndrome

S1…MURMUR

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13
Q

What are the causes of Mitral Regurgitation?

A
  • Idiopathic weakening of valve with age
  • Ischaemic heart disease
  • Infective endocarditis
  • Rheumatic Heart Disease
  • Connective tissue disorders
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14
Q

What are the clinical features of Mitral Regurgitation?

A
  • If acute then pulmonary oedema develops

If chronic then:

  • Dyspnoea
  • Fatigue
  • Lethargy
  • Displaced apex beat
  • Severe MR may cause a split S2
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15
Q

What is the differential diagnosis of Mitral Regurgitation?

A
  • Acute Coronary Syndrome
  • Aortic Sclerosis
  • Mitral Stenosis
  • Infective Endocarditis
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16
Q

What is the pathophysiology of Mitral Regurgitation?

A

This depends on whether the damage to the valve is acute or chronic

IF ACUTE:

  • Sudden onset of Mitral Regurgitation means there is no time for compensatory changes
  • Blood backs up into LV and LA
  • Eventually there is an increase in pressure in the pulmonary circulation
  • Results n pulmonary oedema

IF CHRONIC:

  • Gradual onset of Mitral Regurgitation allows time for compensatory LV hypertrophy and LA dilatation
  • Means there is a long asymptomatic period
  • Eventually heart decompensates, resulting in LV failure
17
Q

What is the main investigation carried out in suspected Mitral Regurgitation?

A

=> ECG
- Broad P wave

=> CXR
- Cardiomegaly

=> Echo

18
Q

What are the routes of management for Mitral Regurgitation?

A
  • If mild, proceed with conservative treatment

- If more severe then repair or replace valve

19
Q

Overview of Aortic Regurgitation

A
  • Can be acute or chronic
  • Known as decrescendo murmur
  • Associated with Marfans Syndrome
20
Q

What are the causes of Aortic Regurgitation?

A

=> Due to valve disease:

  • Rheumatic fever
  • Infective Endocarditis
  • Connective tissue disorders
  • Bicuspid aortic valve

=> Due to aortic root disease:

  • Aortic dissection
  • Ankylosing spondylitis
  • Hypertension
  • Syphilis
  • Marfans, Ehlers-Danlos syndrome
21
Q

What are the clinical features of Aortic Regurgitation?

A
  • Collapsing pulse
  • Wide pulse pressure
  • Quinke’s sign (nailbed pulsation)
  • De Musset’s sign (head bobbing)
22
Q

What is the pathophysiology of Aortic Regurgitation?

A

If acute there medical emergency as blood back up into pulmonary circulation resulting in pulmonary oedema

If chronic then there is time for compensation therefore asymptomatic period

Both acute and chronic can result in cardiogenic shock

23
Q

What are the investigations for Aortic Regurgitation?

A

CXR - shows LV hypertrophy
Echo with Doppler - assessment of severity
ECG

24
Q

What are the routes of management of Aortic Regurgitation?

A
  • Diuretics and vasodilators for mild cases

- Aortic valve replacement for severe cases

25
Q

What is Mitral Stenosis?

A

Pre-systolic accenctuation

26
Q

What are the two rare cardiac valve defects?

A

Tricuspid Regurgitation - Occurs secondary to RV dilatation
Pulmonary Stenosis - Congenital

Pulmonary stenosis presents as fatigue, syncope, RV failure

27
Q

What is the Levine Grading Scale?

A

Grade 1 - Very faint murmur, frequently overlooked
Grade 2 - Slight murmur
Grade 3 - Moderate murmur without palpable thrill
Grade 4 - Loud murmur with palpable thrill
Grade 5 - V. loud murmur with extremely palpable thrill
Grade 6 - Extremely loud murmur can be heard without stethoscope touching heart

28
Q

What are IV drug users at high risk of?

A

Right sided cardiac valvular endocarditis

Tricuspid regurgitation

29
Q

What kind of valvular abnormality does infective endocarditis cause?

A

Regurgitation

30
Q

What sign is common amongst those with coarctation of aorta?

A

Notching of the inferior ribs - not seen in children

=> Other features:

  • Herat failure in infancy
  • Hypertension in adults
  • Radio femoral delay
  • Mid systolic mumur
  • Apical click from the aortic valve
31
Q

What ECG change is commonly seen in those with mitral stenosis?

A

P mitrale

32
Q

What is the most common cause of mitral stenosis?

A

Rheumatic fever

33
Q

What are the features of severe Aortic Stenosis?

A
  • Narrow pulse pressure
  • Slow rising pulse
  • Delayed ESM
  • Soft/absent S2
  • S4
  • Thrill
  • Left ventricular hypertrophy or failure
34
Q

What are the risk factors of Mitral Regurgitation?

A
  • Female
  • Lower body mass
  • Age
  • Renal dysfunction
  • Prior MI
  • Prior Mitral stenosis
  • Collagen disorders
35
Q

What are the clinical features of Mitral Stenosis?

A
  • Mid-late diastolic murmur
  • Loud S1
  • Low volume pulse
  • Malar flush
  • AF

CVS (12 decks)

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