Cardiology Flashcards
Describe the clinical features of MS
Tapping apex beat Loud first heart sound Opening snap early diastole mid diastolic rumbling murmur at the apex, heard best in expiration, left lateral position AF
What are the clinical markers of severe MS?
early opening snap increasing length of murmur signs of pulmonary HTN signs of pulmonary congestion Graham-Steel murmur (PR) Low pulse pressure
What is a Graham Steele murmur?
early diastolic murmur in the pulmonary area radiating down the LSE, louder in inspiration
= Pulmonary regurg, signifies elevated pulmonary artery pressures
What are the clinical signs of pulmonary HTN?
raised venous pressure: systolic V waves parasternal heave loud, palpable P2 PR TR: PSM LLSE, louder in insp
What conditions give a mid diastolic rumbling murmur?
MS TS Severe MR Left atrial mass (myxoma) L) atrial thrombus Cor triatrium Austin flint murmur of AR Carey Coombs murmur of acute rheumatic fever
What are management options for MS?
Perc ballon Mitral valvotomy - usually younger patients, better rheumatic valve disease
Valve replacement - usually older as concomitant MR
Can use mitral valve split score to help determine choice. < 9 considered favourable for valvotomy
What are the CIs to mitral valvuloplasty?
L) atrial thrombus > mild MR MV area > 1.5cm Severe or bicommissural calcification Absence of commissural fusion Severe concomitant AV disease or severe combined TS and TR Concomitant CAD requiring bypass
What the chronic causes of mitral regurgitation?
Degenerative disease Mitral valve prolapse (e.g. Marfan's) Rheumatic - rarely MR alone Papillary muscle dysfunction (could be due to LVF, ischaemia) Connective tissue disease (RA/ank spend) Congenital
What are the acute causes of MR?
IE (perforation of anterior leaflet), rupture of a myxomatous cord
MI (chordae rupture or papillary muscle dysfunction)
Surgery
Trauma
What are the clinical features of MR?
Pansystolic murmur - an early short murmur in acute and a late murmur in MV prolapse
Widely split S2
3rd heart sound, LVF, pulmonary HTN, narrow pulse pressure all markers of severity
Indicators for surgery in MR?
Symptoms If asymptomatic: - if AF/Pulm HTN - EF 30-60% and/or LVESD > 40mm - If EF <30%, high risk but can be considered
What are the causes of aortic stenosis?
1) degenerative
2) bicuspid valve
3) rheumatic valve disease
4) congenital
5) infective endocarditis
What is the differential diagnosis of an ESM louder in expiration?
AS
HOCM
Supravalvular aortic stenosis
What are the criteria for severe AS?
Valve area <1cm, gradient > 40mmhg, mean velocity > 4m/s
When would you refer for AS surgery?
Symptomatic or asymp and one of:
- LV systolic dysfunction
- Signs of pulmonary HTN
- abnormal blood pressure response on exercising
What are surgical options available for AS?
Balloon valvuloplasty for short term symptomatic relief
Valve replacement if fit enough
TAVI for intermediate/high risk surgical candidates
What are the clinical signs of severe AS?
Slow rising pulse Narrow pulse pressure Low volume pulse Systolic thrill Heaving apex Reversed splitting of the 2nd HS Soft S2 4th HS (forceful atrial contraction against a poorly compliant left ventricle) Signs of pulmonary HTN or cardiac failure
What is aortic sclerosis
?Mild thickening and/or calcification of a trileaflet aortic valve without outflow obstruction
What is the differential for a PSM?
MR, TR, VSD, aortopulmonary shunts
What is the differential for a late systolic murmur?
Mitral valve prolapse
Papillary muscle dysfunction
What is the differential for an early systolic murmur?
Acute severe MR
What are the causes of mitral stenosis?
Rheumatic
Severe mitral annular calcification
After mitral valve repair for mitral regurgitation
Congenital
What are the indications for surgery for MS?
Symptoms with valve area of less than 1cm or signs of increasing r)heart pressure
What are the clinical signs of severity of MR?
Enlarged L)ventricle - displaced apex beat Pulmonary HTN 3rd HS Early diastolic rumble Soft 1st HS Small volume pulse L) ventricular failure
What are the indications for surgery for MR?
Class 3 or 4 symptoms
AF or pulm HTN
If EF 30-60% and/or LVESD > 40mm consider intervention
If EF <30%, can be considered but high risk
What are the clinical signs of mitral valve prolapse?
Late systolic click murmur
- valsalva makes the murmur longer and click earlier
- hand grip which increases after load makes it shorter
Which conditions are associated with mitral valve prolapse?
Marfan’s syndrome
ASD
PCKD
What are the complications of mitral valve prolapse?
MR
IE
What are the causes of chronic aortic regurgitation?
Valvular cause: -rheumatic - congenital - seronegative arthropathy, esp ank spond Aortic root: - marfan’s - Aortitis (seronegative arthropathies, RA, tertiary syphilis - dissecting aneurysm - old age
What are the causes of acute AR?
Valvular - IE
Aortic root - marfan’s, HTN, dissecting aneurysm
What are the clinical signs of severity of AR?
Collapsing pulse Wide pulse pressure Length if the decrescendo diastolic murmur 3rd HS Soft A2 Austin flint murmur L) ventricular failure
What are the indications for surgery for AR?
Symptoms
Or LV dysfunction
Pulmonary HTN
