CT 5 Valvular disease Flashcards
what happens during ventricular diastole
passive filling of the ventricles followed by active filling when the atria contract to further push blood into the ventricles
what happens during ventricular systole
aortic and pulmonary valves open
ventricles contract and eject blood into the respective blood vessels
when pressure in vessels exceed that of the ventricles the aortic and pulmonary valves close
what does the first heart sound represent LUB
mitral and tricuspid valve closing at the beginning of ventricular contraction
what does the second heart sound represent DUB
Aortic and pulmonary valve closure after ventricular contraction has finished
when describing murmurs what should be included
S where is the murmur loudest
C character
Radiation
I intensity - how loud out of 6
Pitch
Timing (systolic or diastolic)
- what type if known? ejection systolic? pansystolic?
- best heard where
- accentuated by inspiration (right sided) and expiration (left sided)
- radiation
what is a murmur
turbulent blood flow
characteristics of an ejection systolic murmur
crescendo decrescendo high pitched
what are causes of aortic stenosis
1) congenital aortic stenosis (bicuspid valve)
2) premature calcification of bicuspid valve (30-40yrs onset)
3) calcification of normal tricuspid valve (higher risk in those with rheumatic HD and endocarditis) occurs earlier in those with renal failure and high cholesterol)
what is the triad of symptoms assoicated with aortic stenosis
1) effort dyspnoea
2) effort dizziness or syncope* hallmark of severity
3) effort angina
- sudden cardiac death is rare without presentation of this triad
examination of aortic stenosis
- slow rising pulse best felt with 3 fingers in radial or carotid artery
- absent second heart sound
-narrow pulse pressure - aortic area 2nd right intercostal space
-radiation to carotids
- look for symptoms for HF
*loudness of murmur does correlate to severity of aortic stenosis
treatment of aortic stenosis
- echo is investigation of choice
treatment is initiated when symptoms of triad present or severity leads to HF
surgery for mechanical replacement carries a 5% mortality risk
percutaneous/TAVI can be used for those in high risk
what murmur does mitral regurg present as
often asymptomatic and will present with signs of HF
pan systolic murmur at apex
radiation of murmur to back or axilla
displaced apex beat resulting from dilated LV
during ventricular contraction an incompetent mitral valve will lead to backflow into the left atrium
causes of mitral regurg
1) intrinsic valve problems
most common is RHD
infective endocarditis
chordal rupture
papillary muscle rupture
2) secondary or functional: dilation of the ventricle causes annulus to be stretched but leaflets of valve are fixed structures so cannot accommodate this fully
in regurg does loudness of murmur indicate severity
yes
treatment for mitral regurg
HF therapy - diuretics, acei, BB
surgery to either repair or replace valve
Other causes of systolic murmurs
1) pulmonary stenosis (radiates to axilla and back)
2) tricuspid regurg (radiation to liver) accentuated in end inspiration
3) hypertrophic cardiomyopathy
4) coarctation of aorta
5) ventricular septal defect ( v loud and doesn’t change with respiration)
examples of diastolic murmurs
aortic regurg what happens
in ventricular diastole the atria are filling with blood. the aortic valve has closed but not properly leading to backflow into the ventricle. the atria also begin to passively allow blood flow to ventricles
causes early decrescendo
causes of aortic regurg
1) disease affecting aortic valve:
RHD
infective endocarditis
SLE
2) diseases resulting in dilation of aortic root:
aortic aneurysm
marfans
ankyspond
syphilis
aortic dissection results in acute Aortic regurg
examining for aortic regurg
collapsing pulse
wide pulse pressure
early diastolic murmur heard at left sternal edge (patient leaning forward, end expiration)
corrigan’s sign = visible carotid pulsations
de musset’s sign = head bobbing
quinke sign: nail bed pulsations
mitral stenosis
low pitched rumbling mid diastolic murmur
malar flush
signs of HF
usually in AF
Other causes of diastolic murmurs
1) pulmonary regurg
2) tricuspid stenosis
3) PDA - continuous machinery murmur)
4) ASD
