Features of valvular pathology Flashcards
What are the clinical features of aortic regurgitation?
- Early diastolic murmur (high pitched and ‘blowing’ in character)
- collapsing pulse
- wide pulse pressure
- Quincke’s sign (nailbed pulsation)
- De Musset’s sign (head bobbing)
What are the clinical features of severe aortic regurgitation?
- Mid-diastolic murmur (Austin-Flint murmur)
What conditions cause valve disease resulting in aortic regurgitation?
- rheumatic fever
- infective endocarditis
- connective tissue disease (RA/SLE)
- bicuspid aortic valve
What conditions cause aortic root disease resulting in aortic regurgitation?
- aortic dissection
- spondyloarthropathies (ankylosing spondylitis)
- hypertension
- syphilis
- Marfan’s, Ehlers-Danlos
How does aortic stenosis typically present?
- chest pain
- dyspnoea
- syncope
What are the clinical features of aortic stenosis?
- (delayed) ejection systolic murmur
- narrow pulse pressure
- slow-rising/plateau pulse
- soft/absent S2
- S4
- thrill
What are the causes of aortic stenosis?
- degenerative calcification (most common cause in >65)
- bicuspid aortic valve (most common cause in <65)
- William’s syndrome
post-rheumatic disease - subvalvular (HOCM)
How should an asymptomatic patient with aortic stenosis be managed?
Observe
How should a symptomatic patient with aortic stenosis be managed?
Valve replacement
When should an asymptomatic patient with aortic stenosis be considered for valve replacement?
When valvular gradient is >40 mmHg and they have features such as LV systolic dysfunction
How does mitral regurgitation typically present?
- fatigue
- SOB
- oedema
What are the clinical features of mitral regurgitation?
- pansystolic/holosystolic murmur (high-pitched and blowing in character)
- murmur best heard at the apex and radiating to the axilla
- S1 may be quiet/soft
- widely split S2 (severe MR)
- may produce S3
How does mitral regurgitation appear on ECG?
broad P wave (indicates atrial enlargement)
How might mitral regurgitation appear on CXR?
cardiomegaly - enlarged left atrium + ventricle
What are the treatment options for mitral regurgitation?
- Medical management: nitrates, diuretics, +ve inotropes and intra-aortic balloon pump
- If patient has heart failure: ACE-I, beta-blockers + spironolactone
- Acute, severe regurgitation: surgery
What are the clinical features of mitral stenosis?
- mid-late diastolic, “rumbling” murmur (best heard in expiration)
- loud S1, opening snap
- low volume pulse
- malar flush
- AF
What are the features of severe mitral stenosis?
- length of murmur increases
- opening snap becomes closer to S2
What is the most common cause of mitral stenosis?
Rheumatic fever
Besides rheumatic fever, what are the other potential causes of mitral stenosis? (rare)
- mucopolysaccharidoses
- carcinoid and endocardial fibroelastosis
What is/are the potential cause(s) of an ejection systolic murmur?
- aortic stenosis
- pulmonary stenosis
- HOCM
- atrial septal defect
- tetralogy of Fallot
What is/are the potential cause(s) of an pansystolic/holosystolic murmur?
- mitral/tricuspid regurgitation
- ventricular septal defect (harsh in character)
What is/are the potential cause(s) of an early-to-mid systolic murmur?
- ischaemia of the papillary muscles (will typically occur after MI)
What is/are the potential cause(s) of a late systolic murmur?
- mitral valve prolapse
- coarctation of the aorta
What is/are the potential cause(s) of an early diastolic murmur?
- aortic regurgitation
- Graham-Steel murmur (pulmonary regurgitation - high pitched and blowing in character)
