Heart valves Flashcards
What makes 1st heart sound?
2nd?
Closure of mitral / tricuspid
Closure of aortic / pulm
Which heart sounds are loudest on inspiration?
Expiration ?
Right in or left out
Right (P+T) - as increase in venous flow into right Atrium
Left (A+M) - increase in pulmonary venous return to Left heart
What are the two loudest systolic murmurs
AS / MR
Signs of AS
Ejection systolic murmur
Radiates to carotids (sclerosis does not radiate)
If very severe – may not hear S2
Heaving apex beat
Narrow pulse pressure
Signs of MR
Pansystolic because it leaks throughout systole
Radiates to Axilla
Displaced apex beat
Usual cause of ejection systolic in >70?
<60?
any other causes?
Degenerative
bicuspid
Rheumatic, sclerosis, HCM
Differential of MR ?>
VSD
When do you hear AR?
Signs on auscultation?
Diastole
Radiates to left sternal edge leaning forwards
Displaced apex
Murmur in MS?
Signs on auscultation?
Cause?
what other things do you often get?
Mid-diastolic murmur in apex in left lateral position
Tapping apex
Usually rheumatic cause –
classically get AF and pulmonary HTN due to increased LA pressure
Signs with AR?
Name at least 3
Quincke’s – nail bed capillary pulsation
Collapsing pulse
Wide pulse pressure
Corrigan’s sign – pulsatile JVP/neck pulsation
De Mussett’s sign – head nodding
Duroziez’s sign – murmur on femoral artery compression
Traube’s – ‘pistol shot’ sound over femorals
What is the criteria for severe AS?
Valve area <1cm
Mean valve gradient >40mmHg
EF <40% (heart failure)
Compare mechanical vs Tissue/bioprothetic valve replacement?
Mechanical
Better for younger patients as lasts longer (20-25 years)
Lifelong Warfarin
Will hear ‘click’ as heart sound
Tissue
Older patients with higher bleeding risk
No Warfarin
Lasts ~10 years
Heart sounds normal
Risks of valve replacement?
Bleeding
Thromboembolism/Stroke
Haemolysis – mechanical destruction against valve
Infective endocarditis – early usually staph infection from skin and later Strep. viridans
Atrial fibrillation
Bradyarrhythmia
Why is Bradyarrhythmia more common with AV replacement?
AV node/bundle of his in aortic root (sinus node in RA at base of SVC).
What is a TAVI?
What is main reason this might not be possible?
Transcatheter Aortic Valve Implantation
Cannot if calcified aortic root or calcified access