Lecture 4: Valvular heart disease Flashcards
What are the mid systolic murmurs?
Aortic stenosis
Pulmonary stenosis
(also atrial septal defect and HOCM)
What are the holosystolic murmurs?
Mitral regurgitation
Tricuspid regurgitation
(also VSD)
What is the late systolic murmur?
Mitral valve prolapse
What are the early diastolic murmurs?
Aortic regurgitation
Pulmonary regurgitation
(also Austin-Flint)
What are the mid/late diastolic murmurs?
Mitral stenosis
Tricuspid stenosis
What does pan systolic mean?
Spans across both heart sounds
What is the epidemiology of degenerative valve disease?
Ageing population
What is the epidemiology of Rheumatic valve disease?
Post-streptococcal rheumatic fever
Children and young adults
Disease of poverty and overcrowding
What is the epidemiology of infective valve disease?
Most common on abnormal valves
Virulent organisms (normal valves, strep/staph)
Immunocompromised
What is the epidemiology of congenital valve disease?
Low, static incidence in all populations
Which valves are affected by degenerative valve disease?
Aortic > Mitral
Which valves are affected by rheumatic valve disease?
Mitral > Aortic
Which valves are affected by infective valve disease?
Any valve (left more often than right)
Right if atypical - IVDU
Which valves are affected by congenital valve disease?
Any
What is the most common cause fro AS, AR, MR?
Degeneration
What is the most common cause for mitral stenosis?
Rheumatic fever
What is stenosis?
Narrowing of valve leaflets
Valve leaflets fail to open completely
Leads to build up of back pressure and loss of stroke volume
What is regurgitation?
Failure of leaflets to meet in systole
Leaflets fail to close completely
Allows reverse flow of blood during relaxation of the heart
AKA incompetance
Which valve problem is pressure dependent?
Stenosis
Which valve problem is volume dependent?
Regurgitation
What are the symptoms of aortic stenosis?
The SAD triad:
- Syncope
- Angina
- Dyspnoea
Fatigue - decreased exercise tolerance
Sudden death
What condition can give signs similar to aortic stenosis?
Hypertrophic obstructive cardiomyopathy
What murmur does aortic stenosis cause?
Systolic crescendo/decrescendo
What causes aortic regurgitation?
CREAM
Congenital Rheumatic damage Endocarditis Aortic dissection Marfans
What causes LV dilatation?
Volume overload
What causes LV hypertrophy?
Pressure overload
Which condition causes LA enlargement?
Aortic regurgitation
What murmur is caused by aortic regurgitation?
Early diastolic murmur
What are the symptoms of aortic regurgitation?
Often asymptomatic Chest pain Breathlessness Syncope Catastrophic decompensation
What causes MR?
Valve prolapse, infection, degeneration
Chordal rupture
Annular dilation (secondary to LV dilatation)
What are the consequences of AR?
Volume overload in LV
LV dilatation
Late decompensation of LV function
High volume circulation
What are the consequences of MR?
Volume overload in LV
Pressure overload of right heart - hypertrophy
LV dilatation
Decompensation
What causes a pan-systolic murmur?
Mitral regurgitation
What are the symptoms of MR?
Breathlessness
Lethargy and reduced exercise tolerance
Palpitations - AF
Peripheral oedema
Chest pain
What condition causes a mid-systolic click with a late systolic murmur?
Mitral valve prolapse
What causes MS?
(Almost always) Rheumatic fever
Congenital
Storage disease
Malignancy
What are the consequences of MS?
Breathlessness/congestion - due to pressure back up
Left ventricle physiology usually preserved
What causes a mid-diastolic rumbling murmur?
MS
What are the symptoms of MS?
Breathlessness Peripheral oedema Haemoptysis Palpitations Systemic emboli Fatigue Stridor/dysphagia
What is the limitation of biological valve replacements?
Only last ~10 years
What is the limitation of mechanical valve replacements?
On warfarin for the rest of life
