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PBL SEM 2 > PBL 4 - Heart Valve Disease > Flashcards

PBL 4 - Heart Valve Disease Flashcards

1
Q

what is heart valve disease?

A

diseases or abnormality of any one of the heart valves for any number of reasons

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2
Q

what is a murmur?

A

abnormal blood flow across a heart valve or across a structure within the heart

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3
Q

how is a HVD diagnosed?

A
  • through auscultation of a murmur

- can also be picked up via an ECG or people having other cardiac tests

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4
Q

how is HVD most commonly treated and why?

A

watchful waiting as most people are asymptomatic — patients are just monitored in secondary care or in the community over time

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5
Q

if HVD becomes symptomatic and severe, how is it then treated?

A

either open heart surgery (cardiopulmonary bypass and valve replacement) or repair surgery, or increasingly transcatheter therapies for certain valve lesions

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6
Q

describe aortic stenosis and how it results in LV hypertrophy

A
  • aortic valve becomes heavily calcified with reduced opening — valve becomes thicker
  • heart has to pump with lots of extra force to get the valve to open
  • LV becomes hypertrophied so has to pump harder to punish blood around the body (doesn’t become bigger but more muscular. apex is more forceful)
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7
Q

when is the abnormal blood flow in aortic stenosis and what effect does the thickened valve have on the blood ?

A

in systole — blood becomes turbulent and gets churned up by the thickened aortic valve

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8
Q

where can the aortic valve be auscultated?

A

right 2nd IC space parasternal

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9
Q

what kind of systolic murmur can be heard and where in aortic stenosis?

A

crescendo decrescendo ejection systolic murmur — harsh murmur best heard in the aortic area, radiating to the carotids

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10
Q

what is the pulse pressure like in aortic stenosis?

A

low

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11
Q

symptoms of aortic stenosis

A
  • elevated LVEDP
  • increased pressure in LA
  • increased pressure in pulmonary veins
  • SOB
  • angina
  • exertional dizziness/syncope
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12
Q

what is aortic stenosis most commonly caused by?

A

degenerative aortic valve disease — get calcification deposition on the aortic valve leaflets so it becomes thickened and calcified — usually associated with an ageing process

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13
Q

what other 2 things can aortic stenosis also be caused by?

A
  1. bicuspid aortic valve — 2 leaflets instead of 3 — these degenerate much more quickly
  2. rheumatic heart disease — rare
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14
Q

what are 2 methods of aortic stenosis treatment?

A
  • surgical aortic valve replacement

- increasingly transcatheter approach = TAVI

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15
Q

briefly describe a TAVI (transcatheter aortic valve implantation)

A

go in the groin under local anaesthetic, valve loaded onto a national frame, goes into the femoral artery up into the aorta and crush the old valve out of the way

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16
Q

what is aortic stenosis characterised by?

A

obstruction of the left ventricular outflow —> decreased CO

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17
Q

which is the only valve that usually has 2 leaflets instead of 3?

A

mitral/bicuspid

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18
Q

S1 vs S2 heart sounds

A

S1 = AV valves close (blood in ventricles and ventricles begin to contract)

S2 = aortic/pulmonary valves close

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19
Q

when is systole in terms of S1 and S2?

A

in between S1 and S2

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20
Q

when is diastole in terms of S1 and S2?

A

in between S2 and S1

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21
Q

when is the murmur in aortic stenosis heard in terms of S1 and S2?

A

in between S1 and S2

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22
Q

what is mitral valve regurgitation?

A

when there is a leak of blood from the LV into the LA during systole due to incompetence of the mitral valve for various reasons

= 2nd most common cause of HVD after aortic stenosis

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23
Q

where is the mitral valve?

A

between LA and LV

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24
Q

what kind of murmur can be heard in mitral regurgitation? what does it sound like?

A

holosystolic/pan systolic murmur:

lub-whoooooo-dub (sounds like wind through tunnel)

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25
Q

where is the murmur heard best in mitral regurgitation? radiation?

A

loudest in the apex at the mitral region with radiation round to the axilla and a displaced apex beat

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26
Q

where is the mitral valve heard best?

A

5th IC space mid-clavicular line

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27
Q

why is murmur sometimes heard in apex in mitral regurgitation?

A

LA is quite a posterior structure so murmur often goes into the apex

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28
Q

is a murmur heard in the carotids in mitral regurgitation?

A

no

29
Q

why do you get a displaced apex beat in mitral regurgitation?

A

ventricle becomes volume loaded — displaced apex beat away from the midclavicular line towards the axilla

30
Q

why are patients sometimes in atrial fibrillation with mitral regurgitation?

A

often get a stretched left atrium — atrium becomes more electrically active as it stretches

31
Q

symptoms of mitral regurgitation — how can it lead to SOB?

A
  • elevation of the left atrial pressure that increases the pressure in the lungs — SOB
  • no chest pain
32
Q

what are some causes of mitral regurgitation?

A
33
Q

what’s the most common cause of mitral regurgitation?

A

valvular degeneration

- ‘myxomatous disease’

34
Q

how can endocarditis cause mitral regurgitation?

A

either eats away at the leaflet tips of causes a perforation within the body of the valve leaflet

35
Q

can mitral regurgitation be congenital?

A

yes but rare

36
Q

how can a functional MR cause mitral regurgitation?

A

baggy LV (eg. HF that has stretched the LV) causes the mitral valve annulus to stretch — valve leaflets pulled apart and unable to close

37
Q

how can an ischaemic MR cause papillary muscle rupture hence causing mitral regurgitation?

A

abrupt lack of O2 supply to part of muscle supplying papillary muscle — can break off and rupture — nothing thethering the mitral valve = very severe and usually not survivable

38
Q

what is hypertrophic obstructive cardiomyopathy and how can it cause mitral regurgitation?

A

= genetic thickening of the heart muscle

- when the heart is in systole, the mitral leaflet is dragged towards the septum — causes a leak in the mitral valve

39
Q

treatment of mitral regurgitation?

A
  • mitral valve repair
  • valve replacement
  • transcatheter therapies (mitral clip = transcatheter edge-to-edge repair = clip valve leaflets together_
40
Q

what is aortic regurgitation?

A

occurs when there is back flow of blood from the aorta into the LV as the ventricle relaxes

41
Q

when is flow normal/abnormal in aortic regurgitation?

A

flow is normal in systole and abnormal in diastole

42
Q

what kind of murmur is present in aortic regurgitation?

A

diastolic murmur — often hard to hear — lub-dub-hahhhhh

43
Q

where and when is the murmur in aortic regurgitation best heard?

A

along left sternal edge in expiration = where the column of blood is falling

44
Q

is there a displaced apex in aortic regurgitation?

A

yes

left ventricular volume loading — causes eventually dilation of the LV — displaced apex towards axilla

45
Q

what kind of pulse is present in aortic regurgitation?

A

collapsing (water hammer) pulse (Carrogan’s pulse/ Watson’s water hammer pulse)

46
Q

what is typical of aortic regurgitation in terms of pulse pressure?

A

= wide pulse pressure

- strange blood pressures eg. 180/60 — very big difference between the 2 numbers

47
Q

signs/symptoms of aortic regurgitation

A
  • visible pulsation of the neck vessels
  • strange BPs (wide pulse pressure)
  • SOB due to back pressure into LV
  • elevated atrial pressure
  • can cause pulmonary oedema: acute rise in LA pressure, acute rise in pressure in pulmonary capillaries, acute alveolar oedema
48
Q

what is endocarditis?

A

infection of heart valve — valve eaten away so becomes incompetent

49
Q

what are some causes of aortic regurgitation?

A

i

50
Q

treatment of atrial regurgitation

A
  • most asymptomatic with good LV function — no treatment required
  • symptomatic:: aortic valve or aortic valve replacement — open surgical techniques
51
Q

what is mitral stenosis?

A

= thickening of the mitral valve so it doesn’t open well — difficult to get blood into LV

52
Q

what heart chamber does mitral stenosis affect the most and why?

A

left atrium — left atrial pressure has to be very high to push blood across the very stenosed and thickened mitral valve in diastole

53
Q

when is flow abnormal in mitral stenosis?

A

diastole

54
Q

what kind of murmur is present in mitral stenosis?

A

diastolic murmur which is difficult to hear

55
Q

where and when is the murmur loudest in mitral stenosis and does it radiate anywhere? displacement?

A
  • loudest at apex in the mitral region with radiation round to the axilla — no displacement of apex beat
  • often best heard at the bowel or ask patients to sit on their side and lift their arm up above the head in order to spread the rib spaces out
  • best heard on end expiration
56
Q

what does the diastolic murmur in mitral stenosis sound like?

A
  • very low pitched rumbling sound
  • apex beat has a tapping character (not often felt in clinical practice)
  • leaflet snap — can hear the valve leaflets snapping open — very difficult to hear
57
Q

is mitral stenosis common?

A

no — rare

58
Q

causes of mitral stenosis?

A
  • rheumatic heart disease (rare in UK)

- occasionally degenerative calcification of the mitral valve in dry very elderly patients

59
Q

signs of mitral stenosis?

A
  • very high left atrial pressure — dilation of left atrium — becomes very electrically active — these patients are almost always in atrial fibrillation — irregular HB
  • malar flush = reddening of the cheeks
  • high pressures in lungs — present with SOB, possibly pulmonary oedema (esp. if there is another stressor present eg, pregnant, septic)

= irregularly irregular pulse, diastolic murmur and possibly malar flush

60
Q

treatment of mitral stenosis

A

replacement of heart valve

61
Q

what is Beckers signal? (aortic regurgitation)

A

retinal vessel pulsation on fundoscopy

62
Q

what is De Mussets sign? (aortic regurgitation)

A

head bobbing in time with cardiac cycle

63
Q

what is Dureozizs sign? (aortic regurgitation)

A

diastolic murmur heard over femoral pulses when partly occluded below stethoscope

64
Q

what is Muellers sign? (aortic regurgitation)

A

uvula pulsation

65
Q

what is Quickes sign? (aortic regurgitation)

A

capillary pulsation in nail bed

66
Q

what is Traubes sign? (aortic regurgitation)

A

pistol shot systolic sound in femoral arteries

67
Q

what valve diseases can be caused due to rheumatic heart disease vs rheumatic fever?

A

heart disease = stenosis

fever = regurgitation

68
Q

AF is a sign in which valve diseases?

A

mitral regurgitation and mitral stenosis

PBL SEM 2 (44 decks)

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