Physiology - Heart Valve Diseases Flashcards
What is the New York Heart Association Functional Classification?
On how much exercise one can do:
Class I: No limitation
Class II: Slight limitation of ordinary activity
Class III: Marked limitation of less than ordinary activity
Class IV: Severe limitation of minimal activity or at rest. Slide 7
What are the signs of right sided heart failure?
Raised JVP
Pitting oedema
Hepatic Congestion. Slide 9
What can possibly happen to the location or appearance of the apex beat?
Usually it is in the 5th intercostal space mid clavicular.
However it can become a tapping apex beath in mitral stenosis
Displaced and diffuse in LV dilation
Heaving and displaced in LVH. Slide 12
What would a parasternal heave indicate?
Cor Pulmonale
Pulmonary hypertension. Slide 13
What is a cardiac murmer and what are the categories they can be caused by?
It is the audible turbulence of blood flow and can be innocent or pathological. Slide 16
What are the steps in describing a murmur?
Systole/Diastole What type of murmur Where is it loudest Radiation? What grade of murmur Is it influenced by respiration. Slide 18
Which murmur is pansystolic?
Mitral regurgitation. Slide 23
Where does mitral regurg and aortic stenosis radiate to?
Aortic stenosis - Carotids
Mitral regurg - Axilla
Slide 26
What is the grading of murmers?
I: very quiet II: Quiet and easy to hear III: Loud IV: Loud with thrill V: Very loud with thrill VI: Loud and audible without a stethoscope. Slide 28
What does RILE stand for?
RIGHT sided heart murmurs are louder on INSPIRATION
LEFT sided murmers are louder on EXPIRATION
Slide 30
What are the 3 types of valvular heart disease you can get?
Valve stenosis: Not open correctly
Valve regurg: Not close properly
Mixed valve disease: Neither open/close properly
Slide 35
What can the causes of aortic stenosis be?
Degenerative
Congenital (bicuspid valve forms instead of tri)
Rheumatic
Slide 38
What are the symptoms/ signs and treatment for Aortic stenosis?
Breathlessness, chest pain whcih mimics angina, dizziness.
Low volume pulse, forceful displaced apex.
Conventional valve replacement, TAVI or Balloon aortic valvotomy. Slide 42+43
What are the pros and cons between mechanical and bio-prosthetic heart valves?
Mechanical: Last long, have to take warfarin and used in younger patients
Bio-prosthetic: No warfarin but last 10 years and used in older patients. Slide 45
What is a TAVI?
Transcatheter Aortic Valve Implantation.Slide 46
What are the possible causes for mitral regurgitation be?
Problem with the leaflets
Chordae rupture
Papillary muscles rupture due to ischaemia
Annular dilation Slide 50
What are the signs/symptoms and the treatment for mitral regurg?
Breathlessness, peripheral oedema, fatigue
Displaced apex and a pansystolic murmur.
Diuretics and heart failure meds.
Surgery
Percutaneous (infants)
Slide 55
What are the causes for mitral stenosis?
Mainly rheumatic but rarely congenital. Slide 57
What are the signs/symptoms, characteristic murmur sound and treatment for mitral stenosis?
Breathlessness, palpitations, fatigue
Malar flush, tapping apex and characteristically a mid diastolic rumbling murmur.
Diuretics and treat AF which can be a complication.
Surgery
Balloon valvuloplasty.
Slide 58+62
What are the possible causes for aortic regurg?
Leaflets damages
Annulus e.g. marfans or aortic dissection. Slide 65
What are the signs/symptoms, characteristic murmur sound and treatment for aortic regurg.?
Breathlessness
Collapsing pulse, wide pulse pressure, displaced apex and an early diastolic murmur.
ACEI and surgery
Slide 66+69
