Valve disease Flashcards
Classic triad of presenting symptoms in aortic stenosis? (3)
SOBOE
Syncope
Anginal chest pain
Examination findings in aortic stenosis
Narrow pulse pressure
Crescendo-decrescendo systolic murmur most commonly heard at aortic area (2)
Significance of a) 3rd heart sound b) 4th heart sound in aortic stenosis?
a) associated with left ventricular failure
b) associated with left ventricular hypertrophy
Investigations in aortic stenosis-
a) CXR
b) ECG
c) Echo
a) usually normal- sometimes shows a calcified aortic ring, evidence of heart failure
b) may show LVH
c) diagnostic test
Definitive treatment for aortic stenosis?
Aortic valve replacement (surgical or TAVI)
What is the role for balloon valvuloplasty in aortic stenosis?
Should only be used for patients unsuitable for surgery; most patients will have re-stenosed by 12 months
When is surgery considered for AS?
With syncope or if pressure gradient >50mmHg
Drugs to avoid in severe AS? (3)
ACE inhibitors
Rate-limiting calcium blockers
Beta blockers
Clinical signs of aortic regurgitation?
a) murmur
b) pulse (2)
c) eponymous signs
a) Early diastolic murmur (easily missed)
b) Collapsing pulse (forceful “knocking” when patient’s arm is elevated), wide pulse pressure
c) Corrigan + De Musset sign
Exaggerated arterial pulsations in the neck
Corrigan’s sign
Head nodding in time with pulse
de Musset’s sign
Commonest cause of mitral stenosis?
Rheumatic fever
Commonest presenting symptom in mitral stenosis?
Progressive breathlessness
Sequelae of chronic mitral stenosis?
Persistently raised LA pressure –> pulmonary hypertension –> right heart failure
Examination findings in mitral stenosis
a) murmur
b) praecordium
c) skin signs
a) rumbling mid-diastolic at apex
b) tapping apex, left parasternal heave
c) malar flush
