Valve disease Flashcards
What are the clinical features of Aortic Stenosis? (5)
- High-pitched and loud ejection systolic murmur
- Slow-rising pulse
- Low volume pulse
- Radiates to carotid
- Loudest on expiration
What are the clinical and history features suggestive of severe aortic stenosis? (5)
- Long duration of murmur
- Quiet second heart sound
- Heave
- Angina
- Syncope
What are the differentials for an ejection systolic murmur? (3)
- Aortic stenosis
- Aortic sclerosis
- HOCM
What are the management optios for aortic stenosis? (3)
- Beta blockers
- Avoid ACE-i and nitrates
- Consideration for surgical management:
- Tissue valve replacement
- Metallic valve replacement
- TAVI (if not fit for surgery)
What are the pros and cons of a metallic heart valve?
Pros:
- Durable
Cons:
- Lifelong anticoagulation
What are the indications for a Mitral Valve replacement?
- Mitral stenosis - signs of pulmonary HTN
- Mitral regurgitation
- Infective endocarditis
How would you manage a mitral valve prolapse or replacmenet incompetence?
Surgical repair considered then replacement considered
What are the congenital causes of pulonary valve disease?
- Rubella
- Down’s syndrome
- Turner’s syndrome
- Noonan’s syndrome
What are the features to comment on in congenital valve disease? (3)
- Cyanotic or acyanotic
- Previous surgeries
- Presence of any congenital syndromes
What are the features to comment on in congenital valve disease? (3)
- Cyanotic or acyanotic
- Previous surgeries
- Presence of any congenital syndromes
What are the features of severe Mitral regurgitation? (5)
- Raised JVP
- Loud P2
- S3 gallop rhythm
- Right ventricular heave
- Displaced thrusting apex
What are the symptoms of severe Mitral regurgitation? (3)
- Dyspnoea
- Reduced exercise tolerence
- Fluid overload
What is the JVP?
JVP is a visual reflection of the pressures in the right atrium
Can see externally abnormalities in right heart pressure
e.g. Pulmonary HTN caused a raised JVP
What are the indications of Mitral Valve replacement? (6)
- Symptoms
- Pulmonary hypertension - surgery should ideally be performed before pulmonary hypertension occurs
- Fluid overload
- Reduced ejection fraction
- Acute MR e.g. post MI
- Increased LV dilatation
What are the causes of Mitral Regurgitation? (4)
- Degenerative e.g. age related
- Mitral valve prolapse
- Elhers-Danlos - MI - pipillary muscle rupture
- Infection e.g. rheumatic fever or Infective Endocarditis
What investigations should be performed in Mitral Regurgitation? (6)
- ECG - AF
- Urine dip of haemturia and proteinuria (IE)
- Blood cultures - infective endocarditis
- Routine bloods - anaemia, WCC, CRP, ESR, U&Es
- ECHO - mitral valve, vegetations, prolapse, LV Ejection Fraction
- Chest x-ray
- Fundoscopy (IE)
When should bio valve replacements be offered? (5)
- Young women of child bearing age
- AS >70
- MR >65
- If high risk of haemorrhage
- If poorly compliant with medications and follow up (need to take lifelong warfarin)
When should metallic heart valve replacements be offered? (2)
- Don’t meet criteria for bio
- Already on life-long anticoagulation e.g. in AF
