Valve Disease Flashcards
what are the common signs?
exertional symptoms
chest pain
breathlessness
collapse/ dizzy spells
describe cardiac breathlessness
related to activity (usually)
often associated with ankle swelling
orthopnoea
paroxysmal nocturnal dyspnoea
describe the NY Heart Association Functional Classification
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
what are the signs of right side heart failure?
raised JVP
pitting oedema
hepatic congestion
describe the use of the apex beat
normally 5th intercostal space midclavicular line
tapping apex in mitral stenosis
displaced and diffuse in left ventricular dilatation (volume overload)
heaving and may be displaced in left ventricular hypertrophy (pressure overload)
what is a parasternal heave?
hand left of sternum
right ventricular overload
cor pulmonale/ pulmonary hypertension
what is a cardiac murmur?
audible turbulence of blood flow
can be both innocent and pathological
aortic valve
2nd- 3rd right intercostal space
pulmonary valve
2-3rd left intercostal space
tricuspid valve
left sternal border
mitral valve
apex
describing murmurs
systole or diastole? what type of murmur? where is it loudest? where does it radiate to? what grade or murmur? influenced by respiration?
types of systolic murmurs
pansystolic
ejection systolic
types of diastolic murmurs
early diastolic
mid diastolic
radiation of murmurs
carotids (aortic stenosis)
axilla (mitral regurgitation)
grading of murmurs
I. Very quiet II. Quiet - easy to hear III. Loud IV. Loud with a thrill V. Very loud with a thrill VI. Loud - audible without a stethoscope
right vs left sided murmurs
right sided murmurs are louder with inspiration
additional heart sounds
common innocent murmur mitral regurgitation aortic stenosis aortic regurgitation mitral stenosis
less common 2nd sound splitting 3rd sound 4th sound systolic clicks continuous murmur tricuspid regurgitation pericardial rub
innocent (functional) murmur
soft (less than 3/6 severity)
position dependant
often early systolic
valve stenosis
valves which do not open properly
valve regurgitation
valves which do not close properly
mixed valve disease
valves which neither open properly not close properly
reasons for aortic stenosis
degenerative (age related)
congenital eg bicuspid valve
rheumatic
symptoms and signs of aortic stenosis
breathlessness chest pain dizziness/ syncope low volume pulse forceful displaced apex ejection systolic murmur than can radiate to the carotids
treatment of aortic stenosis
conventional valve replacement
trans catheter aortic valve replacement
balloon aortic valvotomy
mechanical heart valves
longevity
warfarin
younger patients
bio-prosthetic heart valves
no warfarin
10 years
older patients
aortic valve replacement
preferred to TAVI
long term outcomes
no contra-indications
CABG as well
trans catheter aortic valve replacement
co-morbidity
previous sternotomy
causes of mitral regurgitation
leaflets - prolapse - rheumatic - myxomatous (floppy) - endocarditis chordae rupture (degenerative) - prolapse/ flail leaflet papillary muscles rupture - ischaemic annular dilatation - functional
symptoms and signs of mitral regurgitation
breathlessness peripheral oedema fatigue displaced apex pansystolic murmur - axilla cardiomegaly
treatment of mitral regurgitation
medication - diuretics and heart failure (ACE inhibitors) surgical - repair- prolapse - replacement- degenerative percutaneous - clips in infancy
causes of mitral stenosis
essentially rheumatic main cause
congenital rare
symptoms and signs of mitral stenosis
breathlessness fatigue palpitations malar flush tapping apex beat mid diastolic rumbling diastolic murmur localised to apex straight left heart border
treatment of mitral stenosis
medication - diuretics and treat AF surgery - valve replacement balloon valuloplasty
causes of aortic regurgitation
leaflets - endocarditis - connective tissue diseases - rheumatic annulus - marfan's - aortic dissection
symptoms and signs of aortic regurgitation
breathlessness collapsing pulse wide pulse pressure displaced apex early diastolic murmur left sternal edge cardiomegaly
treatment of aortic regurgitation
medication - ACE inhibitors surgery - symptoms and LV dilatation - valve replacement
