Valve Disease Flashcards
What is aortic stenosis?
Narrowing of the aortic valve, causing obstruction of blood moving from the left ventricle to the aorta
What are the causes of aortic stenosis?
Ageing/calcification of valve
- Fusion of commissures
- Retraction and stiffening of the free cusp margins
Congenital bicuspid aortic valve
Rheumatic fever
What is the most common cause of aortic stenosis?
Ageing/calcification of valve
How does aortic stenosis present?
SAD
- Syncope
- Angina/Chest pain
- Dyspnoea on exertion
Auscultation
- High pitched early ejection systolic murmur with crescendo decrescendo
- Radiates to carotid artery/neck
- Best heard at aortic valve
- 4th heart sound
Slow rising pulse
Narrow pulse pressure
Heaving apex beat
Right ventricular heave
Systolic thrill
What investigations are used in aortic stenosis diagnosis?
ECG
CXR
- Calcification
ECHO
- Left ventricular hypertrophy
How is aortic stenosis managed?
Furosemide, provides symptomatic relief while waiting for surgery, nitrates are contraindicated
If asymptomatic, monitor
If symptomatic and under 75, valve replacement
If symptomatic and over 75, transcatheter aortic valve implantation
If asymptomatic but valvular gradient over 40mmHg, consider surgery
Balloon valvuloplasty, for patients with critical disease not fit for valve replacement
What are the two types of valve replacment and the difference between them?
Metallic
- Longer lasting but requires life long warfarin
Tissue valve graft
- Shorter lasting but requires warfarin for only 6 months
Name some complications of aortic stenosis
Left ventricular hypertrophy, causing left sided HF
Arrythmia
Endocarditis
Differentiate between aortic stenosis and aortic sclerosis
Aortic sclerosis does not radiate to carotid
What is aortic regurgitation?
Leakage of blood back to the left ventricle from the aorta upon contraction
What are the causes of aortic regurgitation?
Acute
- Infective endocarditis
- Ascending aortic dissection
- Chest trauma
Chronic
- Connective tissue disorders, such as Marfan’s or Ehlers-Danlos
- Congenital bicuspid aortic valve
- Rheumatic fever
How does aortic regurgitation present?
Long asymptomatic phase before developing symptoms in chronic cases
Auscultation
- Early soft diastolic murmur with immediate decrescendo
- Best heard at tricuspid region when patient sits up
Exertional dyspnoea and orthopnoea
Wide pulse pressure
Bounding pulse
Collapsing pulse
Thrusting apex beat
Corrigan sign
De Musset sign
What are the 4 unsual signs seen in aortic regurgitation?
Corrigan’s sign
Quincke’s sign
Traube’s sign
De Musset’s sign
What is Corrigan’s sign?
Visible carotid pulsations, seen in AR
What is Quincke’s sign?
Capillary pulsations in the nail bed, seen in AR
What is Traube’s sign?
Pistol shots over the femoral arteries, seen in AR
What is De Musset’s sign?
Head nodding in time with the pulse, seen in AR
What investigations are used in aortic regurgitation diagnosis?
ECG
CXR
- Cardiomegaly
ECHO
How is aortic regurgitation managed?
ACEI, to reduce systolic hypertension
Echo every 6–12 months to monitor
Aim to replace the valve before significant LV dysfunction occurs
What is mitral stenosis?
Narrowing of the mitral valve, causing the obstruction of blood moving from the left atrium to the left ventricle
What are the causes of mitral stenosis?
Rheumatic fever
How does mitral stenosis present?
Auscultation
- Mild diastolic rumbling with opening snap
- Heard at mitral region when patient lies to the left
- Loud S1
- Loudest on expiration
Malar flush
Dyspnoea
Hoarse voice
Tapping apex beat
Diastolic thrill
Right ventricular heave
What investigations are used in mitral stenosis diagnosis?
ECG
- AF
- Bifid p wave
CXR
ECHO
Cardiac Magnetic Resonance (CMR)
What is the management of mitral stenosis?
Diuretics in acute phase for symptomatic management
Balloon valvuloplasty, in mild disease
Percutaneous mitral valvotomy, in moderate disease
Mitral valve replacement, in severe disease
Anticoagulants
What is mitral regurgitation?
Leakage of blood back to the left atrium from the left ventricle upon contraction
What are the causes of mitral regurgitation?
Papillary muscle dysfunction, post MI
Dilated cardiomyopathy
Infective endocarditis
Age related calcification/degenerative
Connective tissue disorders
Mitral valve prolapse
- Polycystic kidney disease
- WPW
- Long QT
How does mitral regurgitation present?
Auscultation
- Pansystolic whistling/whoosh all the way through
- Radiates to axilla
- Loudest at mitral valve
- Soft S1
Dyspnoea
Thrusting apex beat
Jerky pulse
What investigations are used in mitral regurgitation diagnosis?
ECG
- Tall p waves
CXR
ECHO
CMR
What is the management of mitral regurgitation?
Acute
- Sodium Nitroprusside
- Dobutamine
Urgent surgical repair or valve replacement
Give features of pulmonary stenosis
Ejection systolic murmur
- Loudest on expiration
Congenital disease
- Noonan syndrome
- Williams syndrome
- Tetralogy of Fallot
- Congenital rubella syndrome
How is pulmonary stenosis managed?
Treatment is considered for patients with transvalvular pressure gradients over 50mmHg
Valvotomy
Balloon angioplasty
Give features of pulmonary regurgitation
Graham-Steel murmur
- Early diastolic, high pitched blowing
Give features of tricuspid regurgitation
Pan systolic murmur
- Loudest at tricuspid valve/lower left sternal edge
- Louder on inspiration
Fever
IVDU
Give features of tricuspid stenosis
Diastolic murmur
- Left sternal edge/tricuspid valve
