Valve Disease Flashcards
Name the two systolic murmurs
Mitral Regurgitation
Aortic Stenosis
Name the two diastolic murmurs
Mitral Stenosis
Aortic Regurgitation
What are the most common causes of Mitral Stenosis?
- Rheumatic Heart disease, secondary to rheumatic fever
- could also be congenital or arthritic
How much is the valve narrowed in stenosis?
From 4-6cm to <2cm
Consequences of Aortic Stenosis?
Increased pressure in Left atrium
- increased pressure in pulmonary veins
- tricuspid and pulmonary valve become incompetent under pressure.
What two factors affect the severity?
Flow rate (dependent on CO, HR) Pressure Gradient
SIGNS of MS
dyspnoea stroke Haemoptosis chest pain infective endocarditis hoarse voice mitral facies JVP- prominent a wave tapping apex beat diastolic thrill RV heave
Investigations for MS
ECG catheterisation
CXR
Echo- ** best for looking at leaflets.
Cardiac MRI
Treatment for ms
meds- diuretics, control AF, anticoagulation
Surgery- valve replacement or valvotomy
Mitral Regurgitation- causes
Rheumatic Heart Disease
Mitral Valve prolapse
Degenerative
change in LV- hypertrophy
MR- consequences?
Chronic- LV will compensate
Acute- LV doesn’t have a chance to compensate- v bad
SIGNS OF MR
Acute- SOB, Pulmonary Oedema, Cardiogenic Shock
Chronic- Fatigue, exhaustion, RH failure, dyspnoea, palpitations
Loud systolic murmur
Hyper dynamic Apex Beat
JVP- elevated in Heart failure`
Investigation in MR
ECG- tall p wave
CXR- oedema
Echo- look at valve **
Treatment of MR
Medical- reduce afterload and preload in acute= diuretics.
Surgery- replace or repair.
Aortic Valve Stenosis causes
Degenerative- due to high stresses on aortic valve
Congenital - bicuspid aortic valve
Consequences of AS
High LV systolic pressure
LVH
High ED pressure
High O2 demand= more susceptible to ischaemia.
SIGNS of AS
Long period will be asymptomatic Symptoms = bad Chest Pain Syncope SOB on exertion Heart Failure Pulse- small and slow rising JVP- prominent in Heart failure Vigorous and hyper dynamic apex beat harsh systolic murmur- carotid
Investigations for AS
ECG- tall r wave
CXR- calcification if valve
ECHO- look at valve and LV function
Treatment of AS
- Only for those with heart failure
- Valve replacement
Aortic Regurgitation- causes?
Dilated Aorta
Bicuspid Aortic Valve
Connective Tissue Disorder- Marfans
Consequences of AR
High EDV and Stroke Volume
Hypertrophy and Dilation= increased demand for O2= MI= Heart Failure
Clinical signs of AR
Chronic- long asymptomatic phase Acute- pulse, large and collapsing quiet diastolic murmur wide pulse pressure hyper dynamic misplaced apex beat.
Investigations of AR
ECG
CXR
ECHO-
Treatment of AR
Medical - vasodilators - delay surgery for 2-3 years.
Surgery - replacement or repair
