Valve diseases and murmurs Flashcards
Aortic stenosis - causes
- Degenerative calcification (>65 y/o)
- bicuspid aortic valve (<65 y/o)
- Rheumatic heart disease
- Williams syndrome (supravalvular)
- HOCM (subvalvular)
Aortic stenosis - presenation
SOB
FATIGUE
CHEST PAIN
SYNCOPE
Aortic stenosis- signs
Harsh ejection systolic murmur Soft/absent S2 S4 Thrill Narrow pulse pressure slow rising pulse LV hypertrophy
Aortic stenosis - investigations
ECHO
CXR
ECG
Aortic regurg - causes
Valve disease:
- Infective endocarditis
- Rheumatic fever
- RA/SLE
- bicuspid valve
Aortic root:
- Hypertension
- Aortic dissection
- Ehlers Danlos/ Marfans
- Ankylosing spondylitis
Aortic regurg - symptoms
- mild= asymptomatic/few symptoms
- severe:
- SOB
- FATIGUE
- CHEST PAIN
- SYNCOPE
- PALPITATIONS
- PERIPHERAL OEDEMA
Aortic regurg- signs
- Early diastolic murmur
- Collapsing pulse - water hammer pulse
- Wide pulse pressure- dynamic circulation
- De Musset’s sign- head bobbing
- Quincke’s sign- capillary pulsation on nailbed
- AUSTIN FLINT MURMUR- mid-late diastolic murmur (in severe aortic regurg)
Aortic regurg- investigations
Echo
CXR
ECG
Mitral regurg- Risk factors
- Female
- increasing age
- low body mass
- previous MI
- Renal failure
- Mitral valve prolapse/ mitral stenosis
- Ehlers Danlos / Marfans
Mitral regurg- causes
- Post MI- damage to papillary muscles or chordae tendineae
- Infective endocarditis
- Mitral valve prolapse
- Rheumatic fever- valves inflammed
- Congenital
Mitral regurg - symptoms
- mainly asymptomatic
- If severe can develop signs of LV failure, pulmonary hypertension and arrhytmias:
- SOB
- Oedema
- fatigue
Mitral regurg- signs
- Ejection systolic murmur
- Pansystolic + radiates to axilla
- Soft S1
- Widley split S2
Mitral regurg- investigations
ECHO
CXR- cardiomegaly
ECG - broad p wave
Mitral regurg- management
Acute mitral regurg: - Nitrates - Positive inotropes - Diuretics - Baloon valvuloplasty Surgery - repair > replacement in degenerative regurg if possible
Chronic heart failure:
- ACEi
- beta blockers
- Spiro
Mitral stenosis- causes
RHEUMATIC FEVER!
others:
- mucopolysacharidoses
- Carcinoid and endocardial fibroelastosis
Mitral stenosis - signs
- mid-Late diastolic murmur (best on expiration)
- Malar flush
- AF
- Low pulse volume
- Loud s1
- Opening snap closer to S2
Mitral stenosis - investigations
CXR- LA enlargement
Echo- cross sectional area <1
systolic murmurs?
- Mitral regurg
- Aortic stenosis
- ASD
- Pulmonary stenosis
- HOCM
- VSD
- Tricuspid regurgitation
- tet of fallot
- Mitral valve prolapse
- Coarctation of aorta
Ejection systolic murmurs?
- Aortic stenosis
- ASD (louder on inspiration)
- Pulmonary stenosis (louder on inspiration)
- HOCM
- Tet of Fallot
Pansystolic/holosystolic murmurs?
- Mitral regurg (blowing)
- VSD - harsh ejection systolic
- tricuspid regurg (louder on inspiration)
Late systolic?
- Mitral valve prolapse
2. coarctation of aorta
Diastolic murmurs ?
- Aortic regurg
- Mitral stenosis
- Austin- Flint
- Graham steel
Early diastolic murmurs?
- Aortic regurg
2. Pulmonary regurg (Graham Steel murmur)
Late diastolic murmurs?
- Mitral stenosis (rumbling)
2. Austin Flint - severe aortic regurg (mid-late diastolic)
Continuous machine gun murmur?
Patent Ductus Arteriosus
