Valve Disorders Flashcards
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What are the clinical features of aortic valve regurgitation
Corigan pulse in the carotid due to the wide pulse pressure - high systolic low diastolic
In capillaries - de quicken sign
De musset sign - head nodding with the pulse
What are the heart sounds heart in aortic regurgitation ?
Early diastolic decrescendo murmur - worsens with hand grip and squatting as more blood goes back through the valve
S3
The early diastolic decrescendo murmur can progress into Austin flint murmur which is harsh crescendo decrescendo mid systolic murmur - representing aortic stenosis ( this is blood rushing back and hitting the mitral valve )
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Cause of aortic stenosis in more than 65
degenerative calcification (most common cause in older patients > 65 years)
post-rheumatic disease
Causes of aortic stenosis
In less than 65
bicuspid aortic valve (most common cause in younger patients < 65 years) = Turner syndrome
Suprvalvular - william’s syndrome
( elfin-like facies
characteristic like affect - very friendly and social
learning difficulties
short stature)
Haydes Syndrome -
angiodysplasia angiodysplasia is a small vascular malformation of the gut. It is a common cause of otherwise unexplained gastrointestinal bleeding and anemia
Aortic stenosis
CKD
subvalvular: HOCM
What are the clinical features of aortic stenosis
Pulsus tardus et parvus - late and small pulse
Systolic thrill at the bifurcation of the carotid arteries
What are the auscultation signs of aortic stenosis
Systolic ejection click
Systolic ejection murmur - harsh crescendo decrescendo murmur
The murmur propagates to the carotid arteries
Manuevers such as valsalva which increases pre load does not change or increase the murmur unlike hypertrophic cardiomyopathy that increases the murmur
SOFT S2 - AS AORTIC VALVE DOES NOT CLOSE PROPERLY - IN SEVERE CASES
Severity of aortic stenosis is by ?
S4
On other physical examinations what are the signs of aortic stenosis ?
Narrow pulse pressure
Mx of aortic stenosis
If symptomatic valve replacement
Surgical AVR- young , reduce risk of bleeding ,
Transcutaneous AVR - high operative risk
Valvular gradient over 40mg - surgery
When is aortic balloon valvuloplasty done ?
Children with no aortic valve calcification
Adults - critical condition - not fit for valve replacement.
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etiology of mitral valve stenosis ?
rheumatic fever!
What are the clinical features of mitral valve stenosis
hemoptysis -pink frothy sputum to sudden haemorrhage
dyspnea - pulmonary venous hypertension
MALAR FLUSH
ATRIAL FIBRILLATION
SECONDARY TO ↑ LEFT ATRIAL PRESSURE → LEFT ATRIAL ENLARGEMENT
Severe - hepatomegaly
LOW VOLUME PULSE
What are the auscultation features in mitral stenosis ?
Mild
Preceding S1 pre systolic murmur or rumble
Early diastolic opening snap
Mid diastolic murmur - heard best in expiration
Moderate
Loud S1
Now loud P2
Early diastolic snap , mid diastolic murmur however the gap has decreased
Severe
Pandiastolic or no murmur at all
S1 can be loud or quiet
P2 can increase
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Treatment of mitral valve stenosis ?
narrow pulse pressure
resistant cardiac failure
= percutaneous mitral valvotomy
Percutaneous mitral only indicated where :
PERCUTENAOUS MITRAL VALVULOTOMY IS CONTRA
SEVERE HF
surgical replacement if the above unsuccessful
contra of percutaneous mitral valvotomy ?
mitral valve are of more than 1.5cm2
presence of left atrial thrombus
greater than mild mitral regurgitation
severe valve calcification
concomitant valve disease of the same side
concomitant coronary artery disease
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What are the osculatory manifestations of mitral regurgitation?
Acute cases - soft systolic decrescendo murmur
Chronic cases quiet s1
Pansystolic murmur radiating to left axilla
S3
Mx for for mitral regurgitation or prolapse.
Mitral valve repair
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valve replacement with warfarin INR target ?
aortic - 3
mitral - 3.5
Valve replacement anticoagulation
Prosthetic heart valves - antithrombotic therapy:
bioprosthetic: warfarin in the begining then aspirin long term
mechanical: warfarin + aspirin
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ostium secundum on ECG ? ((70% of ASDs)
RBBB with RAD
Ostium primum on ECG
RBBB with LAD, prolonged PR interval
