Valve Disorders Flashcards
What are the general symptoms of valve disorders?
Chest pain
Breathlessness
Collapse/dizziness
Exertional symptoms
What is the characteristic features of valve disorder symptoms?
Exertional symptoms
What is the nature of chest pain caused by valve disorders?
Gripping
Squeezing
Heavy
Crushing
What is the breathlessness of valve disorders associated with?
Activity
Ankle swelling
Orthopnoea (breathlessness when lying down)
PND
What is the apex beat?
The pulse felt at maximum impulse
Where is the apex beat felt?
5th intercostal space, mid-clavicular line
What is tapping apex beat a symptom of?
Mitral stenosis
When is the apex beat displaced and diffuse?
LV dilation (volume overload)
When is the apex beat heaving and displaced?
LV hypertrophy (pressure overload)
What is a cardiac murmur?
Audible turbulence of blood flow
What are the causes of cardiac murmurs?
Blood flowing through an abnormal narrowing
Blood flowing in the wrong direction though the heart
An abnormal connection between two different parts of the heart
When is a systolic murmur heard?
Stenosis of either the aortic or pulmonary valve
Regurgitation though the mitral or tricuspid valves
When is a diastolic murmur heard?
Regurgitation through the aortic or pulmonary valves
Stenosis of mitral or tricuspid valves
What type of diastolic murmur do regurgitation through the aortic or pulmonary valves cause?
Early diastolic
What type of diastolic murmur do stenosis of mitral or tricuspid valves cause?
Mid or late diastolic
What is S1?
Mitral and tricuspid valves closing
What is S2
Aortic and pulmonary valves closing
What murmur radiates to the carotids?
Aortic stenosis
What murmur radiates to the axilla?
Mitral regurgitation
What are the grades of murmurs?
I. Very quiet II. Quiet - easy to hear III. Loud IV. Loud with a trill V. Very loud with a trill VI. Loud - audible without a stethoscope
What are the manoeuvres that can be done to make murmurs louder, and which murmurs do they affect?
Sitting forward - aortic murmurs
Lying on side - mitral valve murmurs
Which murmurs does inspiration make louder?
Right sided (pulmonary and tricuspid valves)
Which murmurs does expiration make louder?
Left sided (aortic and mitral valves)
What murmurs are likely to be innocent?
Soft (less than 3/6 severity)
Early systole
What is the characteristic feature of aortic stenosis murmurs?
Ejection systolic murmur that radiates to carotids
What are the characteristic symptoms and signs of aortic stenosis?
Heaving apex
Ejection systolic murmur that radiates to carotids
Loudest on expiration and when sitting forwards
Slow rising pulse
What are the causes of aortic stenosis?
Congenital
Age
Rheumatic
What is the treatment for aortic stenosis?
Conventional valve replacement
Trans-catheter aortic valve replacement (TAVI)
Balloon aortic valvotomy (BAV)
What is the characteristic feature of mitral stenosis murmurs?
Mid-diastolic rumbling murmur localised to apex
What are the characteristic symptoms and signs of mitral stenosis?
Palpitations
Tapping apex beat
Mid-diastolic rumbling murmur localised to apex
What are the causes of mitral stenosis?
Mainly rheumatic
What is the treatment for mitral stenosis?
Medication: diuretics and treat AF
Surgery: valve replacement
Balloon valvuloplasty
What is the characteristic feature of mitral regurgitation murmurs?
Pansystolic murmur heard best at the apex, radiates to axilla
What are the characteristic symptoms and signs of mitral regurgitation?
Displaced apex
Pansystolic murmur
Radiates to axilla
What are the causes of mitral regurgitation?
Degenerative Infective endocarditis Mitral valve prolapse Chordae rupture (degenerative) Connective tissue disease
What is the treatment for mitral regurgitation?
Medication: diuretics, ACE inhibitors
Surgical: repair (prolapse), replacement (degenerative)
What is the characteristic feature of aortic regurgitation murmurs?
High pitched early diastolic murmur
What are the characteristic symptoms and signs of aortic regurgitation?
Collapsing pulse
Displaced apex
Early diastolic murmur, left sternal edge
What are the causes of aortic regurgitation?
Endocarditis Rheumatic Connective tissue disease Marfan's Aortic dissection
What is the treatment for aortic regurgitation?
Medication: ACE inhibitors, diuretics
Surgery: symptoms and LV dilation
Valve replacement
What is the pathophysiology for aortic stenosis?
Aortic stenosis prevents proper LV emptying, leading to increased pressure and hypertrophy
Results in ischaemia of LV myocardium, causing angina, arrhythmias and LV failure
What is the pathophysiology of aortic regurgitation?
Reflux of blood from the aorta to LV causes LV dilation
Diastolic BP decreases and coronary perfusion is decreased
What type of organism causes rheumatic fever?
Group A beta-haemolytic streptococcus
How does rheumatic fever lead to valve dysfunction?
Inflammation leads to fusion the valves over many years
What is the pathophysiology for mitral stenosis?
Harder to pump blood put of the left atrium so pressure increases, causing LA hypertrophy and dilation
This causes pulmonary venous and right heart pressure to increase
Pulmonary oedema develops
Compensatory mechanisms lead to pulmonary hypertension, RV hypertrophy, dilation and failure
What is a common complication of mitral stenosis?
Atrial fibrillation
What is the diagnostic investigation for valve disorders?
Echo
What is the pathophysiology of mitral regurgitation?
Regurgitation into LA causes LA dilation
If acute - pressure increases, pulmonary venous pressure rises, causing oedema
A proportion of the SV is regurgitated so stroke volume increases, causing LV hypertrophy
