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Cardiology > Valve summary > Flashcards

Valve summary Flashcards

1
Q

Where is the aortic valve?

A

Between the left ventricle and aorta

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2
Q

What is aortic stenosis?

A

Narrowing of the aortic valve

Obstructing forward flow through the valve during systole

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3
Q

What are the main causes of aortic stenosis?

A

> 65 Degenerative calcification
<65 Bicuspid aortic valve
Williams syndrome
rheumatic heart disease

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4
Q

What does Williams syndrome present with?

A

Supravalvular aortic stenosis

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5
Q

What murmur does aortic stenosis present with?

A

High pitched ejection systolic murmur

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6
Q

Where is the aortic stenosis murmur heard loudest?

A

Loudest at aortic area (on expiration)

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7
Q

Where does an aortic stenosis murmur radiate to?

A

The carotids

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8
Q

What are the features of severe aortic stenosis?

A
  • narrow pulse pressure
  • slow-rising pulse
  • heaving, non-displaced apex beat
  • soft/absent S2
  • S4
  • thrill (if very severe)
  • left ventricular hypertrophy, LV heave
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9
Q

What might you find on investigation of aortic stenosis?

A
  • ECG :LV hypertrophy
  • CXR: Calcified aortic valve
  • Echo :diagnose and assess severity
  • Cardiac catheter: to assess for CAD which is common
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10
Q

What is the management of aortic stenosis?

A
  • Asymptomatic- observe
  • Symptomatic- valve replacement
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11
Q

What does aortic stenosis cause?

A

Systolic dysfunction

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12
Q

How can aortic stenosis present?

A

Asymptomatic
- chest pain
- exertional dyspnoea
- syncope, dizziness

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13
Q

What is aortic regurgitation?

A

Incompetent aortic valve allows blood to flow back into the ventricle during diastole

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14
Q

What dysfunction does aortic regurgitation cause?

A

diastolic dysfunction

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15
Q

What are the acute causes of aortic regurgitation?

A
  • infective endocarditis
  • ascending aortic dissection
  • chest trauma
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16
Q

What are the chronic causes of aortic regurgitation?

A
  • connective tissue disorders (e.g. Marfan’s, Ehler-Danlos syndrome)
  • connective tissue disease (e.g. rheumatoid arthritis,SLE)
  • rheumatic fever
  • hypertension
  • syphilis
  • ankylosing spondylitis
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17
Q

What murmur does aortic regugitation present with?

A

Low pitched rumbling early diastolic murmur

18
Q

What are the main signs of aortic regurgitation?

A

collapsing pulse
wide pulse pressure
Quincke’s sign (nailbed pulsation)
De Musset’s sign (head bobbing)

19
Q

What are the presenting features of aortic regurgitation?

A
  • exertional dyspnoea
  • orthopnoea and paroxysmal nocturnal dyspnoea
  • palpitations, angina, syncope
20
Q

What are the signs of severe aortic regurgitation?

A
  • mid-diastolic Austin-Flint murmur
  • carotid pulsation
  • de Musset’s sign (= head bobbing)
  • Quincke’s sign (= nailed pulsation)
21
Q

Where is the mitral valve?

A

Between the left atria and left ventricle

22
Q

What is mitral stenosis?

A

Narrowing of the mitral valve

23
Q

What can mitral stenosis result in?

A

Increases in pressure within the left atrium, pulmonary vasculature and right side of the heart.

24
Q

What murmur does mitral stenosis cause?

A

“rumbling” mid-late diastolic murmur

25
Q

Where is the murmur caused by mitral stenosis heard best?

A

On expiration
Over apex and with patient on left side

26
Q

What is the main cause of mitral stenosis?

A

Rheumatic fever

Other: mucopolysaccharidoses, carcinoid and endocardial fibroelastosis

27
Q

What are the main symptoms of mitral stenosis?

A
  • dypnoea
  • fatigue
  • cough
  • orthopnoea and paroxysmal nocturnal dyspnoea
28
Q

What are the main signs of mitral stenosis?

A
  • malar flush
  • low volume pulse
  • loud S1 — opening snap
  • non-displaced, tapping apex beat
  • AF (due to enlarged left atrium)
29
Q

What are the features of severe mitral stenosis?

A

length of murmur increases
opening snap becomes closer to S2

30
Q

What would you see on investigations of someone with mitral stenosis?

A

CXR: Left atrial enlargement
- ECG: AF, P-mitrale, RV hypertrophy
- ECHO: diagnose and assess severity
- Cardiac catheterisation; atrial pressure monitoring

31
Q

What is the management fot mitral stenosis?

A

AF: Warfarin
Asymptomatic: monitor
Symptomatic: surgical valve replacement or percutaneous balloon valvuloplasty

32
Q

What is mitral regurgitation?

A

Blood leaks from the left ventricle into the left atrium during systole

33
Q

What does mitral regurgitation cause?

A

Systolic dysfunction

34
Q

What are the main causes of mitral regurgitation?

A

Following coronary artery disease or post-MI
Mitral valve prolapse
Infective endocarditis
Rheumatic fever
Congenital

35
Q

What is a big RF for mitral regurgitation?

A

Collagen disorders e.g. Marfan’s Syndrome and Ehlers-Danlos syndrom

36
Q

How is the murmur described in someone with mitral regurgitation?

A

Pansystolic “blowing” murmur

37
Q

Where is the mitral regurgitation murmur heard best?

A

At the apex and radiating into the axilla

38
Q

How can mitral regurgitation present?

A

Asymptomatically- main
- lethargy and fatigue
- dyspnoea
- cough
- orthopnoea, paroxysmal nocturnal dyspnoea

39
Q

What would you find on investigation of mitral regurgitation?

A

ECG : broad P wave (atrial enlargement)
CXR: Cardiomegaly (enlarged left atrium and ventricle)
ECHO: diagnose and assess severity

40
Q

What clinical sign can occur in severe mitral reguegitation?

A

Splitting of the S2 heart sound

41
Q

What is preferred in the management of mitral regurgitation?

A

Valve repair over replacement

Cardiology (66 decks)

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