Valve summary Flashcards
Where is the aortic valve?
Between the left ventricle and aorta
What is aortic stenosis?
Narrowing of the aortic valve
Obstructing forward flow through the valve during systole
What are the main causes of aortic stenosis?
> 65 Degenerative calcification
<65 Bicuspid aortic valve
Williams syndrome
rheumatic heart disease
What does Williams syndrome present with?
Supravalvular aortic stenosis
What murmur does aortic stenosis present with?
High pitched ejection systolic murmur
Where is the aortic stenosis murmur heard loudest?
Loudest at aortic area (on expiration)
Where does an aortic stenosis murmur radiate to?
The carotids
What are the features of severe aortic stenosis?
- narrow pulse pressure
- slow-rising pulse
- heaving, non-displaced apex beat
- soft/absent S2
- S4
- thrill (if very severe)
- left ventricular hypertrophy, LV heave
What might you find on investigation of aortic stenosis?
- ECG :LV hypertrophy
- CXR: Calcified aortic valve
- Echo :diagnose and assess severity
- Cardiac catheter: to assess for CAD which is common
What is the management of aortic stenosis?
- Asymptomatic- observe
- Symptomatic- valve replacement
What does aortic stenosis cause?
Systolic dysfunction
How can aortic stenosis present?
Asymptomatic
- chest pain
- exertional dyspnoea
- syncope, dizziness
What is aortic regurgitation?
Incompetent aortic valve allows blood to flow back into the ventricle during diastole
What dysfunction does aortic regurgitation cause?
diastolic dysfunction
What are the acute causes of aortic regurgitation?
- infective endocarditis
- ascending aortic dissection
- chest trauma
What are the chronic causes of aortic regurgitation?
- connective tissue disorders (e.g. Marfan’s, Ehler-Danlos syndrome)
- connective tissue disease (e.g. rheumatoid arthritis,SLE)
- rheumatic fever
- hypertension
- syphilis
- ankylosing spondylitis
What murmur does aortic regugitation present with?
Low pitched rumbling early diastolic murmur
What are the main signs of aortic regurgitation?
collapsing pulse
wide pulse pressure
Quincke’s sign (nailbed pulsation)
De Musset’s sign (head bobbing)
What are the presenting features of aortic regurgitation?
- exertional dyspnoea
- orthopnoea and paroxysmal nocturnal dyspnoea
- palpitations, angina, syncope
What are the signs of severe aortic regurgitation?
- mid-diastolic Austin-Flint murmur
- carotid pulsation
- de Musset’s sign (= head bobbing)
- Quincke’s sign (= nailed pulsation)
Where is the mitral valve?
Between the left atria and left ventricle
What is mitral stenosis?
Narrowing of the mitral valve
What can mitral stenosis result in?
Increases in pressure within the left atrium, pulmonary vasculature and right side of the heart.
What murmur does mitral stenosis cause?
“rumbling” mid-late diastolic murmur
Where is the murmur caused by mitral stenosis heard best?
On expiration
Over apex and with patient on left side
What is the main cause of mitral stenosis?
Rheumatic fever
Other: mucopolysaccharidoses, carcinoid and endocardial fibroelastosis
What are the main symptoms of mitral stenosis?
- dypnoea
- fatigue
- cough
- orthopnoea and paroxysmal nocturnal dyspnoea
What are the main signs of mitral stenosis?
- malar flush
- low volume pulse
- loud S1 — opening snap
- non-displaced, tapping apex beat
- AF (due to enlarged left atrium)
What are the features of severe mitral stenosis?
length of murmur increases
opening snap becomes closer to S2
What would you see on investigations of someone with mitral stenosis?
CXR: Left atrial enlargement
- ECG: AF, P-mitrale, RV hypertrophy
- ECHO: diagnose and assess severity
- Cardiac catheterisation; atrial pressure monitoring
What is the management fot mitral stenosis?
AF: Warfarin
Asymptomatic: monitor
Symptomatic: surgical valve replacement or percutaneous balloon valvuloplasty
What is mitral regurgitation?
Blood leaks from the left ventricle into the left atrium during systole
What does mitral regurgitation cause?
Systolic dysfunction
What are the main causes of mitral regurgitation?
Following coronary artery disease or post-MI
Mitral valve prolapse
Infective endocarditis
Rheumatic fever
Congenital
What is a big RF for mitral regurgitation?
Collagen disorders e.g. Marfan’s Syndrome and Ehlers-Danlos syndrom
How is the murmur described in someone with mitral regurgitation?
Pansystolic “blowing” murmur
Where is the mitral regurgitation murmur heard best?
At the apex and radiating into the axilla
How can mitral regurgitation present?
Asymptomatically- main
- lethargy and fatigue
- dyspnoea
- cough
- orthopnoea, paroxysmal nocturnal dyspnoea
What would you find on investigation of mitral regurgitation?
ECG : broad P wave (atrial enlargement)
CXR: Cardiomegaly (enlarged left atrium and ventricle)
ECHO: diagnose and assess severity
What clinical sign can occur in severe mitral reguegitation?
Splitting of the S2 heart sound
What is preferred in the management of mitral regurgitation?
Valve repair over replacement
