Valvular Disease Flashcards
When will the apex beat be tapping?
Mitral stenosis
When will the apex beat be displaced and diffuse?
LV dilatation
When will the apex beat be heaving and possibly displaced?
LV hypertrophy
If there is a parasternal heave to the left of the sternum what does this suggest?
Cor pulmonale or pulmonary hypertension
What is the best test for valvular disease?
ECHO
What is a murmur?
Audible turbulence of blood flow
Where do you listen for the aortic valve?
2nd right intercostal space (parasternal)
Where do you listen for the mitral valve?
At the apex
What makes the first heart sound?
Mitral and tricuspid valves closing (systole)
What makes the second heart sound?
Aortic and pulmonary valves closing (diastole)
What are the two types of systolic murmurs?
Pansystolic and ejection systolic
What are the two types of diastolic murmur?
Early diastolic and mid diastolic
What murmur radiates to the carotids?
Aortic stenosis
What murmur radiates to the axilla?
Mitral regurgitation
Which grade of murmur indicates a thrill?
IV
What does grade VI murmur mean?
It is audible without a stethoscope
What type of murmurs are louder with inspiration?
Right sided
What murmur can cause 2nd sound splitting?
Aortic stenosis
What murmur can cause a third sound?
AR
What murmur can cause a 4th heart sound?
Mitral stenosis
What murmur can cause systolic clicks?
A continuous murmur
What is an innocent murmur?
Tricuspid regurgitation
What murmur can a pericardial rub cause?
MR
What are innocent murmurs commonly?
Early systolic (never diastolic)
What is stenosis?
Valve doesn’t open properly
What is regurgitation?
Valve doesn’t close properly
What are causes of aortic stenosis in the >65s?
Calcified valve
What is usually the cause of aortic stenosis in the <65s?
Bicuspid valve
Can aortic stenosis be rheumatic?
Yes
What are symptoms of aortic stenosis?
Breathless, chest pain, dizziness/syncope
How would you describe an aortic stenosis murmur?
Early systolic murmur radiating to the carotids
What is the treatment for asymptomatic AS?
None- observe
What is the treatment for asymptomatic AS with a valvular gradient >40mmHg and LV systolic dysfunction?
Surgery
How would you treat a symptomatic case of AS?
Valve replacement or 2nd line balloon valvuloplasty
When are mechanical heart valves used?
Younger patients
Which type of heart valve replacement requires warfarin?
Mechanical
When are bio-prosthetic heart valves used?
Older patients
When is a TAVI used instead of a replacement for aortic valve damage?
Patients with co-morbidities or a previous sternotomy
What are causes of MR?
Leaflets, chordae rupture, papillary muscle rupture, annular dilatation
What are leaflet causes of MR?
Prolapse, rheumatic, myxomatous, endocarditis
What are papillary muscle ruptures related to?
Ischaemia
What are symptoms of MR?
Breathless, peripheral oedema, fatigue
How would you describe the murmur of MR?
Pansystolic murmur radiating to the axilla
How can MR be treated medically?
Diuretics and heart failure medication (ACE I’s)
When are repairs and replacements used for MR?
Repair- prolapse
Replacement- degenerative
What is a treatment used for MR in infancy?
Percutaneous clips
What is the main and minor causes of MS?
Rheumatoid and rarely congenital
What are symptoms of MS?
Breathless, fatigue, palpitations (AF)
How would you describe the murmur of MS?
Mid-diastolic rumbling murmur localised to the apex
How can MS be treated medically?
Diuretics and treat AF
How can MS be treated surgically?
Valve replacement or balloon valvuloplasty
What are causes of AR?
Leaflet (endocarditis, connective tissue disease, rheumatic) or annulus (Marfan’s or aortic dissection)
What is the only symptom of AR?
Breathlessness
How would you describe the murmur of aortic regurgitation?
Early diastolic murmur localised to the left sternal edge
How can AR be treated medically?
ACE inhibitors
When should surgery be given for AR and what should it be?
Valve replacement if symptomatic with LV dilatation
What can cause a displaced apex?
Mitral or aortic regurgition
Slow rising pulse?
AS
Loud S1 and opening snap
MS
Wide pulse pressure?
AR
Malar flush?
MS
Narrow pulse pressure?
AS
Low volume pulse?
MS
Collapsing pulse?
AR
Soft S1?
MR
Soft S2?
AS
What can cause a forceful displaced apex beat?
AS
What can cause a straight left heart border?
MS
