Valvular disease Flashcards
If the apex beat is: tapping displaced and diffuse heaving and may be displaced What does this indicate?
Tapping: mitral stenosis
Displaced and diffuse: mitral stenosis
Heaving: left ventricular hypertrophy
If you feel a parasternal heave what does this indicate?
right ventricular overload
When describing murmurs - what is it important to mention?
Systole or diastole?
What type of murmur?
Where is it loudest?
Where does it radiate to?
Carotids (aortic stenosis)
Axilla (mitral regurgitation)
Grade of murmur
is it influenced by respiration
When do you know if a heart murmur is systolic?
- same time as pulse
- in between heart sounds one and two
When do you know if a heart murmur is diastolic?
after second heart sound
are right sided or left sided murmurs louder with inspiration?
right sided
Describe the grading of murmurs
I. Very quiet II. Quiet - easy to hear III. Loud IV. Loud with a thrill V. Very loud with a thrill VI. Loud - audible without a stethoscope
What are the special manouvres for murmurs? which movement for which special manouvre?
Roll onto left side and listen to mitral area with bell during expiration – mitral stenosis
Lean forward and listen over aortic area during expiration – aortic regurgitation
Aortic stenosis:
-what causes aortic stenosis?
Degenerative (age related)
Congenital
E.g bicuspid valve
Rheumatic
aortic stenosis What are the symptoms and signs?
Symptoms:
Breathlessness
Chest pain
Dizziness/syncope
Signs:
low volume pulse
forceful displaced apex
What is the murmur for aortic stenosis?
Ejection systolic murmur that can radiate to the carotids
What is the murmur for aortic stenosis?
Ejection systolic murmur, loudest at aortic area, that can radiate to the carotids
What are the three different treatments for aortic stenosis?
Conventional valve replacement (this is still preferred as long term outcomes and no contraindications)
Trans catheter aortic valve replacement (TAVI)
Balloon Aortic valvotomy (BAV)
what is the difference between a mechanical and a bio-prosthetic heart valve?
Mechanical:
- longevity
- warfarin
- for younger pts
Bio-prosthetic:
- no warfarin
- 10yrs
- older pts
Mitral regurgitation: what are the causes 4
Leaflets:
- Prolapse
- Rheumatic
- Myxomatous (floppy)
- Endocarditis
Chordae rupture (degenerative) -Prolapse/flail leaflet
Papillary muscles rupture
-Ischaemic
Annular dilatation
-Functional
What are the symptoms and signs for mitral regurgitation?
Symptoms:
- breathlessness
- peripheral oedema (because it is a high volume problem)
- fatigue
Signs:
-displaced apex
What is the murmur of mitral regurgitation?
Pansystolic murmur, max at apex, radiating to axilla
What treatment is available for mitral regurgitation?
Medication
-Diuretics and heart failure (ACE inhibitors)
Surgical
- Repair – prolapse
- Replacement - degenerative
Percutaneous
Clips in infancy – encouraging results
Mitral stenosis: what is the main cause? any other causes?
- rheumatic main cause
- congenital rare
What are the symptoms and signs of mitral stenosis?
Symptoms:
- breathlessness
- fatigue
- palpitations (AF)
Signs:
- malar flush
- tapping apex beat
What is the murmur for mitral stenosis?
mid diastolic rumbling murmur with accentuation pre-systolic (quiet and gets louder)
will be heard after opening snap (opening snap as valve forced open)
What is the treatment of mitral stenosis?
Medication
Diuretics and treat AF
(causes AF as there’s enlargement of left atrium)
Surgery
Valve replacement
Balloon Valvuloplasty
Aortic regurgitation: what are the causes? 2
Leaflets
- Endocarditis
- Connective tissue diseases
- Rheumatic
Annulus
- Marfans
- Aortic dissection
What are the symptoms and signs of aortic regurgitation?
symptom: breathlessness
Signs: collapsing pulse, displaced apex
What is the murmur assoc. with aortic regurgitation?
Early diastolic murmur heard on the left sternal edge
Absence of Silence after S2
What is the treatment of aortic regurgitation?
Medication
ACE inhibitors
Surgery
Symptoms and LV dilatation
Valve replacement
Why is there splitting of the second heart sound?
physiological splitting can occur during inspiration as the pulmonary component of the second heart sound delaying after the aortic component
What could a third heart sound suggest?
- physiological: passive filling of ventricles
- pathological: heart failure
What does a fourth heart sound suggest?
pathological: active filling of a stiff/non-compliant ventricle filling during atrial contraction, due to e.g. hypertrophy.
