Valvular disease Flashcards
What is the New York Heart Association Functional Classification?
It is a grading system for heart disease based on activity levels
What are the 4 classifications?
- Class 1I - no limitation
- class II - slight limitation of ordinary activity
- Class III- Marked limitation of less than ordinary activity
- class IV - severe limitation of minimal activity or at rest
What is a pan systolic murmur?
It has the same volume through the 1st and 2nd heart sounds.
Occurs in mitral regurgitation
What is an ejection systolic murmur?
A sound that increases in loudness from the 1st heart sound to the second heart sound
Occurs in mitral stenosis
What are the two types of diastolic murmur?
-early and late diastolic murmur
Which type of diastolic murmur is mitral stenosis?
-mid diastolic rumbling murmur
If aortic stenosis were to radiate, where would it radiate to?
-carotids
If mitral regurgitation were to radiate, where would it radiate to?
-axilla
Describe the grading of murmurs
I- Very quiet II- Quiet without thrill III- loud without thrill IV - loud with thrill V- very loud with thrill VI - audible without steth
What does inspiration do to murmurs?
Increased venous return on inspiration causes louder right sided murmurs
What is the most common cause of aortic stenosis?
degeneration of the valve
What are the characteristics of aortic stenosis?
- thickened leaflets
- degenerates with age
- related to same mechanism that causes atherosclerosis (not conclusive evidence)
- will not open properly due to wear which results in aortic stenosis
What are the symptoms of aortic stenosis?
- breathlessness
- chest pain
- dizziness/syncope
What are the signs of aortic stenosis?
- low volume pulse
- forceful displaced apex
- ejection systolic murmur which can radiate to the carotids
if an aortic stenosis is symptomatic what does that indicate?
It means it is significant
What causes pain in aortic stenosis?
- Not sufficient CO therefore can start to develop LVH meaning more muscle mass.
- This leads to a mismatch in demand and supply
- Causing angina like chest pain
What causes an ejection murmur?
-pressure gradient between left ventricular pressure and aortic pressure
How do you treat aortic stenosis?
- conventional valve replacement
- trans catheter aortic valve replacement
- balloon aortic valvotomy
What is the issue with Trans catheter aortic valve replacement?
limited use in limited patients in limited centres
What are the benefits and disadvantages of a mechanical prosthetic heart valve?
-last longer therefore more suitable for young patients but need anticoagulation for life
What are the benefits and disadvantages of a bio-prosthetic heart valve?
Last up for up to 10 years so are good for older patients but dont need anticoagulants
What are the pros of Aortic valve replacement?
- still preferred
- long term outcomes
- no contra indications
- Coronary artery bypass at same time
What causes mitral regurgitation?
- problems with the leaflets
- Chordae rupture
- papillary muscle rupture
- annular dilation
What are the symptoms of mitral regurgitation?
- breathlessness (due to back pressure)
- peripheral oedema (due to RVF from LVF)
- fatigue
What are the signs of mitral regurgitation?
- displaced apex beat
- pan systolic murmur
What is the treatment for mitral regurgitation?
- medications (diuretics and ACEI)
- surgery (repair or replace)
- percutaneous (clips in infancy)
Why are meds given in mitral regurgitation?
- used to control symptoms.
- patient can continue with no surgical treatment if meds are used and get regular Echos
- if patient deteriorates then do surgery
What re the cuases of mitral stenosis?
- rheumatic (main cause)
- congenital (rare)
What are the symptoms of mitral stenosis?
- breathlessness
- fatigue
- palpitations (AF)
What are the signs of mitral stenosis?
- malar flush (not in all patients)
- tapping apex beat
- mid diastolic rumbling
- left atria starts to enlarge - AF on ECG will complicate HF
What may you see on a CXR in mitral stenosis?
straight left heart border
What is the treatment for mitral stenosis?
- meds (diuretics and treat AF)
- Surgery (valve replacement)
- balloon valvuloplasty
What can be used to treat AF/
-B blockers or calcium channel blockers
When would balloon valvuloplasty be used?
Can be good in people with co morbidity factors so surgery isn’t a great option for them
What are the causes of aortic regurgitation?
- leaflet abnormalities
- annulus - dilation of proximal aorta
What re the symptoms of aortic regurgitation?
Breathlessness
What are the signs of aortic regurgitation?
- collapsing pulse
- wide pulse pressure
- displaced apex
- early diastolic murmur left sternal edge
How does wide pulse pressure occur?
– if aortic valve doesn’t close properly, large end diastolic volume due to leakage of blood which causes large SV and large systolic blood pressure. Ie leading to low diastolic pressure but high systolic pressure.
What is the treatment for aortic regurgitation?
- medication (ACEI)
- surgery valve replacement)
When is surgery needed in aortic regurgitation?
- symptomatic
- LV dilation
