Valvular Disease Flashcards
What is the clinical presentation of valvular heart disease?
Chest pain, breathlessness, collapse/dizzy spells. Exertional symptoms.
Describe the New York Heart Functional Classification (NYHA).
I - no limitation. II - slight limitation. III - marked limitation of less than ordinary activity. IV - severe limitation of minimal activity or at rest.
What are the signs of right heart failure?
Raised JVP. Pitting oedema (put 1 finger pressure above medial malleolus). Hepatic congestion.
What will the apex beat be like in mitral stenosis?
Tapping apex.
What causes the parasternal heave?
Due to right ventricular overload e.g. cor pulmonale/pulmonary hypertension.
What questions should you answer when describing murmurs?
Systole or diastole? What type of murmur? Where is it loudest? Where does it radiate to? What grade of murmur? Influenced by respiration?
What are the 2 types of systolic murmur and what condition is it associated with?
Pansystolic (goes all the way through with same volume) e.g. mitral regurgitation. Ejection systolic (volume increases then decreases) e.g. aortic stenosis.
What are the types of diastolic murmur?
Early diastolic (loud at start and decreases). Mid-diastolic (rumbling).
What is a common feature of right sided murmurs?
They are louder with inspiration.
What are features of innocent murmurs?
Soft (less than 3/6 severity).
Position dependent.
Often early systolic (diastolic murmurs always pathological).
What is mixed valve disease?
Valves which neither open properly nor close properly.
What are the non-invasive and invasive investigations of valvular heart disease?
Non-invasive: echo.
Invasive: cardiac catheterisation.
What are 3 causes of aortic stenosis?
- Degenerative (age related, commonest cause).
2. Congenital e.g. bicuspid
What are the symptoms of aortic stenosis?
Breathlessness, chest pain (they will not have sufficient output to coronary arteries and will get LVH leading to ischaemic chest pain), dizziness/syncope.
What are the signs of aortic stenosis?
Low volume pulse, forceful displaced apex, ejection systolic murmur that can radiate to the carotids.
What is the diagnostic investigation for valve disease?
Echocardiogram.
What is the treatment for aortic stenosis?
Conventional valve replacement, trans catheter aortic valve replacement (TAVI), balloon aortic valvotomy (BAV).
What are the features of mechanical and bio-prosthetic valves?
Mechanical: longevity (more suitable in younger patients), need warfarin for life.
Bio-prosthetic: no warfarin needed, 10 years, older patients.
What are the benefits of aortic valve replacement (AVR, open heart surgery) over transcatheter aortic valve implantation (TAVI)?
It is still preferred, better long term outcomes, used when no-contraindications, can do CABG at same time.
When would you do TAVI instead of AVR?
If there was co-morbitidity meaning they could not withstand surgery, or if they had a previous sternotomy (makes it difficult to do surgery again).
What problems involving the leaflets could cause mitral regurgitation?
Prolapse, rheumatic, myxomatous (floppy), endocarditis.
What problems involving chordae rupture (degenerative could cause mitral regurg)?
Prolapse/fail of leaflet.
What can cause the papillary muscles to rupture (causes mitral regurg)?
Ischaemia.
What are the symptoms of mitral regurgitation?
Breathlessness, peripheral oedema, fatigue.
