Valvular disease Flashcards
What is an aortic stenosis murmur?
Ejection systolic
Crescendo-decrescendo
Radiation to the carotid
What intensifies an aortic murmur?
Amyl nitrate
Raising legs
Squatting
Expiration
What reduces an aortic murmur?
Valsalva manœuvre
What is De Musset’s sign?
Head bobbing with each heart beat
Aortic regurgitation
What is Corrigan’s sign?
Exaggerated carotid pulse
Aortic Regurgitation
What is Quinke’s sign?
Nailbed pulsation
Aortic regurgitation
What causes aortic regurgitation?
Due to valve disease: Rheumatic fever Infective endocarditis Connective tissue disease Bicuspid valve
Due to aortic root: Aortic dissection Ankylosing spondylitis Hypertension Syphilis Marfan's Ehler-Danlos
What heart sound do you hear when you feel the pulse?
S1
Order of valve closure?
Left sided valves first, right second - important when they split
Non-pathological murmurs?
High flow through normal valve
Pregnancy
Anaemia
Thyrotoxicosis
A fixed split S2?
Atrial septal defect
Cause of S4?
LVH - pressure wave of atria contracting to push blood into ventricles
Occurs late in diastole
‘A-stiff-wall’
Cause of S3?
Blood oscillation in ventricles
Heart failure, constrictive pericarditis, mitral regurgitation
Mid in diastole
‘slosh-ing-IN’
Causes of aortic stenosis?
Congenital, bicuspid valve
Rheumatic fever
Calcification - most common
Symptoms of aortic stenosis?
Angina
Syncope
Congestive heart failure
What is a thrill?
Palpable murmur
Feels like a vibration
Other sounds in aortic stenosis?
Systolic ejection click
Soft S2
Splitting of S2 on expiration
S4
Pulse in aortic stenosis?
Small and slow rising
Aortic regurgitation murmur?
High pitched
Early diastolic
Decrescendo
What is Hill’s sign?
Popliteal systolic blood pressure exceeding brachial by >60 mmHG
Aortic Regurgitation
Pulse in aortic regurgitation?
Bounding or collapsing
What is mitral stenosis?
Thickening of the valve, cusp fusions, and calcium deposition resulting in a narrowed orifice and progressive immobility of the valve cusps
Causes of mitral stenosis?
Aortic valve disease Rheumatic fever Congenital Lutembacher's syndrome SLE RA Carcinoid Infective endocarditis Amyloid deposition
Symptoms of mitral stenosis?
Dyspnoea Cough Haemoptysis Weakness Fatigue oedema Arrhythmia Malar flush
Mitral stenosis murmur?
Mid diastolic rumble
Opening snap
Heard best in left lateral decubitus position
Causes of mitral regurgitation?
Aortic valve disease Rheumatic fever Myocarditis Dilated cardiomyopathy Hypertensive heart disease Ischaemic heart disease Infective endocarditis Rupture of the chordae tendinae
What is lutembacher’s syndrome?
Acquired mitral stenosis and an atrial septal defect
Mitral regurgitation murmur?
Pansystolic murmur
Blowing
High pitched
Quiet S1
ECG finding in mitral stenosis?
Bifid p wave - atrial enlargement
Native valve endocarditis pathogens?
Streptococci viridans
Enterococci
Staphylococci
IV drug user endocarditis pathogens?
Right sided valvular involvement Staph Aureus Streptococci Gram -ve bacilli Polymicrobial
Prosthetic valve endocarditis pathogens?
Coagulase negative staphylococci
Staph Aureus
Enterococci
Staphylococcus epidermidis - early infection
Major duke criteria?
\+ve blood cultures Echo findings: Endocardial vegetation Perivalvular abscess Dehiscence of prosthetic valve New valvular regurgitation
Minor duke criteria?
IV drug user Prosthetic valve Fever Arterial emboli Mycotic aneurysm Septic pulmonary infarcts Conjunctival haemorrhages Janeway lesions
What is the dukes criteria?
Diagnostic criteria for endocarditis
Symptoms of endocarditis?
Fever/chills Night sweats Malaise/fatigue Anorexia/Weight loss New regurgitant murmur Janeway lesion Osler nodes Roth spots Rheumatoid factor Splinter haemorrhages
What is a Janeway lesion?
Haemorrhagic, macular, painless plaques on palms and soles
What are Osler nodes?
Small painful nodular lesions usually found on the pads of the fingers or toes
What are Roth spots?
Oval, pale retinal lesions surrounded by haemorrhage
Complications of infective endocarditis?
Congestive heart failure
Systemic embolisation
Mycotic aneurysm
Splenic abscess
What is mycotic aneurysm?
Infected aneurysm arising from bacterial infection of the arterial wall
Consequences of mitral stenosis?
Left atrial hypertrophy
Pulmonary oedema
Right sided heart failure
Tricuspid regurgitation
Consequence of mitral regurgitation?
Left atrial dilatation
Pulmonary hypertension
What is Barlow’s syndrome?
Prolapsing mitral valve Excessively large mitral valve leaflets Enlarged mitral annulus Long cordae Disordered papillary muscle contraction
Causes of tricuspid stenosis?
Uncommon
Rheumatic heart disease
With other mitral/aortic disease presnet
Carcinoid syndrome
Consequence of tricuspid stenosis?
Reduced cardiac output Increased right atrial pressure Hepatomegaly Ascites Oedema
Tricuspid stenosis murmur?
Mid diastolic
Louder on inspiration
Functional tricuspid regurgitation?
Right ventricle dilatation
Cor pulmonale
MI
Pulmonary hypertension
Organic tricuspid regurgitation?
Rheumatic heart disease
Infective endocarditis
Carcinoid syndrome
Ebstein’s anomaly
What is ebstein’s anomaly?
Congenitally malpositioned tricuspid valve
Tricuspid regurgitation murmur?
Blowing
Pansystolic
Heard on inspiration
Causes of pulmonary stenosis?
Congenital
Rheumatic fever
Carcinoid syndrome
Consequences of pulmonary stenosis?
Obstructed right ventricular emptying
Right ventricular hypertrophy
Pulmonary stenosis murmur?
Hard, mid systolic ejection murmur
Thrill
Pulmonary closure delayed and soft
Pulmonary regurgitation?
Most common acquired lesion of the pulmonary valve
Dilation of pulmonary ring secondary to pulmonary hypertension
Pulmonary regurgitation murmur?
Decrescendo diastolic murmur
Symptoms of mitral prolapse (Barlow’s syndrome)?
Atypical chest pain - submammary or substernal
Murmur of mitral valve prolapse?
Mid-systolic click