Valvular disease Flashcards
What is a tapping apex beat a sign of?
Mitral Stenosis
What is a parasternal heave a sign of?
Right ventricular overload e.g. cor pulmonale/ pulmonary hypertension
What is a cardiac murmur?
audible turbulence of blood flow either innocent or pathological
What are the descriptors of a murmur?
Systole or diastole? What type of murmur? Where is it loudest? Where does it radiate to? What grade of murmur? (Influenced by respiration?)
What does the first heart sound signal?
The start of systole
What does the second heart sound signal?
The start of diastole
What murmur will commonly radiate to the carotids?
Aortic stenosis
What murmur will commonly radiate to the axilla?
Mitral regurgitation
What are the grades 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 murmurs are louder with inspiration?
Right-sided murmurs
What are the 5 common murmurs?
Innocent Murmur Mitral Regurgitation Aortic Stenosis Aortic Regurgitation Mitral Stenosis
What is an innocent (functional) murmur?
A soft (<3/6) early systolic murmur. Diastolic murmurs are always pathological but listen carefully to systolic to see if it is innocent
What is valve stenosis?
The valves don’t open properly
What is valve regurgitation?
The valves don’t close properly
What is mixed valve disease?
The valves don’t open or close properly
What are the cardiac investigations which can be carried out?
Non-invasive - Echo
Invasive - cardiac catheterisation
What are the causes of aortic stenosis?
Degenerative (age related)
Congenital - bicuspid valve instead of tricuspid
Rheumatic
What are the symptoms of aortic stenosis?
Breathlessness
chest pain
Dizziness/ syncope
What are the clinical signs of aortic stenosis?
Low volume pulse
Forceful displaced apex
Ejection systolic murmur that can radiate to the carotids
How do you treat aortic stenosis?
Conventional valve replacement
Trans catheter aortic valve replacement (TAVI)
Balloon Aortic valvotomy (BAV)
What are the general history signals that it may be valvular disease?
Chest pain
Breathlessness
Collapse/ dizzy spells
Exertional symptoms are characteristic
What are the complications of aortic stenosis?
Left ventricular hypertrophy
What are the descriptors of cardiac chest pain?
Gripping
Squeezing
Heavy
Crushing
What are the characteristics of cardiac breathlessness?
Related to activity (usually)
Often associated with ankle swelling
Orthopnoea
Paroxysmal Nocturnal Dyspnoea (PND)
What are the Classes in the New York Heart Association Functional Classification (NYHA) - (for breathlessness due to heart problems - heart failure of valvular disease)?
Class I - 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 are the factors to consider in mechanical valves?
They last longer - potentially for life
There is a mechanical click of the second heart sound
Patient needs to be on lifelong warfarin - high risk especially as they get older
Given to younger patients
What are the factors to consider in Bio-prosthetic valves?
They don’t need to take warfarin
They only last 10 years
They are generally given to older patients
When is TAVI offered?
To patients who are not suitable for conventional surgery
Done through the groin
Stroke risk is a bit higher than conventional surgery
What is currently preferred aortic valve replacement or TAVI?
AVR - there is more long term evidence
What are the causes of mitral regurgiation?
Leaflet - Prolapse - Rheumatic - Myxomatous (floppy) (congential) - Endocarditis Chordae rupture (degenerative) - Prolapse/flail leaflet Papillary muscles rupture (infarct where the chords attach to the muscle ischemic mitral regurgitation) Annular dilatation - Functional (due to cardiac failure)
What are the symptoms of mitral regurgitation?
Breathlessness
Peripheral Oedema
Fatigue
What are the clinical signs of mitral regurgitation?
Displaced apex beat
Pansystolic murmur in the axilla (throughout systole)
What are the complications of Mitral regurgitation?
Left ventricular failure
Pulmonary hypertension
What is the medical treatment of mitral regurgitation?
Diuretics and heart failure medication if needed (ACE inhibitors)
What is the surgical treatment of mitral regurgitation?
repair - when prolapse of the valve
replacement - when there is degenerative disease of the valve
(only conventional surgery - repair will always be
What is a mitral clip?
a percutaneous technique were the leaflets are pulled together with a clip - not that popular
What causes mitral stenosis?
Rheumatic disease or congenital but very rare
What are the symptoms of mitral stenosis?
Breathlessness
Fatigue
Palpitations (AF)
What are the clinical signs of mitral stenosis?
Malar flush
Tapping apex beat
Mid-diastolic rumbling murmur localised to apex - turning the patient on their left helps to hear it
Medical treatment of mitral stenosis?
treat the AF diuretics
Surgical treatment of mitral stenosis?
Valve replacement and balloon valvuloplasty
What are the causes of aortic regurgitation?
The leaflets can be affected by - endocarditis - connective tissue diseases - rheumatic Annulus affected by - marfans - aortic dissection
Symptoms of aortic regurgitation?
Breathlessness
Clinical signs of aortic regurgitation?
Collapsing pulse
Wide pulse pressure
Displaced apex beat
Early diastolic murmur left sternal edge
What are the medications given for aortic regurgitation?
ACE inhibitors - to preserve heart function
What is cardiomegaly?
An enlarged heart
What are the potential surgical interventions for aortic regurgitation?
valve replacement - only conventional is an option
Given in patients who are symptomatic and have LV dilatation
