Valvular Disease Flashcards
What does a clinical diagnosis in cardiology include?
Physical examination- murmurs and signs of heart failure
History - restriction and functional capacity
Investigations-
non-invasive,= echo
invasive = Cardiac catherization
What type of symptoms are characteristic of valvular disease?
Exertional symptoms
Clinical history for valvular heart disease?
Chest pain
Breathlessness
Collapse/Dizzy spells
Cardiac breathlessness and valvular disease?
Usually related to activity
Often associated with ankle activity
Orthopnoea - SOB lying down
PND- attack of severe SOB and ocughing that wakes someone up
Functional classification of Valvular disease?
Class 1- No limitation
Class 2- Slight limitation of ordinary activity
Class 3- Marked limitation of less than ordinary activity
Class 4- Severe limitation of minimal activity or at rest
What is involved in a cardiology clinical exam?
- General appearance
- Arterial pulse- radial, carotid
- Venous pulse- JVP
- Palpation- apex, parasternal heave
- Auscultation- Heart sounds and murmurs
3 signs of right heart failure?
Raised JVP
Pitting oedema
Hepatic congestion
Describe the apex beat in mitral stenosis?
Tapping
When is the apex beat displaced and diffuse?
Left ventricular dilation (volume overload)
Describe the apex beat in left ventricular hypertrophy?>
Heaving
Maybe displaced
Pressure overload
How to find the parasternal heave and what situation would it be present in?
Hand to the left of sternum
Right ventricular overload- cor pulmonale, pulmonary hypertension
What is a cardiac murmur?
Audible turbulence of blood flow
Can be either innocent or pathological
Process and points for describing 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?
Process and points for describing 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 happens in the first heart sound?
Mitral and tricuspid valve shut
Start of systole
What happen sin 2nd heart sound?
Pulmonary and aortic valve shut
Start of diastole
Phonogram of murmurs showing
- Normal
- Aortic stenosis
- Mitral regurgitation
- Aortic regurgitation
- Mitral stenosis
- Patient ductus arteriosus
Types of systolic murmurs?
Pansystolic
Ejection systolic
Types of diastolic murmur?
Early diastolic murmur
Mid diastolic
Pansystolic murmur diagram?
*
Ejection systolic murmur diagram?
**
Early diastolic murmur diagram?
**
Mid diastolic murmur diagram?
What condition does a murmur radiate to the carotids?
Aortic stenosis
Where does a mitral regurgitation murmur radiate to?
Axilla
Grading of murmurs?
1= Very quiet 2= Quiet- easy to hear 3= Loud 4= Loud with a thrill 5= Very loud with a thrill 6= Loud- audible without stethoscope
Which murmurs are louder with respiration?
Right sided murmurs
What murmur has a 2nd heart sound splitting?
Aortic stenosis
Third heart sound splitting?
Aortic regurgitation
What heart sound is split in mitral stenosis?
4th heart sound
When is an innocent murmur present?
Tricuspid regurgitation
When is there a pericardial rub?
Mitral regurgitation
What additional heart sounds occurs in a continuous murmur?
Systolic clicks
Describe an innocent/functional murmur?
Soft
Position dependent
Often early systolic (diastolic murmurs are always pathological)
What is valvular stenosis?
Valves which do not open properly
What is valve regurgitation?
Valves which do not close properly
What is mixed valve disease
Valves which neither open nor close properly
Categories of aortic stenosis?
Degenerative
Congenital
Rheumatic
Symptoms of aortic stenosis?
Breathlessness
Chest pain
Dizziness/syncope
Signs of aortic stenosis?
Low volume pulse
Forevful displaced apex
Ejection systolic murmur that can radiate to the carotids
Aortic stenosis ECG?
Treatment of aortic stenosis?
Conventional valve replacement
Trans catheter aortic valve replacement (TAVI)
Balloon aortic valvotomy (BAV)
Describe mechanical heart valves eg who would receive, drugs the would have, how long they last
Longevity
Younger patients
Warfarin
Describe bio-prosthetic valves?
Lasts 10 years
No warfarin
Older patients
AVR vs TAMI
Trans catheter aortic valve replacement
Aortic valve replacement
AVR=
- Still preferred
- Long term outcomes
- No contra-indications
- CAGB aswell
TAMI=
- Co-morbidity
- Previous sternotomy
Causes of mitral regurgitation?
Leaflets- prolapsing, rheumatic,myxomatous (floppy) or endocarditis
Chordae rupture - prolapse/ flail leaflet
Papillary muscle rupture - ischaemic
Annular dilation
Symptoms of mitral regurgitation?
Breathlessness
Peripheral oedema
Fatigue
Signs of mitral regurgitation?
Displaced apex
Pansystolic murmur
Treatment for mitral regurgitation?
Medication - diuretics and ACEI
Surgery - Repair- (prolapse), replacement (degenerative)
Percutaneous - Clips in infancy
Main cause of mitral stenosis?
Rheumatic
Symptoms of mitral stenosis?
Breathlessness
Fatigue
Palpitations (AF)
Signs of mitral stenosis?
Malar Flush
Tapping apex beat
Mid diastolic rumbling diastolic murmur localized to apex
Treatment of mitral stenosis?
Medication - Diuretics and treat AF
Balloon valvuloplasty
Surgery valve replacement
Causes of aortic regurgitation?
Leaflets- endocarditis, connective tissue diseases, rheumatic
Annulas- marfans, aortic dissection
Symptoms of aortic regurgitation?
Breathlessness
Signs of aortic regurgitation?
Collapsing pulse
Wide pulse pressure
Displaced apex beat
Early diastolic murmur left sternal edge
Treatment for aortic regurgitation?
Medication= ACE inhibitors Surfery= valve replacement, Symptoms and LV dilatation
Most common valve lessions?
aortic stenosis, mitral regurgitation, mitral stenosis and aortic regurgitation
