Valvular Disease Flashcards
What creates the first heart sound?
Mitral and tricuspid valves closing
What creates the second heart sound?
Aortic and pulmonary valves closing
When is a systolic murmur heart?
Between S1 and S2
When is a diastolic murmur heard?
After S2
Where do you auscultate the aortic valve?
Right, 2nd/3rd intercostal space
Where do you auscultate the pulmonary valve?
Left, 2nd/3rd intercostal space
Where do you auscultate the tricuspid valve?
Left sternal border
Where do you auscultate the mitral valve?
Apex
Which murmur classically radiates to the carotids?
Aortic stenosis
Which murmur classically radiates to the axilla?
Mitral regurgitation
What are some of the presenting features with a murmur?
Reduced functional capacity –> exertion symptoms are characteristic of valvular disease
- chest pain
- SOB
- collapse
What are the invasive and non invasive options for investigating a murmur?
Non invasive - Echo
Invasive - cardiac catheterisation
What type of murmur is aortic stenosis?
Ejection systolic
Radiates to carotids
How would you describe the pulse in aortic stenosis?
Slow rising
What are some causes of aortic stenosis?
Degenerative (age related)
Congenital - bicuspid valve
Rheumatic
What are the treatment options for aortic stenosis?
Conventional valve replacement
TAVI - trans catheter aortic valve implantation
Balloon aortic valvotomy (BAV)
What are the two types of prosthetic heart valves?
Mechanical e.g. metal
Bio-prosthetic e.g. pig valve
Which type of prosthetic valve is best in younger patients and why?
Mechanical –> lasts longer
Which type of prosthetic valve is best in older patients and why?
Bio-prosthetic –> have to take warfarin
only lasts 10 years
When would TAVI be used over conventional valve replacement surgery?
If significant co-morbidites meaning surgery not possible
surgery favoured otherwise
What type of murmur is mitral regurgitation?
Pansystolic
Radiating to the axilla
What are some of the clinical features of mitral regurgitation?
SOB
Peripheral oedema
Fatigue
Displaced apex
Which structural abnormality is often seen with mitral regurgitation?
LV dilatation
How is mitral regurgitation managed?
Medication –> treat HF
Surgery –> repair/replace
What is the most common cause of mitral stenosis?
Rheumatic fever
What type of murmur is mitral stenosis?
Mid-diastolic rumbling murmur
Localised to apex
What are some signs of mitral stenosis?
Malar flush
Tapping apex beat
What are some causes of aortic regurgitation?
Leaflets:
- endocarditis
- connective tissue disease
- rheumatic
Annulus:
- Marfan’s
- aortic dissection
What is the main symptom in aortic regurgitation?
SOB
What type of murmur is aortic regurgitation?
Early diastolic murmur
at left sternal edge
What is the best way to hear aortic regurgitation?
Sit forward and hold breath on expiration
What type of pulse would you expect in aortic regurgitation?
Collapsing
What are the treatment options for aortic regurgitation?
Medication: ACE inhibitors
Surgery: if symptoms + LV dilatation
–> valve replacement
What does the murmur sound like in a PDA?
Machine like
Which murmur does infective endocarditis most commonly cause?
Aortic regurgitation
What type of murmur is tricuspid regurgitation?
Loud pan systolic
Which murmur causes a slow rising pulse?
Aortic stenosis
Which murmur causes a collapsing pulse?
Aortic regurgitation
What is pulsus paradoxus and what might cause it?
Decrease in BP on inspiration –> weaker pulse
Tamponade or constrictive pericarditis
What is pulsus alterans and what causes it?
Alternating strong and weak pulses
Indicated severe LV systolic dysfunction –> severe HF
What might you find on examination of pulses in someone with Takayasu’s arteritis?
Absent pulses
