Valvular Disease Flashcards
What group of symptoms are typical of patients with valvular heart disease?
Exertional symptoms
- chest pain
- breathlessness
- collapse and dizzy spells
How do patients often describe chest pain which is originating from their heart?
Gripping – Squeezing – Heavy - Crushing
What other signs may indicate that a person’s breathlessness is due to a cardiac cause?
- Related to activity (usually)
- Often associated with ankle swelling
- Orthopnoea (breathless when lying down)
- Paroxysmal Nocturnal Dyspnoea (PND)
What signs on examination would point towards failure of the Right side of the Heart?
- Raised JVP
- Pitting oedema
- Hepatic congestion
Where is the apex beat usually located?
Left 5th intercostal space
mid-clavicular line
How does the apex beat differ in disease?
- Tapping apex in mitral stenosis
- Displaced and diffuse in left ventricular dilatation
- Heaving and may be displaced in left ventricular hypertrophy
What is a parasternal heave and what condition may cause this?
- heave felt on examination when hand is positioned to left of sternum
- caused by RV overload
=> cor pulmonale/pulmonary hypertension
What is a cardiac murmur?
- Audible turbulence of blood flow
- Can be Innocent OR pathological
What makes each of the 2 heart sounds, and what do these heart sounds signify?
1st Heart sound
- Mitral and tricuspid valve closing
- Start of SYSTOLE
2nd Heart sound
- Aortic and pulmonary valves closing
- Start of DIASTOLE
What pathological murmurs are heard during SYSTOLE (i.e. between heart sounds 1 and 2)?
Aortic stenosis (ejection SYSTOLIC murmur) Mitral Regurgitation (Pansystolic)
Which pathological murmurs are heard during DIASTOLE (after the 2nd heart sound)?
- Aortic regurg.
- Mitral Stenosis (occurs right before 1st heart sound starts again => opening snap)
Where can murmurs radiate to?
Carotids (aortic stenosis)
Axilla (mitral regurgitation)
How is the volume of a murmur graded?
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
Right-sided heart murmurs are louder on inspiration. TRUE/FALSE?
TRUE
=> tricuspid and pulmonary valve murmurs
Describe the characteristics of an innocent or functional murmur
- Quiet (<3 on grading)
- Position dependent
- Often early systolic
Diastolic murmurs are ALWAYS pathological. TRUE/FALSE?
TRUE
What are the main reasons that valves do not work properly?
VALVE STENOSIS
- Valves do not open properly
VALVE REGURGITATION
- Valves do not close properly
MIXED VALVE DISEASE
- Valves neither open nor close properly
What are the main causes of aortic stenosis?
- Degenerative (age related)
- Congenital (E.g bicuspid valve)
- Rheumatic disease
What are the main symptoms of aortic stenosis?
- chest pain
- breathlessness
- dizziness/syncope
What signs can present with aortic stenosis?
- Low volume pulse
- Forceful displaced apex
- Ejection systolic murmur that can radiate to the carotids
How is aortic stenosis treated?
- Conventional valve replacement
- Trans catheter aortic valve replacement (TAVI)
- Balloon Aortic valvotomy (BAV)
What are the two types of valves that can be used for replacement in aortic stenosis, and who is suitable for each?
Mechanical valve
- lasts longer
- need warfarin coverage
- used for younger patients (congenital bicuspid valve)
Bio-prosthetic Valve
- No warfarin needed
- Only last around 10 years
- Given to older patients
Aortic valve replacement is still preferred over TAVI. TRUE/FALSE?
TRUE
- no contraindications to the procedure
- long term outcomes are better
What parts of the mitral valve can become damaged to cause mitral regurgitation?
- Leaflets
- Chordae rupture (degenerative => become floppy)
- Papillary muscles rupture (ischaemia)
- Annular dilatation
What can cause problems with the mitral valve LEAFLETS and lead to mitral regurgitation?
- Prolapse
- Rheumatic disease
- Myxomatous (floppy)
- Endocarditis
What are the main symptoms of mitral regurgitation?
- Breathlessness
- Peripheral oedema
- Fatigue
What signs on examination indicate a diagnosis of mitral regurgitation?
- Displaced apex beat
- Pansystolic murmur radiating to axilla
What sign does mitral regurgitation cause on CXR?
Cardiomegaly
How is mitral regurgitation treated?
- Diuretics
- ACEi (Similar to heart failure)
Surgical:
- Repair – prolapse
- Replacement - degenerative
Percutaneous:
- Clips in infancy
Mitral stenosis is mainly caused by what disease?
Rheumatic fever
What are the main symptoms of mitral stenosis?
- Breathlessness
- Fatigue
- Palpitations (AF)
What signs of mitral stenosis may be apparent on examination?
- Malar flush
- Tapping apex beat
- Mid diastolic rumbling murmur localised to apex
What CXR sign may indicate a diagnosis of mitral stenosis?
straight left heart border
How can mitral stenosis be treated?
- Diuretics and treat AF
Surgery:
- Valve replacement
- Balloon Valvuloplasty
What may cause aortic regurgitation?
Leaflets
- Endocarditis
- CT disease
- Rheumatic
Annulus (part of fibrous skeleton of heart)
- Marfans
- Aortic dissection
What is the main symptom of aortic regurgitation?
breathlessness
WHat signs may be noticed on examination of a patient with aortic regurgitation?
- Collapsing pulse
- Wide pulse pressure
- Displaced apex
- Early diastolic murmur left sternal edge
What sign may aortic regurgitation cause on a CXR?
Cardiomegaly
How is aortic regurgitation treated?
- ACE inhibitors
Surgery:
- only given to symptomatic patients with LV dilatation
- Valve replacement
