Valvular Diseases Flashcards
Murmurs associated with the 4 main types of valvular diseases
AS(S) BUMP: aortic stenosis, murmur is like a ‘bump’ so crescendo-decrescendo SYSTOLIC murmur with ejection click
HARD(D) FALL: aortic regurgitation, DIASTOLIC murmur, murmur is like a ‘fall’ so collapsing
MSS(D) YOU: mitral stenosis, diastolic murmur, murmur shaped like a smile so loud opening snap then it gets quiter
MR(S) THROUGH: mitral regurgitation, diastolic murmur, ‘straight through’ so PANSYSTOLIC murmur
Pathophysiology of MS + most commoncauses
thickening and immobility of valve leaflets –> obstruction of blood flow from LA to LV –> LA pressure increases –> LA hypertrophy and dilatation –> increase in pulmonary venous, pulmonary arterial and right heart pressure –> development of pulmonary oedema
Causes
1. secondary to rheumatic fever (infection with strep pyogenes)
2. IE
3. valve calcification
Sx and signs of MS
Sx:
- dyspnoea
- orthopnoea (both due to pulmonary oedema)
- fatigue
- haemoptysis (due to increased pulmonary pressure)
Signs:
- malar flush (dusty pink colouration of cheeks due to decreased CO, think about blushing when youve ‘MSSED YOU’)
- AF is common
- RHF due to pulmonary HTN
- Loud S1 opening snap, mid-diastolic murmur
Ix for MS
Echo**
ECG: LA enlargement (P-mitrale, p wave shaped like M in sinus rhythm)
CXR: LA enlargement, pulmonary oedema
Tx for MS
Mechanical problem, medical tx does not prevent progression
Surgical: balloon valvuloplasty, mitral valve replacement
Medical: BBlockers, CB, digoxin [prolong diastole by controlling HR]. diuretics [reduce preload], penicillin [prophylaxis for recurrent rheumatic fever]
Pathophysiology + causes of MR
Backflow of blood from LV to LA during systole, mild regurgitation is normal.
But backflow consistently causes LA dilatation and LV hypertrophy (to increase contractility and maintain overall CO) –> pulmonary HTN –> progressive LV volume overload –> progressive HF (heart compensates for 10-15 years, becomes symptomatic when ejection fraction drops <60%)
Causes:
1.myxomatous degeneration (weakening of chordae tendinea resulting in floppy mitral valve that causes mitral valve prolapse)
2. valve abnormnalities
3. IE
Sx and signs of MR
- exertional dyspnoea
- orthopnoea
- fatigue
- pulmonary oedema
- rHF
Signs:
- AF
- displaced, forceful apex (due to LV dilatation)
- Soft S1, loud P2 (closure of pulmonary valve)
- prominent 3rd heart sound (sudden rush of blood back into dilated LV in early diastole)
- pan-systolic murmur at apex radiating to axilla
Ix for MR
- ECG: P-mitrale, AF
- Echo**
- cardiac catheterization (confirm dx, exclude other valve disease)
What is the most common valvular disease in Europe?
Aortic valve stenosis
Pathophysiology + causes of AS
Patho: narrowing of aortic valve, obstructed LV emptying –> increased LV pressure and compensatory LV hypertrophy –> ischaemia of LV myocardium
Causes
1. calcification (eps in elderly)
2. congenital biscuspid aortic valve (BAV)
3. rheumatic heart disease
Sx and signs of AS
Elderly person with chest pain, exertional dyspnoea and syncope = consider AS!
Triad: syncope + angina + HF
dyspnoea on exertion
dizziness
Signs:
- crescendo-decrescendo systolic murmur that radiates to carotid
- ejection click
- slow rising carotid pulse (pulsus tardus), and decreased pulse amplitude (pulsus parvus)
Ix for AS
ECG: LV hypertrophy: depressed St segments, T-wave inversions
CXR: LV hypertrophy, calcified aortic valve, dilatation of descending aort
Echo**
Tx for AS
rigorous dental hygiene due to risk of IE
Do NOT give vasodilators - may trigger hypotension and syncope
Surgical replacement of aortic valve (transcutaneous aortic valve implantation [TAVI])
Pathophysiology + causes of AR
Leakage of blood into LV from aorta during diastole due to ineffective coaption of aortic cusps –> LV dilatation and hypertrophy to maintain CO –> leads to HF and decreased diastolic pressure –> decreased coronary perfusion –> with larger LV size + increased O2 demands, cardiac ischaemia develops
Causes:
- rheumatic disease (most common worldwide)
- congenital and degenerative abnormalities (most common in developed countries)
- IE (most common acute)
RFs include tissue disorders: SLE, Marfan’s, Ehlers-Danlos
Sx and signs of AR
Sx
- asymptomatic for years
- exertional dyspnoea
- palpitations
- agina
- syncope
Signs:
- wide pulse pressure
- Muller’s sign: visible pulsation of uvula
- Quinke’s sign: visible capillary nailbed pulsation
- Taube’s sign: systolic and diastolic sounds heard over femoral artery
- Corrigan’s pulse: (water hammer) rapid forceful pulse with quick collapse, blood flows back to axilla when arm lifted suddenly
- De Musset’s sign: head nodding with each heartbeat
